體外成熟培養(IVM)最大卵泡達1-1.4cm時取卵可達最佳胚胎品質

多囊性卵巢病患, 使用自然誘導排卵取卵後體外成熟培養(IVM)
須於最大卵泡達1-1.4cm時取卵可達最佳卵子成熟率與胚胎品質
IVM培養液: 含 75 mIU/ml FSH, 75 mIU/ml LH
觀察胚胎分裂時間 post ICSI: 18h-->42h-->66h

http://humrep.oxfordjournals.org/content/23/12/2680.full

Selection of the optimal day for oocyte retrieval based on the diameter of the dominant follicle in hCG-primed in vitro maturation cycles

1. Weon-Young Son1, 
2. Jin-Tae Chung, 
3. Belen Herrero, 
4. Nicola Dean,
5. Ezgi Demirtas, 
6. Hananel Holzer, 
7. Shai Elizur, 
8. Ri-Cheng Chian and
9. Seang Lin Tan

+Author Affiliations

1. McGill Reproductive Center, Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, QC H3A 1A1, Canada

1. 1Correspondence address. Fax: +1-514-843-1496. E-mail: weon-young.son@muhc.mcgill.ca

• Received May 18, 2008.
• Revision received July 25, 2008.
• Accepted August 1, 2008.

 

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Abstract

BACKGROUND The efficiency of in vitro maturation (IVM) techniques is suboptimal compared with controlled ovarian stimulation combined with IVF cycles, and studies are needed to identify factors that predispose IVM cycles to success or failure. We compared the outcome of IVM cycles with different dominant follicle (DF) size at oocyte retrieval following hCG priming.

METHODS IVM was performed in 160 patients with polycystic ovaries (171 cycles). We administered 10 000 IU hCG s.c. 35–38 h before oocyte collection when endometrial thickness reached at least 6 mm. IVM cycles were retrospectively analyzed according to DF diameter as follows; Group 1: DF diameter ≤10 mm, Group 2: between 10 and 14 mm, Group 3: >14 mm.

RESULTS A positive correlation was observed between DF size and number of in vivo matured oocytes collected (Group 1, 2 and 3 = 6.9, 10.6 and 15.1%, respectively). The rates of IVM, fertilization and embryo development were similar among the sibling immature oocytes collected from the three groups. However, clinical pregnancy rate in Group 2 (40.3%) was higher than Group 3 (17.1%) (P < 0.05). Moreover, implantation rates in Groups 1 (13.6%) and 2 (14.3%) were higher than Group 3 (4.9%) (P < 0.01).

CONCLUSIONS Our results suggest that oocyte collection in IVM cycles should be performed when the DF is 14 mm diameter or less. Sibling immature oocytes may be affected detrimentally if a DF >14 mm is present at oocyte collection.

Table II.

Comparison of fertilization and embryo development rates of in vivo matured oocytes among the three groups.

Variables	Group 1 (≤10 mm)	Group 2 (10<to≤14 mm)	Group 3 (>14 mm)
No. of oocytes collected	1406	1215	617
No. of oocytes matured on collection day (%)	97 (6.9)a	129 (10.6)b	93 (15.1)c
No. of normal fertilized (2PN) oocytes (%)	75 (77.3)	94 (72.9)	73 (78.5)
No. of embryos cleaved (%)	74 (98.7)	92 (97.9)	72 (98.6)
No. of good quality embryos (%)*	46 (61.3)	60 (63.8)	51 (69.9)

• *The number of good quality embryos divided by the number of two-pronuclear (2PN) zygotes. ^abcDifferent letter superscripts denote significant differences (P < 0.01) among values within a row.

Table III.

Details for embryology of immature oocytes collected from the three groups in hCG-primed IVM cycles.

Variables	Group 1 (≤10 mm)	Group 2 (10< to ≤14 mm)	Group 3 (>14 mm)
No. of oocytes cultured in vitro	1309	1086	524
No. of total MII oocytes matured in vitro (%)	850 (64.9)	707 (65.1)	350 (66.8)
No. of normal fertilized (2PN) embryos (%)	611 (71.9)	507 (71.7)	254 (72.6)
No. of embryos cleaved (%)	560 (91.7)	428 (84.4)	227 (89.4)
No. of good quality embryos (%)*	235 (38.5)	173 (34.1)	90 (35.4)

• *The number of good quality embryos divided by the number of 2PN zygotes. MII, metaphase II.