Treatment variables in relation to oocyte maturation: Lessons from a clinical micromanipulation-assisted in vitro fertilization program
Treatment variables in relation to oocyte maturation: Lessons from a clinical micromanipulation-assisted in vitro fertilization program
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DOI：
10.1007/bf02765838
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发表时间：
1997-07-01
影响因子：
3.1
通讯作者：
Fisch, B
中科院分区：
文献类型：
--
作者：
Avrech, OM;Goldman, GA;Fisch, B
目的：为了了解在IVF周期中应用促性腺激素释放激素类似物（GnRH-a）时观察到的妊娠率提高的机制，我们研究了治疗变量与卵母细胞核成熟度之间的可能关系。设计：回顾性评估了无卵丘、裸露卵母细胞的核成熟度，从接受GnRH-a和促性腺激素控制性超排卵后进行显微操作辅助IVF治疗的女性中获得。研究背景是一家三级学术医疗中心的不孕症和IVF单位。参与者：221名患者接受了435个治疗周期。主要结果测量：这是生殖囊完整的未成熟（GVII）卵母细胞的比例。研究的3520个卵母细胞中有154个（4.4%）处于GVII期。在66个治疗周期（15.2%）和54例患者（24.4%）中发现了这些卵母细胞。周期中，GVII卵母细胞被检测到没有不同的，其中所有吸出的卵母细胞在以下方面是成熟的：患者年龄，类型和持续时间的不孕症，控制性卵巢过度刺激方案和卵子的时间回升。然而，GVII组的特点是一个显着更高的峰值雌二醇水平，以及更高数量的成熟卵泡可视化超声（直径>14毫米）和卵母细胞retrieved.Conclusions：比较目前的研究结果与以前发表的数据，它似乎是包括促性腺激素释放激素-a的刺激方案与较低比例的未成熟卵母细胞。较高的卵母细胞核不成熟发生率显然与卵巢对刺激的反应明显更好相关。在具有正常精子伴侣的患者中观察到的未成熟卵母细胞的高发生率和先前周期中的低受精率可能表明，在这些病例中的一些情况下，受精失败是由于卵母细胞而不是精子功能障碍。
Objective: In an effort to understand the mechanism underlying the improved pregnancy rate observed in IVF cycles when gonadotropin-releasing hormone analogues (GnRH-a) are applied, we investigated a possible relationship between treatment variables and oocyte nuclear maturity.Design: Nuclear maturity was retrospectively assessed in cumulus-free, denuded oocytes, obtained from women undergoing micromanipulation-assisted IVF treatment following controlled ovarian hyperstimulation with GnRH-a and menotropins.Setting: The setting was the infertility and IVF unit of a tertiary academic medical center.Participants: Two hundred twenty-one patients underwent 435 treatment cycles.Main Outcome Measure: This was the proportion of germinal vesicle-intact immature (GVII) oocytes.Results: One hundred fifty-four of the 3520 oocytes studied (4.4%) were in the GVII stage. These oocytes were found in 66 of the treatment cycles (15.2%) and in 54 of the patients (24.4%). Cycles in which GVII oocytes were detected did not differ from those in which all the aspirated oocytes were mature in the following respects: patient age, type and duration of infertility, controlled ovarian hyperstimulation protocol and time of ovum pickup. However the GVII group was characterized by a significantly higher peak estradiol level, as well as a higher number of mature follicles visualized sonographically (diameter >14 mm) and oocytes retrieved.Conclusions: Comparing the present findings with previously published data, it appears that the inclusion of GnRH-a in the stimulation regimen is associated with a lower proportion of immature oocytes. A higher occurrence of oocyte-nuclear immaturity is apparently associated with a significantly better ovarian response to stimulation. The high incidence of immature oocytes observed in patients with normospermic partners and low fertilization rates in previous cycles may suggest that the fertilization failure in some of these cases is due to oocyte, rather than sperm, dysfunction.