體外胚胎成熟培養(IVM)重要概念

體外卵子成熟培養(IVM)的cases, 取卵時機應為hCG打後38h (而非35h)

IVM主要對象為PCO

取卵時機約最大卵泡達1-1.4cm

<10mm之卵泡也有可能取出成熟MII卵子

IVM療程通常不施打排卵針FSH

IVM卵子優先使用ICSI受孕，比IVF受孕率高

IVM培養約24-48h
IVM成熟率約60-70%
IVM懷孕率約10-20%
IVM著床率約5-10%

http://humupd.oxfordjournals.org/content/16/6/675.full

Figure 7

COC morphology of oocytes with dispersed CC collected from different size of follicles. (A) M-II-stage oocyte with clumped corona radiata retrieved from <8 mm follicle. (B) GV-stage oocyte with clumped corona radiata retrieved from <8 mm follicle. (C) M-II-stage oocyte with little expanded corona radiata retrieved from 9 to 11 mm follicle. (D) GV-stage oocyte with little expanded corona radiata from 9 to 11 mm follicle. (E) M-II-stage oocyte with expanded corona radiata retrieved from ≥12 mm follicle. (F) GV-stage oocyte with expanded corona radiata from ≥12 mm follicle (original magnification ×200). PB, first polar body; GV, Germinal vesicle; M-II, Metaphase II. Reprinted from an article in Reproductive BioMedicine Online by Son et al. (2008a), with permission from Reproductive Healthcare Ltd.

Figure 6

CC expansion of M-II stage oocytes retrieved at the time of collection. (A) A M-II stage oocyte retrieved from 9 mm diameter follicle in HCG-primed IVM cycles. (B) A M-II stage oocyte retrieved from 18 mm diameter follicle in COH cycles (original magnification ×200). PB, first polar body.

Table I

Outcome of IVM cycles from literature in PCO or PCOS patients.

Authors (year)	No. of cycles	No. of embryo transfer cycles	Gonadotrophin priming	Mean No. of oocytes retrieved	Culture time (h)	In vitromaturation rate (%)	Implantation rate (%)	Clinical pregnancy rate/embryo transfer (%)
Cha et al. (2000)	94	85	None	13.6	48	75.1	6.9	27.1
Chian et al. (2000)	11	11	None	7.8	48	69.1	14.8	27.3
	13	13	HCG	7.4	48	84.3	16.7	38.5
Mikkelsen and Lindenberg (2001)	12	9	None	6.8	28–36	44.0	0	0
	24	21	FSH	6.5	28–36	59.0	21.6	33.3
Child et al. (2001)	PCO: 53	53	HCG	10.0	48	76.0	8.9	23.1
	PCOS: 68	68		11.3		77.0	9.6	29.9
Child et al. (2002)	107	107	HCG	10.3	48	76.0	9.5	21.5
Lin et al. (2003)	35	35	FSH + HCG	21.9	48	76.5	9.5	31.4
	33	33	HCG	23.1	48	71.9	11.3	36.4
Cha et al. (2005)	203	187	None	15.5	48	NA	5.5	21.9
Le Du et al. (2005)	45	40	HCG	11.4	48	63.0	10.9	22.5
Söderström-Anttila et al. (2005)	PCO: 13	9 (IVF)	None	9.3	24–36	60.6	13.3	22.2
	7	5 (ICSI)	None			49.2	0	0
	PCOS: 18	17 (IVF)	None	14.3	24–36	54.3	34.5	52.9
	10	9 (ICSI)	None			53.2	12.5	22.2
Son et al. (2006)	27	27	None	18	48–52	74.8	6.5	22.2
	12	12	HMG	16.6	48–52	70.7	6.8	25.0
	23	23	HCG	17.6	48–52	73.0	12.2	39.1
Son et al. (2007b)	415	415	HCG	14.1	48–52	74.0	9.7	28.4
	106	106 (blastocyst)	HCG	24.4	48–52	78.2	26.8	51.9
Wei et al. (2008)	36	36	FSH + HCG	9.4	48	70.4	6.2	16.7
	34	34	Metformin + FSH + HCG	12.4	48	76.7	15.3	38.2
Son et al. (2008c)	171	171	HCG	18.9	48	65.3	11.9	29.8
Ge et al. (2008)	89	89	None	17.0	48	67.1	16.5	41.6
Benkhalifa et al. (2009)	332	289	HCG	9.0	48	79.7	6.4 (ongoing)	19.7