PCO的卵子需要較長的hCG刺激以達成熟狀態
其機轉牽涉複雜之生長激素與血管生長因子VEGF, renin,
http://humrep.oxfordjournals.org/content/20/6/1562.full
Prolonged HCG action affects angiogenic substances and improves follicular maturation, oocyte quality and fertilization competence in patients with polycystic ovarian syndrome
+Author Affiliations
- 1To whom correspondence should be addressed. Email: eda.bokal@guest.arnes.si
- Received November 24, 2004.
- Revision received December 28, 2004.
- Accepted January 11, 2005.
Abstract
BACKGROUND: The aim of this study was to determine whether, in polycystic ovarian syndrome (PCOS) patients, HCG action prolonged for 4 h improves the action of angiogenic substances [ovarian renin angiotensin system and vascular endothelial growth factor (VEGF)], and consequently follicular maturation, oocyte quality and oocyte fertilization competence. METHODS: In this prospective study 20 patients with PCOS undergoing IVF were included. Oocyte retrieval was carried out either 34 or 38 h after HCG administration. Each follicle was analysed for prorenin, active renin, VEGF and estradiol. Oocytes were evaluated for quality (mature, immature, degenerated oocytes), as were the embryos (low or high). RESULTS: In the HCG +38 h group there were 245 follicles, and in the HCG +34 h group 240 follicles. In the HCG +38 h group, log active renin was lower (2.78 ± 0.20 versus 2.91 ± 0.25; P<0.001) and VEGF higher (2276.0 ± 790.1 versus 1946.6 ± 954.5 pg/ml; P<0.001). The odds ratio for obtaining oocytes from follicles was 1.6 [95% confidence interval (CI) 1.1–2.6; P=0.02], and for developing high quality embryos 7.6 (95% CI 2.8–20.9; P<0.001) in favour of the HCG +38 h group. CONCLUSIONS: Follicular maturation and oocyte quality are related to the intrafollicular influences of active renin and VEGF in a time-dependent manner after HCG administration, whereas fertilization competence is related to VEGF only.
Table I.
Comparison of different quality oocytes, fertilization competence and high-quality embryo rates between two groups of PCOS patients
| HCG +38 h [n (%)] | HCG +34 h [n (%)] | P-value | |
|---|---|---|---|
| Empty follicular aspirates | 128 (52.2) | 149 (62.1) | 0.029 |
| Degenerative oocytes | 16 (13.7) | 10 (11.0) | NS |
| Immature oocytes | 7 (6.0) | 5 (5.5) | NS |
| Normal-appearing MII oocytes | 94 (80.3) | 76 (83.5) | NS |
| IVF | |||
| Fertilized oocytes | 27 (81.8) | 26 (42.7) | <0.001 |
| High-quality embryos | 20 (74.1) | 12 (46.2) | 0.038 |
| ICSI | |||
| Fertilized oocytes | 36 (42.9) | 13 (43.3) | NS |
| High-quality embryos | 21 (58.3) | 3 (23.1) | 0.029 |
- In the HCG +38 h group, oocyte retrieval was carried out 38 h after HCG administration; in the HCG+34 h group, it was done 34 h after HCG administration.
- NS, not significant.
Table II.
Comparison of concentrations of prorenin, active renin, VEGF and E2 in follicular aspirates (empty and those containing oocytes), and of follicular diameters between two groups of PCOS patients
| Follicular characteristics | HCG +38 h (n) | HCG +34 h (n) | P-value |
|---|---|---|---|
| Log of prorenin | 4.09±0.27 (209) | 4.16±0.29 (192) | 0.01 |
| Log of active rennin | 2.78±0.20 (245) | 2.91±0.25 (240) | <0.001 |
| VEGF (pg/ml) | 2276.0±790.1 (245) | 1946.6±954.5 (189) | <0.001 |
| E2 (nmol/l) | 322.9±49.2 (244) | 340.9±58.9 (238) | <0.001 |
| Diameter of follicles (cm) | 2.2±0.4 (245) | 2.1±0.4 (240) | 0.02 |
- In the HCG +38 h group, oocyte retrieval was carried out 38 h after HCG administration; in the HCG +34 h group, it was done 34 h after HCG administration.
- All values are mean±SD.
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