Objective: To investigate the effect of in vitro maturation(IVM) , fertilization and embryo transfer of immature oocytes derived from mild stimulated cycles on treatment of infertility women with polycystic ovarian syndrome (PCOS).rnMethods: A total of 31 infertility women with PCOS underwent IVM cycles which were primed with human menotrophin (HMG) from January 2010 to August 2011. All patients were pre-treated with metformin and oral conceptive for 3 months. The sexual hormone assay and transvaginal ultrasound scan were performed until lead-follicle reach to 14 mm in diameter and endometrial thickness≥7 mm, then a single injection of 10,000 IU of human chorionic gonadotropin (hCG) to prime follicles 36 hours before oocyte retrieval. The retrieved oocytes were cultured in IVM culture solution to maturation, then the mature oocytes were inseminated by intracytoplasmic sperm injection (ICSI) and the embryo transfers were performed 2 or 3 days later. The results were compared with those of infertile women with PCOS treatment by conventional IVF.rnResults: Oocyte retrieval was performed in 29 cycles (two cycles were cancelled due to follicle dominance). The time of stimulation was from 6 to 11 days. The dosage of HMG was from 6 to 26 ampoules. And the duration of in vitro maturation range was 8 to 31 hours. Embryo transfer was performed in 24 cycles. The oocyte pickup rates, oocyte maturity, fertilization, cycle cancellation due to severe ovarian hyperstimulation syndrome (OHSS), implantation, pregnancy and miscarriage rates were 88.2% (262/297) 86.6% (227/262), 68.7% (156/227), 6.9% (2/29), 29.2% (14/48), 50% (12/24) and 8. 3% (1/12), respectively. At the same period, infertility patients with PCOS underwent 144 conventional IVF cycles and 65 cycles were cancelled to avoid severe OHSS (45. 1%). The rates of implantation, pregnancy and miscarriage were 26. 3% (42/160), 45. 6% (36/79) and 41. 7% (15/36), respectively. There was no significant difference in implantation and pregnancy rates between two groups, while the rates of sever OHSS and miscarriage were much lower in IVM cycles than those in conventional IVF group.rnConclusions: Our results showed that infertile patients with PCOS who were pretreated with oral-contraceptive and metformin and used in vitro matured oocytes from mini-stimulated ovaries could obtain similar pregnancy rate and better pregnancy outcomes than the patients treated by conventional IVF. It might be offered as one of replacement treatment for traditional IVF in women with PCOS.%目的 探讨微刺激方案结合未成熟卵母细胞体外成熟培养(in vitro maturation,IVM)治疗多囊卵巢综合征(PCOS)不孕的临床应用价值. 方法 对2010年1月至2011年8月在陕西省妇幼保健院生殖中心就诊的有体外受精-胚胎移植(IVF-ET)指征同时合并PCOS的部分不孕患者,给予妈富隆及二甲双胍预处理后采用小量尿入绝经期促性腺素(HMG)促排卵(微刺激),在卵泡直径达14 mm、内膜厚度≥7 mm时注射入绒毛膜促性腺激素(hCG) 10,000 IU,36h后取卵,卵子体外培养,成熟后行卵胞浆内单精子注射(ICSI)受精,48～72 h后行胚胎移植.以同期进行常规IVF治疗的PCOS不孕患者作为对照组. 结果 IVM 31周期,2周期因卵泡优势化取消取卵,29个取卵周期微刺激时间6～11 d,HMG用药量6～26支,≥10 mm卵泡共297个,获卵262枚,IVM培养时间8～31 h.移植24周期,中度及以上卵巢过度刺激综合征(OHSS)发生率6.9％(2/29).获卵率、卵子的成熟率、受精率分别为88.2％(262/297)、86.6％ (227/262)、68.7％(156/227),新鲜周期种植率、妊娠率及临床流产率分别为29.2％ (14/48)、50％(12/24)和8.3％ (1/12).同期行常规IVF治疗的PCOS不孕患者共144周期,45.1％(65/144)因中度及以上OHSS取消移植,新鲜移植周期妊娠率及流产率分别为45.6％(36/79)和41.7％(15/36).两组妊娠率无显著差异,IVM组严重OHSS和自然流产发生率显著下降. 结论 PCOS不孕患者经妈富隆及二甲双胍预处理后采用微刺激+ IVM助孕可获得与常规IVF相似妊娠率及更好的妊娠结局,同时可避免严重OHSS的发生风险,可以替代常规IVF作为PCOS不孕症的一种有效治疗手段.
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