两种未成熟卵母细胞体外成熟培养液的运用效果比较

目的:通过比较自行研配的培养液与商品化培养液在卵母细胞体外成熟中的运用效果,为进一步优化体外成熟培养体系提供依据?方法:分别选择使用自行配制培养液的(IVM-A组)110个周期和使用商品化(IVM-B组)培养液的99个周期,并以同期行ICSI的治疗周期为对照(ICSI-C1和ICSI-C2),比较两组在体外成熟?胚胎发育?胚胎种植?临床妊娠及结局等方面的差异?结果:在两对照ICSI-C1和ICSI-C2各项指标无差异的情况下,IVM-A组体外成熟和胚胎发育等方面均高于IVM-B组,且可移植胚胎率?优质胚胎率明显提高(P < 0.05或P < 0.01),可移植胚胎率已达到ICSI组水平?虽然表面上IVM-A组在胚胎种植率?妊娠率(临床妊娠率)?活产率等指标低于IVM-B组,但不同阶段的对照组其指标明显改变,ICSI-C2(2006年以后)明显好于ICSI-C1?这种差异可能与近年来的临床治疗方案的改善及宫腔镜的使用有关?值得注意的是,IVM-A的流产率只有10.53%,显著低于其他3组,而同期的对照(ICSI-C1)却明显高于ICSI-C2,提示使用自行配制培养液培养的胚胎可显著降低流产的发生?但由于样本量还不够大,结果尚待进一步验证?结论:自行配制的培养液具有较好的运用效果,可能与其中额外添加的mHFF及E2等有关?但系统尚需进一步优化,以保证其高效?安全?价廉?

Comparison of application for two kinds of in-vitro matured culture mediums

Objective:The application was compared between the self-made medium and commercial medium,in order to provide basis for the optimization of the in-vitro oocyte matured system. Methods:Using the cycles of ICSI in corresponding period as the controls (ICSI-C1 and ICSI-C2),110 and 99 clinical cycles of IVM using the self-made medium (IVM-A) and the commercial medium (IVM-B) were collected,respectively,and the differences between IVM-A and IVM-B were compared in in-vitro matured,embryo development,embryo implantation,clinical pregnancy and outcomes. Results:In the situation of non-difference between the two control group (ICSI-C1 and ICSI-C2),the in-vitro mature and embryo development in IVM-A were better than those in IVM-B,and the rate of transplanted embryo as well as the high-quality embryo showed significant differences (P < 0.05 or P < 0.01). Although the rate of the embryo implantation,pregnancy and live birth in IVM-A were lower than those in IVM-B,actually,the differences were not significant due to the fact that the index in ICSI-C2(2006 or later) was also better than that of ICSI-C1,which was associated with the improvement of the clinical therapy scheme and the use of hysteroscope as well. Interestingly,the abortion in IVM-A was lowest among all the groups (10.53%),there was significant difference between IVM-A and IVM-B (P < 0.05) while the rate in ICSI-C2 (as the control for IVM-B) was obviously lower than that in ICSI-C1 (as the control for IVM-A),which suggested that the embryo cultured from the self-made medium might reduce the abortion. Due to the limited samples (2/19),the results should be further confirmed. Conclusion:The application of the self-made IVM medium showed better effect,which might be associated with the additional adding the mHFF and E2. However,the system need to be further optimized in order to ensure it should be effective,safe and cheap.