Fukuda M, Fukuda K, Andersen C Y, Byskov A G
Fukuda Ladies Clinic, Ako, Hyogo, Japan.
Hum Reprod. 1998 Jun;13(6):1590-4. doi: 10.1093/humrep/13.6.1590.
The present study was undertaken to evaluate whether the site of ovulation affects the following follicular phase length and pre-embryo development during infertility treatment with ovarian stimulation using clomiphene citrate. A total of 363 cycles in 97 patients undergoing infertility treatment (182 intrauterine insemination (IUI) cycles in 60 patients and 181 in-vitro fertilization (IVF) cycles in 52 patients) were studied. The cycles were divided into two main groups: preceding unilateral ovulation (PUO) and preceding bilateral ovulation (PBO). In the PUO group, the cycles were subdivided into contralateral ovulation, bilateral ovulation and ipsilateral ovulation. In IVF cycles alone, bilateral ovulations were further divided into bilateral ovulation-contralateral side and bilateral ovulation, ipsilateral side. Contralateral ovulations were seen in 134 of 240 cycles (56%), excluding bilateral ovulation and PBO. The follicular phase length in contralateral ovulation (16.2 +/- 2.6 days, mean +/- SD) was significantly (P < 0.05) shorter than that of ipsilateral ovulation (16.9 +/- 2.8). There were no significant differences of follicular phase length among contralateral ovulation, bilateral ovulation and PBO. Of IVF cycles including contralateral ovulation-ipsilateral ovulation and bilateral ovulation a total of 107 preovulatory follicles was assessed in the contralateral side (contralateral ovulation + bilateral ovulation-contralateral side) and 97 in the ipsilateral side (ipsilateral ovulation + bilateral ovulation, ipsilateral side). The oocyte retrieval rate (88%), fertilization rate (84%), cleavage rate (95%), embryo transfer rate (70%) of contralateral follicles were higher than those of ipsilateral follicles (71, 62, 86, 38% respectively) and those of PBO (76, 62, 87, 41% respectively). The total pregnancy rate of both IUI and IVF did not differ among contralateral ovulation (15%), ipsilateral ovulation (8%), bilateral ovulation (11%) and PBO (10%). The results confirm and extend our previous findings in natural cycles, suggesting that local ovarian factors, e.g. from corpus luteum, affect the health of preovulatory follicle and the enclosed oocyte in the same ovary (ipsilateral) negatively. Contralateral selection of preovulatory follicles in the succeeding cycle shortens the follicular phase length and favours pre-embryo development. The chance of conceiving during ovarian stimulation with clomiphene citrate may thus be affected by the site of ovulation in the previous cycle.
本研究旨在评估在使用枸橼酸氯米芬进行卵巢刺激的不孕症治疗过程中，排卵部位是否会影响随后的卵泡期长度和胚胎前期发育。对97例接受不孕症治疗的患者的363个周期进行了研究（60例患者的182个宫内人工授精（IUI）周期和52例患者的181个体外受精（IVF）周期）。这些周期被分为两个主要组：单侧排卵前（PUO）和双侧排卵前（PBO）。在PUO组中，周期又细分为对侧排卵、双侧排卵和同侧排卵。仅在IVF周期中，双侧排卵进一步分为双侧排卵-对侧和双侧排卵-同侧。在240个周期中的134个（56%）观察到对侧排卵，不包括双侧排卵和PBO。对侧排卵的卵泡期长度（16.2±2.6天，平均值±标准差）显著（P<0.05）短于同侧排卵（16.9±2.8）。对侧排卵、双侧排卵和PBO之间的卵泡期长度没有显著差异。在包括对侧排卵-同侧排卵和双侧排卵的IVF周期中，对侧（对侧排卵+双侧排卵-对侧）共评估了107个排卵前卵泡，同侧（同侧排卵+双侧排卵-同侧）评估了97个。对侧卵泡的卵母细胞采集率（88%）、受精率（84%）、分裂率（95%）、胚胎移植率（70%）高于同侧卵泡（分别为71%、62%、86%、38%）和PBO（分别为76%、62%、87%、41%）。IUI和IVF的总妊娠率在对侧排卵（15%）、同侧排卵（8%）、双侧排卵（11%）和PBO（10%）之间没有差异。结果证实并扩展了我们之前在自然周期中的发现，表明局部卵巢因素，例如来自黄体的因素，对同侧卵巢中排卵前卵泡和其中包裹的卵母细胞的健康有负面影响。在下一个周期中选择对侧排卵前卵泡会缩短卵泡期长度并有利于胚胎前期发育。因此，在使用枸橼酸氯米芬进行卵巢刺激期间受孕的机会可能会受到前一周期排卵部位的影响。
