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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。
OBJECTIVE: To provide basis for further optimization of maturation culture system in vitro by comparing the effect of self-developed culture broth with commercial broth in oocyte maturation in vitro. Methods: Ninety-nine cycles of (IVM-A) and (IVM-B) broth were selected and used as control (ICSI-C1 And ICSI-C2) were compared between the two groups in vitro maturation, embryo development, embryo implantation, clinical pregnancy and outcome differences. Results: In the two control ICSI-C1 and ICSI-C2 indicators without any difference, IVM-A group in vitro maturation and embryo development were higher than the IVM-B group, and the rate of transplanted embryos, high-quality embryos was significantly (P <0.05 or P <0.01), and the rate of transplantable embryos reached the level of ICSI group. Although on the surface IVM-A group was significantly lower than the IVM-B group in embryo implantation rate, pregnancy rate (clinical pregnancy rate), live birth rate and other indicators, the indexes in the control group at different stages significantly changed. ICSI-C2 ) Was significantly better than ICSI-C1. This difference may be related to the improvement of clinical treatment programs in recent years and the use of hysteroscopy. It is noteworthy that the IVM-A miscarriage rate was only 10.53%, significantly lower than the other three groups, while the same period of the control (ICSI-C1) was significantly higher than that of ICSI-C2, suggesting that the use of self-formulated culture medium embryos can be significantly Reduce the incidence of abortion. However, due to the sample size is not big enough, the results have yet to be further verified. Conclusion: The self-prepared culture fluid has a good effect, which may be related to additional mHFF and E2. However, the system needs to be further optimized to ensure its efficient, safe and inexpensive.