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目的探讨常规体外受精(IVF)结合未成熟卵母细胞体外培养(IVM)的临床应用价值。方法对2004年6月至2006年3月在沈阳东方医疗集团菁华医院就诊的多囊卵巢综合征(PCOS)、既往和本次超促排卵用药反应不良的患者,在自然周期或者降调节超排用药周期10～14d超声监测,如有1～2个直径≥14mm的优势卵泡发育,其他卵泡均<10mm,则注射人绒毛膜促性腺激素(HCG)10000IU,36h后将优势卵泡和小卵泡内的卵子同时取出,成熟卵子当天、未成熟卵子体外培养28～30h后行体外受精,受精后观察48～72h行胚胎移植。结果行IVF+IVM周期32个(共49个优势卵泡),移植30周期,26个周期获得31个优势卵子(当天成熟29个,成熟率93.5%,29/31),非优势卵泡共获得未成熟卵子359个,成熟194个(54.0%,194/359)。优势卵子及未成熟卵子的成熟率、受精率、卵裂率及优质胚胎率分别为93.5%、65.5%、100.0%、78.9%和54.0%、83.5%、95.7%、36.1%。18个有优势卵子参与移植的16个移植周期临床妊娠8例,没有优势卵泡参与移植的14个移植周期,临床妊娠2例。HCG日优势卵泡直径为14～17mm时,优势卵泡卵子成熟率、受精率,未成熟卵子成熟率、受精率,均无明显差别。结论IVF+IVM可应用于PCOS和卵巢反应不良的患者,优势卵泡直径14～17mm可以作为注射HCG的时间。
Objective To investigate the clinical value of routine in vitro fertilization (IVF) combined with immature oocyte in vitro culture (IVM). Methods From June 2004 to March 2006, patients with Polycystic Ovary Syndrome (PCOS) treated at Shenyang Oriental Medical Group Jinghua Hospital, previous and current patients with poor ovarian response were randomly divided into two groups: The drug cycle 10 ~ 14d ultrasound monitoring, if there are 1 to 2 diameter follicles ≥ 14mm follicle development, other follicles are <10mm, the injection of human chorionic gonadotropin (HCG) 10000IU, 36h after the dominant follicles and small follicles Of the eggs were removed at the same time, the same day as mature eggs, immature eggs cultured in vitro 28 ~ 30h in vitro fertilization, fertilization after 48 ~ 72h line embryo transfer. RESULTS: Thirty-two IVF + IVM cycles were performed in 32 cycles (49 dominant follicles), 30 cycles were obtained and 31 dominant eggs were obtained in 26 cycles (29 mature, 93.5%, 29/31) 359 mature eggs, 194 mature (54.0%, 194/359). The maturation rate, fertilization rate, cleavage rate and quality embryo rate of dominant and immature eggs were 93.5%, 65.5%, 100.0%, 78.9% and 54.0%, 83.5%, 95.7% and 36.1%, respectively. Eighteen of the 18 transplanted clinical pregnancies with dominant ovaries involved in transplantation had 8 cases of pregnancy, 14 cases had no dominant follicles involved in transplantation, and 2 cases had clinical pregnancy. When the dominant follicle diameter was 14 ~ 17mm, there was no significant difference in the maturation rate, fertilization rate, immature egg maturation rate and fertilization rate among the dominant follicles. Conclusions IVF + IVM can be used in patients with PCOS and ovarian dysfunction. The dominant follicle diameter of 14 ~ 17mm can be used as the time of HCG injection.