Kornilov Nikolay Valerievich, Pavlova Marina Nikolaevna, Yakovlev Pavel Pavlovich
Centre for Reproductive Medicine, Co.Ltd. "Next Generation Clinic", St. Petersburg, Russia, 197110.
Centre for Reproductive Medicine, Co.Ltd. "Next Generation Clinic", Moscow, Russia, 107140.
J Assist Reprod Genet. 2021 Jun;38(6):1303-1309. doi: 10.1007/s10815-021-02085-5. Epub 2021 Jan 26.
We report the pregnancy and live birth achieved after in vitro maturation (IVM) of oocytes and PGT-A in a 23-year-old patient suffering from ovarian gonadotropin resistance. A woman with resistant ovary syndrome (ROS) had secondary amenorrhea, high FSH levels (25.34 mIU/mL) and LH (29.6 mIU/mL), low estradiol levels (15.2 pg/mL), and high serum AMH levels (38.0 ng/mL), associated with an increased antral follicle count (AFC) of 45. Without gonadotropin priming and HCG trigger, ultrasound-guided transvaginal oocyte retrieval was performed. Aspiration of antral-stage follicles allowed the retrieval of 15 immature oocytes. After oocyte collection, immature oocytes were cultured in the IVM medium. Following IVM, six of them reached metaphase II stage. Resultant matured oocytes were fertilized by intracytoplasmic sperm injection (ICSI). Embryos obtained were cultured to the blastocyst stage. On day 5, three embryos reached blastocyst stage. Trophectoderm biopsy and PGT-A were performed on two better quality embryos on day 5 after fertilization. Two biopsied embryos were reported to be euploid. PGT-A was performed utilizing next-generation sequencing (NGS\MPS). One embryo was transferred in an artificial thaw cycle and resulted in a viable intrauterine pregnancy and live birth. Our experience indicates that there is no requirement for gonadotropin stimulation and use of b-hCG trigger prior to IVM in patients with ROS. The results suggest that oocytes obtained with IVM in patients with ROS are capable of meiotic and mitotic division, fertilization, and generation of euploid embryos. IVM appears to be a valuable approach in patients with ROS, allowing them to have genetically connected offspring.
我们报告了一名23岁卵巢促性腺激素抵抗患者，其卵母细胞经体外成熟（IVM）及植入前遗传学检测（PGT-A）后成功妊娠并分娩活婴。一名患有抵抗性卵巢综合征（ROS）的女性出现继发性闭经，促卵泡生成素（FSH）水平较高（25.34 mIU/mL），促黄体生成素（LH）水平较高（29.6 mIU/mL），雌二醇水平较低（15.2 pg/mL），血清抗缪勒管激素（AMH）水平较高（38.0 ng/mL），同时窦卵泡计数（AFC）增加至45个。在未使用促性腺激素预处理及人绒毛膜促性腺激素（HCG）触发的情况下，进行了超声引导下经阴道卵母细胞采集。抽吸窦期卵泡获得了15枚未成熟卵母细胞。卵母细胞采集后，将未成熟卵母细胞置于IVM培养基中培养。IVM后，其中6枚卵母细胞达到减数分裂中期II期。所得成熟卵母细胞通过卵胞浆内单精子注射（ICSI）受精。获得的胚胎培养至囊胚期。在第5天，有3枚胚胎发育至囊胚期。在受精后第5天，对2枚质量较好的胚胎进行了滋养外胚层活检及PGT-A检测。据报告，2枚活检胚胎均为整倍体。PGT-A检测采用了新一代测序技术（NGS\MPS）。在人工解冻周期中移植了1枚胚胎，结果获得了 viable 宫内妊娠并分娩活婴。我们的经验表明，对于ROS患者，IVM前无需进行促性腺激素刺激及使用β-HCG触发。结果表明，ROS患者经IVM获得的卵母细胞能够进行减数分裂和有丝分裂、受精并产生整倍体胚胎。IVM似乎是ROS患者的一种有价值的方法，使他们能够拥有有基因关联的后代。
