未成熟卵母细胞体外成熟培养治疗多囊卵巢综合征不孕患者的妊娠结局

新生儿肺炎死亡,其余至今未发现明显畸形.10例早产,占21.3%(10/47),36例足月产,占76.6%(36/47),1例过期妊娠.新生儿平均出生体重2972 g,低体重儿17例,占26.2%(17/65).结论 多囊卵巢综合征不孕患者行未成熟卵母细胞IVM培养后,虽然获得了较高的临床妊娠率,而且早期流产率、异位妊娠率、妊娠并发症发生率、围产儿死亡及新生儿缺陷的发生率等不高,但多胎妊娠、早产、低出生体重儿发生率较高.     

Live birth following IVF/ICSI using oocytes from donor who was conceived via IVF: a case report

Purpose

The purpose of the study was to report a case of live birth following donor oocyte in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in which the oocyte donor herself was conceived via IVF. To our knowledge, such a case has not been previously reported.

Methods

Retrospective chart review; this case is reported after chart review of a successful outcome.

Results

A 42 year-old woman, with diminished ovarian reserve, and her husband desired to conceive. She underwent a fresh IVF/ICSI cycle with her own oocytes, which unfortunately was not fruitful in terms of pregnancy or cryopreserved embryos. The couple was counseled regarding the option of donor oocytes, and they elected to proceed with a fresh cycle of donor oocyte IVF/ICSI. The couple selected an anonymous oocyte donor from a donor agency who was a first-time oocyte donor and, interestingly, was conceived via IVF herself. The fresh donor oocyte/IVF/ICSI cycle did not result in pregnancy; however, two supernumerary blastocysts were cryopreserved for future cycles. The recipient’s subsequent frozen-thawed embryo transfer (FET) resulted in a singleton gestation and live birth.

Conclusions

An oocyte donor who was conceived via IVF had good ovarian response to stimulation, a good number of oocytes retrieved, and the formation and cryopreservation of blastocysts which, in a subsequent FET cycle, resulted in pregnancy and live birth for a recipient couple. To our knowledge, this is the first case reported of live birth with the use of donor oocytes from an oocyte donor who herself was conceived via IVF.     

发育不同一性双胎妊娠的并发症临床分析

目的 探讨发育不同一性双胎妊娠的并发症特点及双胎发育不同一性发生的相关因素。方法 以双胎胎儿体重差＞20％为发育不同一性双胎妊娠诊断标准,回顾性分析96例发育不同一性双胎(观察组)和349例发育一致双胎(对照组)的临床资料,比较两组在妊娠并发症、合并症、分娩情况和围产儿预后等方面的差异。结果 (1)观察组晚期流产、羊水过多、双胎输血综合征和胎盘早剥的发生率分别为13．5％(13／96)、22．9％(22／96)、9．4％(9／96)和5．2％(5／96),明显高于对照组的4．3％(15／349)、10．0％(35／349)、1．4％(5／349)和1．1％(4／349),两组比较,差异有统计学意义(P＜0．05)。(2)观察组围产儿死亡和胎儿畸形的发生率分别为22．9％(44／192)和5．2％(10／192),明显高于对照组的4．4％(31／698)和1．3％(9／698),两组比较,差异有统计学意义(P＜0．01)。(3)观察组胎儿体重轻者较体重重者的围产儿死亡率高,分别为30．2％(29／96)和15．6％(15／96),两组比较,差异有统计学意义(P＜0．05);体重差分别为≤20％、20％～30％和≥30％时,围产儿死亡率分别为4．4％、11．0％和41．9％;胎儿畸形发生率分别为1．3％、5．1％和5．4％,3者间分别比较,差异有统计学意义(P＜ 0．05)。结论发育不同一性双胎妊娠主要的并发症为晚期流产、羊水过多、双胎输血综合征、胎盘早剥、围产儿死亡和胎儿畸形。双胎中体重轻者围产儿死亡率高,且随体重差别增大围产儿死亡和胎儿畸形发生率升高。     

The effect of immature oocytes quantity on the rates of oocytes maturity and morphology, fertilization, and embryo development in ICSI cycles

Purpose

The goal was to evaluate the role of the number of retrieved immature oocytes on mature oocyte counts and morphology, and also the rates of fertilization and embryo development in ICSI cycles.

Methods

101 ICSI cycles were included in this prospective evaluation. Patients were divided into 2 groups of A (≤ 2 immature oocytes) and B (> 2 immature oocytes). In sub-analysis, the impacts of the number of GV and MI oocytes were assessed on the rates of fertilization and embryo development. Also, correlations between the numbers of immature and mature oocytes, as well as maternal age between two groups were analyzed. Assessments of oocyte morphology, fertilization, embryo quality and development were done accordingly.

