In Vitro Activation of Follicles and Fresh Tissue Auto-transplantation in Primary Ovarian Insufficiency Patients.
In Vitro Activation of Follicles and Fresh Tissue Auto-transplantation in Primary Ovarian Insufficiency Patients.
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原发性卵巢功能不全患者的卵泡体外激活和新鲜组织自体移植
DOI：
10.1210/jc.2016-1589
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发表时间：
2016-11
期刊：
影响因子：
--
通讯作者：
Sun Y
中科院分区：
文献类型：
--
作者：
Zhai J;Yao G;Dong F;Bu Z;Cheng Y;Sato Y;Hu L;Zhang Y;Wang J;Dai S;Li J;Sun J;Hsueh AJ;Kawamura K;Sun Y
内容：最近，两名原发性卵巢功能不全（POI）患者在体外激活（IVA）治疗后，接受了冷冻解冻的卵巢组织自体移植，分娩了健康婴儿。目的：本研究旨在报告首例POI患者新鲜卵巢组织移植后IVA治疗后活产的病例，同时监测卵泡发育和血清激素变化。设计：这是一项前瞻性观察性队列研究。设定：我们对14例POI患者进行了IVA治疗，平均年龄为29岁，自末次月经以来的平均持续时间为3.8年，平均基础FSH水平为94.5 mIU/mL。干预措施：在IVA治疗之前，所有患者均接受常规激素治疗，无卵泡发育。我们从POI患者中取出一个卵巢，并用Akt刺激剂治疗。我们改进了早期手术，采用简化的方案将新鲜组织移植回。主要结局指标：在14例患者中的6例（43%）中，共检测到15个卵泡发育波，4例患者成功取卵，获得6个卵母细胞。对于两个没有自发卵泡生长的患者，人绝经期促性腺激素治疗在移植后6-8个月诱导卵泡生长。取卵后体外受精，获得4枚早期胚胎。在胚胎移植后，一名患者怀孕并生下了一名健康的男婴，另外三个胚胎正在冷冻保存中。结论：IVA技术可以有效激活部分POI患者体内的残留卵泡，让他们怀上自己的遗传后代。IVA也可用于治疗卵巢功能障碍患者，包括老年妇女和癌症幸存者。
Context: Recently, two patients with primary ovarian insufficiency (POI) delivered healthy babies after in vitro activation (IVA) treatment followed by auto-transplantation of frozen-thawed ovarian tissues. Objective: This study sought to report the first case of live birth after IVA treatment following fresh ovarian tissue grafting in patients with POI, together with monitoring of follicle development and serum hormonal changes. Design: This was a prospective observational cohort study. Setting: We performed IVA treatment in 14 patients with POI with mean age of 29 years, mean duration since last menses of 3.8 years, and average basal FSH level of 94.5 mIU/mL. Interventions: Prior to IVA treatment, all patients received routine hormonal treatments with no follicle development. We removed one ovary from patients with POI and treated them with Akt stimulators. We improved upon early procedures by grafting back fresh tissues using a simplified protocol. Main Outcome Measures: In six of the 14 patients (43%), a total of 15 follicle development waves were detected, and four patients had successful oocyte retrieval to yield six oocytes. For two patients showing no spontaneous follicle growth, human menopausal gonadotropin treatment induced follicle growth at 6–8 months after grafting. After vitro fertilization of oocyte retrieved, four early embryos were derived. Following embryo transfer, one patient became pregnant and delivered a healthy baby boy, with three other embryos under cryopreservation. Conclusion: IVA technology can effectively activate residual follicles in some patients with POI and allow them to conceive their own genetic offspring. IVA may also be useful for treating patients with ovarian dysfunction including aging women and cancer survivors.
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