【摘要】 目的:探索在不用或小剂量使用促性腺激素条件下对多囊卵巢患者的未成熟卵母细胞体外培养至成熟、受精、卵裂和妊娠的可行性。方法:阴道B超引导下穿刺取卵后将卵子分别培养于3种不同培养基:基本培养基(f-HTF+75 mIU/mL rFSH+500 mIU/mL rhCG)+10%SPS(SPS组), 基本培养基+20% hFF(FF组)和基本培养基+20% hFF+2 ng/mL rEGF(FF+EGF组),共培养25-48 h,然后行体外受精和胚胎培养。结果:体外培养卵丘-卵母细胞复合体102个,成熟率65.69%,受精率83.58%,2PN率71.43%,卵裂率51.72%,优质胚胎率40.00%。FF组较SPS组有更高的成熟、受精、卵裂和优质胚胎率,再添加EGF后卵子的成熟、受精和优质胚胎率增加。刺激组和未刺激组在卵子成熟、受精、卵裂和优质胚胎率方面均无显著差异。PCO患者卵子的成熟、受精、卵裂和优质胚胎率均高于PCOS患者,ICSI组优质胚胎率增加,但均无统计学差异。随培养时间延长,卵子的成熟、受精、卵裂和优质胚胎率均升高,其中正常受精率和卵裂率有显著差异(P<0.05)。结论:PCO和PCOS患者行IVM可行,二者无明显差异。培养液中添加激素、FF、EGF以及延长培养时间至48 h,可促进卵子成熟。但有关临床用药、培养条件仍有待改善,进一步提高卵子和胚胎质量以获得妊娠。更多还原

【Abstract】 Objective: To study the possibility of in vitro maturation, fertilization and embryo developmentas well as pregnancy of immature oocytes with polycystic ovary (PCO). Methods: From July 2002 to March 2003, a total of 12 women underwent 13 natural or Gn primed IVM cycles. Oocyte-cumulus complex (OCC) acquiredwere randomized sequentially cultured in one of the three mediums for 25-48 h: basal medium (f-HTF+75 mIU/mLrFSH+500 mIU/mL rhCG)+10% SPS (group 1), basal medium +20% hFF (group 2) or basal medium +20% hFF+2 ng/mL rEGF (group 3). All women undertook B-ultrasonic examination since day 3 of menstruation, with orwithout 75-150 IU hMG for 3-5 days. Aspiration was performed transvaginally between day 9 and day 17. Allcumulus-enclosed oocytes of healthy appearance were matured in culture medium in vitro for 25-48 h before invitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Results: A total of 118 oocytes were retrievedand the average rates acquied was 9.83. The percentage of oocytes reaching metaphase Ⅱwas significantly higherin the group 3 (73.58%), compared with group 1 (63.33%) (P<0.05). There were no significant difference in therates of oocyte fertilization and cleavage between these groups. There was no significant difference of maturation,fertilization and cleavage rate between oocytes from Gn primed and unprimed patients, and between oocytes fromPCO and PCOS patients. Oocytes cultured for 48 h had significant higher rates of fertilization and cleavage. ICSIgroup had more good embryos than IVF group, but the difference was not significant. No pregnancy was obtainedin these groups. Conclusion: These results indicate it is feasible for PCO patients to go through IVM. Gn, FF, EGFand longer culture period may improve the maturational potential of the oocyte from PCO patients. But theres stillspace to improve in clinical prescription, culture condition, so as to advance the quality of embrys and the preg-nancy rate.更多还原