Results

There was no correlation between the immature oocytes quantity with the number of mature ones. There were insignificant differences for embryo development between two groups, but fertilization rate was higher in group A (P = 0.03). In sub-analysis, insignificant differences were observed between two groups of ≤ and >2 GV and MI oocytes for rates of fertilization and embryo development. Also, the rates of clinical pregnancy and delivery were insignificant between groups. The rate of morphologically abnormal oocytes had no significant difference between two groups, except for wide perivitelline space (PVS) which was higher in group A (P = 0.03). There was no significant difference for maternal age between two groups.

Conclusions

In cases with few retrieved immature oocytes, rates of fertilization and incidence of wide PVS may increase, although immature oocytes may not have any negative impacts on early embryo development, or the rates on number of mature oocytes.     

Analysis of Minnesota Multiphasic Personality Inventory-2 profiles of prospective anonymous oocyte donors in relation to the outcome of the donor selection process

Objective: To examine the scores of prospective anonymous oocyte donors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in four outcome groups.

Design: Chart review.

Setting: Academic medical center.

Patient(s): One hundred fifty prospective anonymous oocyte donors who underwent a preliminary screening and a 1-hour structured psychological interview and who completed the MMPI-2.

Intervention(s): Psychological evaluation prior to donation.

Main Outcome Measure(s): Scores on the MMPI-2 and outcomes of the donor selection process.

Result(s): Seventy (47%) women were accepted as donors and completed one donation cycle; 30 (20%) were accepted as donors but did not donate because of medical reasons or relocation; 18 (12%) were accepted as donors but were noncompliant; and 32 (21%) were rejected as donors because of psychological concerns. Statistically significant differences were found between outcome groups on scales F, K, 1, 2, 7, 8, and 0. Although these differences were statistically significant, all group subscale mean scores were in the average to low-average range and differences between group means were small.

Conclusion(s): The MMPI-2 differentiates between prospective donor outcome groups, but psychologists need to interpret the results of the MMPI-2 carefully in the context of clinical interview information.     

The impact of Alpha/ESHRE consensus regarding oocytes with aggregates of smooth endoplasmic reticulum (SERa) on in vitro fertilization outcome

Purpose

The present study aimed to gather information on the impact of Alpha/European Society of Human Reproduction and Embryology (ESHRE) consensus regarding oocytes with aggregates of smooth endoplasmic reticulum (SERa) on in vitro fertilization outcome. In particular, we investigated if patients undergoing intracytoplasmic sperm injection (ICSI) and whose oocytes are discarded due to SERa have a higher chance of embryo transfer cancellation compared to patients without SERa oocytes.

Methods

This is a nested case–control study drawn from the cohort of women referring for in vitro fertilization with ICSI. Cases were patients showing at least one oocyte with SERa at the time of injection. Controls were subsequent patients showing no SERa oocytes and matched ratio 1:1 for age, clinical indication to in vitro fertilization (IVF), and body mass index. The main outcome was the rate of embryo transfer cancellation.

Results

The percentage of women experiencing a transfer cancellation (absence of suitable oocytes or viable embryos) in their ICSI cycle were significantly higher in cases (18 %) compared to controls (8 %) (p = 0.02); however, adjusted odds ratio for FSH and number of SERa oocytes, of follicles, of retrieved oocytes, and of inseminated oocytes were not statistically significant.

Conclusions

We have shown that the exclusion of SERa oocytes from ICSI cycles causes an increased frequency of transfer cancellation. This effect is mostly due to the reduced number of available oocytes after exclusion of SERa oocytes.     

Neonatal outcome in discordant eutrophic twins: twin growth.

OBJECTIVE: To compare maternal characteristics and neonatal outcome in discordant twin gestations (DT) and concordant twin gestation (CT). METHOD: Maternal and neonatal data base of live twins >25 weeks' gestation (N=351 pairs) were reviewed for antepartum complications, labor beginning, mode of delivery, neonatal complications, malformations and perinatal mortality. The chi-squared analysis and Student t-tests were used to analyze the differences between discordant and concordant premature and term twin pairs, and appropriate for gestational age (AGA) twins, separately. RESULTS: DT occurred in 15.1% of all twin pregnancies. In preterm and term DT there were significantly more elective cesareans. Growth discordance among preterm and term eutrophic twins was not connected with increased neonatal death or other complications, except higher incidence of early neurological signs in term DT. CONCLUSION: We strongly believed that prematurity and not discordant growth of eutrophic twins has important influence on neonatal outcome.     

