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The Study on Relationship of Oocyte and Embryo Quality with Clinical Characteristics and Outcome of Infertile Women with PCOS

Author: SongJuan
Tutor: ChenShiLing
School: Southern Medical University,
Course: Obstetrics and Gynaecology
Keywords: Polycystic ovary syndrome (PCOS) Polycystic ovary (PCO) In vitro fertilization - embryo transfer (IVF-ET) Egg quality Embryo quality
CLC: R711.6
Type: Master's thesis
Year: 2008
Downloads: 282
Quote: 1
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Abstract

The first part of PCOS and non-PCOS infertility patients, egg and embryo quality and clinical characteristics and treatment outcome relationship [research purposes infertile patients with polycystic ovary syndrome (PCOS), only polycystic ovarian ultrasound morphology change (PCO ) infertility patients with normal ovarian response quality of eggs and embryos of infertile patients, clinical characteristics and in vitro fertilization - embryo transfer (IVF-ET) treatment outcome, and to explore its relationship to the clinical treatment of infertility in PCOS reference. [Materials and Methods] in patients with couples the parties informed consent case, the to accept IVF-ET treatment of infertility patients Nanfang Hospital, Center for Reproductive Medicine in January 2005 - January exclude to meet one of the following conditions: ( 1)> 38 years of age, or the basis of follicle stimulating hormone (FSH) 10miu/ml; couples line of (2) in patients with IVF-ET treatment before a full set of check, in addition to the treatment of indications related to the inspection results, the remainder of the examination was abnormal . Select selected patients who meet one of the following conditions: (1) the reference to the 2003 Rotterdam experts meeting PCOS diagnostic criteria, the clinical diagnosis of PCOS; (2) only ovarian ultrasound morphology change without hyperandrogenism clinical polycystic or biochemical manifestations, the rules of the menstrual cycle, basal body temperature was bipolar or more menstrual cycles continuous B-ultrasound monitoring of follicle development proven law ovulation, and except for the other endocrine diseases; (3) normal ovarian ultrasonographic appearance of gonadotropin (Gn ) stimulate normal reaction no hyperandrogenism performance, menstrual cycle rules, confirmed regularly holding the eggs and the exclusion of other endocrine diseases. A total of 460 cases included in the study, fresh row IVF-ET cycles 486. Among them, the diagnosis of PCOS and 189 cases, fresh row IVF-ET cycles 202 as PCOS group; pure PCO those 129 cases, fresh row IVF-ET cycle 134, as only the PCO group; normal ovarian morphology and the normal reaction of Gn 142 fresh cases, row IVF-ET cycle 150 as a control group. Mid-luteal long protocol ovarian hyperstimulation, and B ultrasound-guided oocyte retrieval. Patients with her husband the day to take sperm oocyte retrieval in patients. Indications meet the oocyte cytoplasm sperm injection (ICSI) the COH day as well as previous Semen laboratory results, four hours after ovulation demolition eggs, and observe egg morphology, maturity. Does not comply with ICSI indications underwent conventional IVF insemination. Observed in all patients ovum fertilization rate and embryo growth, select high-quality embryos row the third day after ovulation (Day3) transplantation and continued follow-up of patients with pregnancy. The pronuclear stage Day3 morphology score to assess the quality of the transferred embryos transferred embryos. Analysis PCOS, the only PCO and normal ovarian reaction infertility patients clinical features, the quality of eggs and embryos and IVF-ET treatment outcome. Data are mean ± standard deviation. SPSS11.5 software one-way analysis of variance (One-wayANOVA), multiple non-parametric tests for independent samples (of K Independent the Samples Test), R × C contingency table x ^{2 test for statistical Analysis. P <0.05 was considered statistically significant. [Results] 1. Groups, the average age of the basic characteristics of the group of infertility patients, duration of infertility, the basis of estradiol (E ₂), FSH level no significant difference (P> 0.05); PCOS group, body mass index, the basis of luteal-generated hormone (LH), LH / FSH, total testosterone (T) concentration is higher than the PCO-only group and the control group, the difference was statistically significant (P> 0.05); PCOS group and the PCO group only the basis of the number of antral follicles increased compared with the control group, the difference was statistically significant (P <0.05). HCG injection day clinical characteristics and clinical