Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF
Influence of ovarian stimulation with HP-hMG or recombinant FSH on embryo quality parameters in patients undergoing IVF
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DOI：
10.1093/humrep/dem221
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发表时间：
2007-09-01
影响因子：
6.1
通讯作者：
Arce, Joan-Carles
中科院分区：
文献类型：
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作者：
Ziebe, Soren;Lundin, Kersti;Arce, Joan-Carles
背景：关于不同促性腺激素制剂对胚胎质量影响的数据有限。方法：这项评估是一项随机、盲法、多国试验的一部分，该试验对 731 名接受高纯度人绝经期促性腺激素 (HP-hMG; MENOPUR) (n = 363) 或重组 FSH (rFSH; GONAL-F) (n = 368) 刺激后接受 IVF 的女性进行。持续妊娠是主要终点 [HP-hMG 27% 和 rFSH 22%；比值比 (OR)（95% 置信区间，CI）1.25 (0.89-1.75)]。所有 7535 个卵母细胞每天都会由当地胚胎学家和由三名胚胎学家组成的中央小组以盲法方式进行评估，直到第 3 天（胚胎移植）。结果：在局部评估中，HP-hMG 组获得的每个卵母细胞的优质胚胎比例 (11.3%) 高于 rFSH (9.0%) (P = 0.044)，但在中央评估中相当（分别为 9.5% 和 8.0%）。在卵裂球数量和破碎程度方面观察到有利于 HP-hMG 的显着差异，而 HP-hMG 和 rFSH 之间的卵裂球大小均匀性、片段定位、多核频率和同质细胞质相当。 HP-hMG 的活产率、持续妊娠率和持续着床率均高于 rFSH [48% vs 32% (P = 0.038)、48% vs 32% (P = 0.038)、41% vs 27% (P = 0.032)]。与 rFSH 相比，HP-hMG 冷冻保存后具有至少 50% 存活卵裂球的胚胎比例和恢复有丝分裂的胚胎比例更高。结论：卵巢刺激期间使用的促性腺激素制剂的成分对一些胚胎质量参数有影响。 HP-hMG 刺激产生的优质胚胎的植入能力似乎有所提高，但其机制仍需阐明。
BACKGROUND: There are limited data on the impact of different gonadotrophin preparations on embryo quality. METHODS: This evaluation was part of a randomized, assessor-blind, multinational trial, conducted in 731 women undergoing IVF after stimulation with highly purified human menopausal gonadotropin (HP-hMG; MENOPUR) (n = 363) or recombinant FSH (rFSH; GONAL-F) (n = 368). Ongoing pregnancy was the primary end-point [HP-hMG 27% and rFSH 22%; odds ratio (OR) (95% confidence interval, CI) 1.25 (0.89-1.75)]. All 7535 oocytes retrieved were evaluated daily until day 3 (embryo transfer) in a blinded manner both by local site embryologists and a central panel of three embryologists. RESULTS: The proportion of top-quality embryos per oocyte retrieved was higher with HP-hMG (11.3%) compared with rFSH (9.0%) (P = 0.044) in the local assessment, but comparable in the central assessment (9.5 and 8.0%, respectively). Significant differences in favour of HP-hMG were observed for number of blastomeres and degree of fragmentation, while uniformity of blastomere sizes, localization of fragments, frequency of multinucleation and homogeneous cytoplasm were comparable between HP-hMG and rFSH. The live birth, ongoing pregnancy and ongoing implantation rates for top-quality embryos were higher with HP-hMG than rFSH [48 versus 32% (P = 0.038), 48 versus 32% (P = 0.038), 41 versus 27% (P = 0.032)]. Both the proportion of embryos with at least 50% surviving blastomeres after cryopreservation and embryos resuming mitosis were more frequent with HP-hMG compared with rFSH. CONCLUSIONS: Composition of gonadotrophin preparations used during ovarian stimulation has an impact on some embryo quality parameters. The capacity to implant of the top-quality embryos derived from stimulation with HP-hMG appears to be improved, although the mechanism needs to be elucidated.