Acrosome index is not an absolute predictor of the outcome following conventional in vitro fertilization and intracytoplasmic sperm injection

Purpose: To investigate if including evaluation of acrosome index (AI) in the semen analysis of teratozoospermic samples could help to predict for which patients intracytoplasmic sperm injection (ICSI) is necessary. Methods: The fertilization rate, pregnancy rate, and percentage of good quality embryos were compared after performing conventional in vitro fertilization (IVF) and ICSI, respectively, using sibling oocytes. The role of AI was evaluated by dividing patients into two groups; Group A (AI < 7%) and Group B (AI 7%). Results: A significant difference in fertilization rate was observed between Group A and B after conventional IVF. In Group A, the fertilization rate, embryo transfer rate, and percentage of good quality embryos were higher after ICSI than after IVF. In Group B, the fertilization and pregnancy rates were numerically but not significantly higher after IVF compared to ICSI. Conclusion: Evaluation of acrosome index will not accurately predict fertilization, although this study shows that a sperm sample with less than 5% normal forms and an AI greater than 7% may achieve a mean fertilization rate >70% after conventional IVF.     

Intracytoplasmic sperm injection and conventional in vitro fertilization for sibling oocytes in cases of unexplained infertility and borderline semen

Purpose: In a prospective study, conventional IVF and intracytoplasmic sperm injection (ICSI) were performed on sibling oocytes of 22 patients with unexplained infertility (Group A) and 24 patients with borderline semen (Group B).Results: In Group A, there was no significant difference (P=0.070) in the fertilization rate per oocyte between ICSI (63%) and conventional IVF (50.7%), however, there was total failure of fertilization in conventional IVF in 5 of the 22 patients with IVF and none in ICSI. In group B, there was a significant difference (P<0.001) between the fertilization rate per oocyte in ICSI (59%) and conventional IVF (27.1%). There was total failure of fertilization in 11 patients after conventional IVF and none after ICSI.Conclusions: The study showed that 22.7% of unexplained infertility and 45.8% of patients with borderline semen would have lost their chance of embryo transfer completely because of total failure of fertilization if ICSI was not performed on some oocytes in this cycle.Presented in part at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Vienna, Austria, April 3–7, 1995.     

Oocyte cryopreservation: the birth of the first Hungarian babies from frozen oocytes

PURPOSE: To present data obtained with clinical application of oocyte cryopreservation. METHODS: Slow freezing/rapid thawing in PBS based medium containing 1.5 M propanediol + 0.3 M sucrose. RESULTS: A total of 127 embryos were transferred into 54 patients (1.9 embryo/cycle, 64 transfer cycles). Clinical pregnancy rate of 20% per cycle (13/64) and 24.0% per patient were achieved. Up-to-date, six patients delivered seven healthy babies; there are four ongoing pregnancies. Three abortions (23%) and one biochemical pregnancy (0.7%) was obtained. Implantation rates of 11% per transferred embryos (14/127) and 6.5% (14/215) per thawed eggs were found. In each case, normal karyotype was detected. No difference was found in the ratio of spindle positive oocytes at the polscope analyses done before and after freezing (75.8% vs. 82.5%). CONCLUSION: Egg freezing is not a routine procedure yet, but there will certainly be a place for it in the future of assisted reproductive medicine.     

Follicular and luteal phase endometrial thickness and echogenic pattern and pregnancy outcome in oocyte donation cycles

Purpose  To study the effect of endometrial thickness (ET) and echogenic pattern (EP) in oocyte donation cycles upon pregnancy outcomes. Methods  Seventy-nine cycles resulting in blastocyst embryo transfer were evaluated. Donors underwent ovarian hyperstimulation using rFSH and GnRH-antagonist. Recipients were synchronized to donors using GnRH-agonist down-regulation followed by fixed dose of estrogen (E2) and progesterone (P4) following hCG. Transvaginal ultrasound (US) obtained ET and EP 10-11 days after initiation of E2 and on day of embryo transfer. Primary outcome was ET and EP in pregnant and non-pregnant cycles. Stimulation and embryology data was analyzed in donors to assess differences prior to transfer. Results  Fifty-nine cycles resulted in clinical pregnancy. No differences were observed in pregnant vs. non-pregnant cycles in proliferative or secretory ET and EP. Similar baseline and stimulation characteristics were found in pregnant and non-pregnant cycles. Regression analysis showed end thickness were not predictive of pregnancy outcomes. Conclusions  Endometrial characteristics in recipients prior to and following progesterone were not predictive of pregnancy outcomes. Capsule Endometrial thickness and echogenic pattern do not appear to be predictive of outcomes in oocyte donation cycles.