Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center (Drs Chang, Chin, Hsu), Chang Gung University, Taoyuan, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center (Drs Chang, Chin, Hsu), Chang Gung University, Taoyuan, Taiwan.
J Minim Invasive Gynecol. 2022 Jul;29(7):905-914. doi: 10.1016/j.jmig.2022.04.011. Epub 2022 Apr 27.
Recent findings have shown mechanical fragmentation of ovarian cortex and ovarian drilling could promote follicle growth in patients with premature ovarian insufficiency and polycystic ovarian syndrome, respectively. A common element shared by these treatments is the mechanical disturbance of ovarian extracellular matrix tissues. We thus hypothesized a simplified whole-ovary laparoscopic incision (WOLI) procedure may provide the intrinsic stimuli needed to activate resting follicles in patients with an extremely poor ovarian response (EPOR) who had negligible chance of becoming pregnant with their own oocytes via modern in vitro fertilization practice.
Retrospective pilot study.
The study was conducted in a research medical center in Taiwan.
Women who had multiple canceled ovarian stimulation cycles due to the lack of follicle growth were recruited. A total of 6 patients with EPOR received the WOLI procedure, which covers the whole surface of ovaries, in 2015 to 2017.
After receiving an outpatient WOLI procedure, ovarian response and follicle growth were monitored for 90 days with or without gonadotropin stimulation. Embryo quality and clinical outcomes were analyzed.
After the WOLI treatment, 5 of 6 patients had significant increases in serum estradiol level and improved follicle growth (p = .001). Multiple oocytes were retrieved from each of these patients, and it led to thawed embryo transfer (ET) cycles in 4 patients (p = .010). On average, the duration from the WOLI procedure to the first ovum pickup was 24 days (11 to 58 days). After ET, 2 patients became pregnant and delivered healthy babies. Two other patients received ET, and 1 led to a chemical pregnancy. One patient had cryopreserved embryos with pending transfer.
The standardizable WOLI procedure restored hormonal responses in a majority of patients with EPOR. Further validation of this novel and yet simple laparoscopic procedure, which requires only 1 laparoscopic surgery, may provide a practical option to reactivate the aging ovarian environment in patients with EPOR and premature ovarian insufficiency.
最近的研究结果表明，卵巢皮质的机械破碎和卵巢钻孔分别可以促进卵巢早衰和多囊卵巢综合征患者的卵泡生长。这些治疗方法的一个共同要素是对卵巢细胞外基质组织的机械干扰。因此，我们假设简化的全卵巢腹腔镜切口（WOLI）程序可能为那些通过现代体外受精实践几乎没有机会用自身卵子怀孕的卵巢反应极差（EPOR）患者提供激活休眠卵泡所需的内在刺激。
回顾性试点研究。
该研究在台湾的一家研究医疗中心进行。
因卵泡生长不足而多次取消卵巢刺激周期的女性被招募。2015 年至 2017 年，共有 6 名 EPOR 患者接受了 WOLI 手术，该手术覆盖了卵巢的整个表面。
在接受门诊 WOLI 手术后，在不使用促性腺激素刺激的情况下，监测卵巢反应和卵泡生长 90 天。分析胚胎质量和临床结局。
WOLI 治疗后，6 名患者中有 5 名血清雌二醇水平显著升高，卵泡生长改善（p=0.001）。从这些患者中均取出多个卵子，并导致 4 名患者进行解冻胚胎移植（ET）周期（p=0.010）。平均而言，从 WOLI 手术到第一次取卵的时间为 24 天（11 至 58 天）。ET 后，2 名患者怀孕并分娩健康婴儿。另外两名患者接受了 ET，其中 1 名导致生化妊娠。1 名患者有冷冻胚胎待移植。
标准化的 WOLI 程序恢复了大多数 EPOR 患者的激素反应。进一步验证这种新颖且简单的腹腔镜手术，仅需 1 次腹腔镜手术，可能为 EPOR 和卵巢早衰患者重新激活老化的卵巢环境提供一种实用的选择。
Zotero 插件