outcome of IVF-ET treatment cycles in each group of infertility patients in each group (HCG Day) E ₂ levels, endometrial thickness ≥ 10 mm follicles PCOS group and the PCO group only a significant difference (P> 0.05); PCOS group and the only the PCO group of Gn starting amount of total Gn dosage lower than that of the control group, the difference was statistically significant (P> 0.05); number of follicles ≥ 14mm, the total number of follicles and oocyte number are increased compared with the control group, and the eggs decreased, and the difference was statistically significant (P> 0.05). Each group of embryo implantation rate, clinical pregnancy rate, to continue pregnancy rate and a single egg retrieval cycle cumulative pregnancy rate was no significant difference (P> 0.05). The PCOS group of biochemical pregnancy rate and embryonic loss rate is higher than the other two groups, but the difference was not significant (P> 0.05); the PCOS group of early spontaneous abortion rate than the other two groups increased, PCOS and PCO-only group OHSS incidence increased , the difference was statistically significant (P <0.05). 3 group of infertility patients egg quality vacuoles appear rate compare each group, the occurrence rate of refractive bodies (RB), smooth endoplasmic reticulum (SER) occurrence particles abnormal rate, diode abnormal rate zona abnormal rate perivitelline abnormal rate was no significant difference (P> 0.05); MII eggs PCOS group with only PCO group normal ovum rate, normal fertilization rate than the control group, the difference was significant (P <0.05) group of infertility patients embryo quality group formation ratio of the number of embryos, number of embryos transferred, transplanted a 7-8 embryo cells (7-8c) Ⅰ no statistically significant difference (P> 0.05); PCOS group quality embryos rate frozen embryo rate, transplant embryo quality score, transplant 2 7-8c Ⅰ-stage embryos less than the other two groups, the difference was statistically significant (P <0.05). [Conclusion] 1.PCOS, only the PCO and clinical characteristics of the patients with normal ovarian infertility PCOS infertility patients the basis of LH, T secretion, suggesting that high LH, within the environment of the high T may be one of the reasons various manifestations of PCOS; PCO infertile patients only these endocrine abnormalities, the basic characteristics similar to normal ovarian infertility patients. Compared with the control group, PCOS group and the only the PCO group of infertility patients Gn stimulate performance hyperresponsiveness, Gn less, while the the COH number increased, at the same time increased the risk of the occurrence of OHSS. 2.PCOS, PCO and normal ovarian infertility patients only egg and embryo quality PCOS infertility patients were of eggs, the MII egg rate and normal morphology egg rate is significantly reduced egg quality decrease prompts PCOS infertility patients, mainly for cells mature degree reduce the increase in egg abnormal morphology, fertilization rate, and thus lead to high quality embryo rate dropped, the decrease in available for transplant 7-8c Ⅰ-stage embryos, transferred embryo quality score decreased, may be the proportion of frozen embryos is also significant with the decline, likely with PCOS the patient's underlying LH the T secretion increased. 3.PCOS, the only PCO and normal ovarian infertility IVF-ET treatment outcome in patients with fresh IVF-ET treatment cycle, PCOS and non-PCOS infertility patients have equal access to pregnancy; PCOS infertility patients with early embryonic loss and The increased rate of spontaneous abortion may reduce the quality of eggs and embryos, and continue to affect the embryo's developmental potential of related. The second part of the different subtypes PCOS infertility patients with egg and embryo quality and clinical characteristics and treatment outcome relationship [research purposes genotyping of PCOS according to the Rotterdam diagnostic criteria, egg and embryo quality analysis the different subtypes PCOS infertility patients, Clinical characteristics and treatment outcome of IVF-ET, and explore their mutual relations, to provide a reference for clinical diagnosis and treatment of PCOS infertility patients. [Data and Methods] diagnostic criteria for PCOS according to the Rotterdam experts meeting in 2003, the parting of a the PCOS group of the first part of this study infertility patients could be divided into three subtypes: (1) PCO thin hair ovulation / anovulation Kaohsiung hormone clinical / biochemical manifestations in patients with a total of 54 cases, fresh row IVF-ET cycle 58 as type Ⅰ group; (2) PCO thin hair ovulation / anovulatory patients with a total of 117 cases, line IVF-ET 126 fresh cycles as Ⅱ type group; (3) PCO the hyperandrogenism clinical / biochemical manifestations in patients with a total of 18 cases, 18 rows of fresh IVF-ET cycles, as type Ⅲ group. The experimental material, equipment, and experimental methods with the first part. Statistically the same way as the first portion. [Results] 1. The different subtypes average age of the group of the basic characteristics of the different subtypes PCOS infertility patients, duration of infertility, body mass index, the basis of E ₂, FSH, LH, LH / FSH, basic antral follicle number without significantly with difference (P> 0.05); type Ⅰ group basis of LH, LH / FSH type Ⅱ group and Ⅲ type group increased, but the difference is not significant with (P> 0.05); type Ⅰ group and type Ⅲ group of The basic T concentrations higher than the type Ⅱ group, the difference was statistically significant (P <0.05). Different subtypes of the clinical characteristics and clinical outcomes in patients with different subtypes PCOS infertility treatment cycle of IVF-ET group the day of HCG E ₂ levels, endometrial thickness ≥ 10 mm follicles the number of follicles ≥ 14mm, the total number of follicles and oocyte retrieval was no significant difference (P> 0.05); compared with type Ⅱ group and Ⅲ group, group type I Gn time and Gn dosage increased, but the difference was not significant (P> 0.05); I type group Gn starting amount of the eggs decreased compared to the other two groups to increase the type of group I and type III group, the difference was statistically significant (P <0.05). Type I group the rate of embryo implantation, clinical pregnancy, ongoing pregnancy and single oocyte retrieval cycle cumulative pregnancy rate compared with the other two groups to reduce the type of group I and type III group embryo loss rate, early spontaneous abortion rate than type Ⅱ group liters , but the difference was no statistically significant (P> 0.05); OHSS increase in the incidence of type group I and type III group, the difference was statistically significant (P <0.05). Vacuoles appear rate for different subgroups of the quality of the eggs of each group of infertility patients, RB occurrence rate, particle abnormal rate, diode abnormal rate, zona abnormal rate of the perivitelline abnormal rate, MII egg rate, normal morphology egg was no significant difference (P> 0.05); reduced normal fertilization rate than the type of group I and type III group II type group, but the difference was not significant (P> 0.05). SER occurrence rate of type Ⅰ and Ⅲ group type Ⅱ group increased, the difference was statistically significant (P <0.05). 4 of each type PCOS infertility patients of embryo quality compare each group form a number of embryos transplanted a 7-8c Ⅰ-stage embryos of proportion without significantly with difference (P> 0.05); type Ⅰ group and type Ⅲ group of high-quality embryos rate frozen embryo rate, transplant embryo quality score transplantation 2 7-8c Ⅰ-stage embryos less than type Ⅱ group, the difference was statistically significant (P <0.05). [Conclusion] 1.PCOS clinical classification of the patients and clinical features of PCOS infertility patients in accordance with the Rotterdam diagnostic criteria typing, different subtypes showed similar clinical features, typing methods prompted Rotterdam diagnostic criteria reflect the basic disease characteristics . PCOS infertility patients with type Ⅰ basis of LH and T concentrations elevated over the other two types of the relatively adverse reaction Gn stimulus, extend performance Gn time, the Gn amount of increase COH fewer, may be the most serious disease of a type . PCOS infertility patients of different subtypes of the egg, embryo quality and clinical outcomes analysis Ⅰ and Ⅲ PCOS infertility patients with hyperandrogenism performance and significantly reduce its egg and embryo quality, may interfere with the egg because the body hyperandrogenism development capacity, thus affecting the quality embryo formation. PCOS infertility patients with clinical manifestations of the different subtypes variety of heterogeneity, but on the whole, the various types of PCOS infertility patients received similar clinical outcomes of IVF-ET treatment. I and type III PCOS infertility patients early embryonic loss and increased rate of spontaneous abortion, speculated that androgens may be too much and in vivo impact to continue the developmental potential of embryos.}

The Study on Relationship of Oocyte and Embryo Quality with Clinical Characteristics and Outcome of Infertile Women with PCOS

Abstract

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