摘要
目的探讨多囊卵巢综合征(PCOS)伴不孕患者单个卵泡卵泡液中脂溶性维生素水平与胚胎发育及新鲜胚胎周期临床结局的相关性。方法选取PCOS伴不孕且需进行体外受精-胚胎移植的97例患者作为研究对象。于月经周期第2天或第3天给予卵巢刺激方案治疗,皮下注射重组人绒毛膜促性腺激素36 h后,经阴道超声引导下取卵(成熟卵母细胞)并收集单个卵泡的卵泡液。采用高效液相色谱法检测单个卵泡卵泡液中维生素A、维生素E水平,采用酶联免疫吸附法检测单个卵泡卵泡液中维生素D、维生素K水平。评估培养第3天(D_(3))、第5天(D_(5))的胚胎质量并进行胚胎形态学等级评分。分析单个卵泡卵泡液中脂溶性维生素水平与卵母细胞受精、胚胎发育及新鲜胚胎周期临床结局的相关性。结果共收集到1036个成熟卵母细胞的卵泡液。单个卵泡卵泡液中维生素A水平为656.27(628.50,688.00)ng/mL,维生素D水平为21.39(17.22,22.91)ng/mL,维生素E水平为3129.55(3052.26,3193.00)ng/mL,维生素K水平为0.72(0.71,0.73)ng/mL。831个成熟卵母细胞成功受精,发育至D_(3)胚胎718个,发育至D_(5)胚胎397个。新鲜胚胎周期(单胚胎移植)中D_(3)移植胚胎82个,D_(5)移植胚胎15个,临床妊娠42例。单个卵泡卵泡液中维生素A、维生素E水平与其对应的卵母细胞成功受精均相关(均P<0.05);单个卵泡卵泡液中维生素D水平与其对应的卵母细胞发育至D_(3)、D_(5)及新鲜胚胎周期临床妊娠均相关(均P<0.05);单个卵泡卵泡液中脂溶性维生素水平与其对应的D_(3)、D_(5)胚胎形态学等级评分均无相关性(均P>0.05)。结论PCOS伴不孕患者单个卵泡卵泡液脂溶性维生素中,维生素A、维生素E水平升高是卵母细胞成功受精的保护因素,维生素D水平升高是胚胎发育及新鲜胚胎周期临床妊娠的保护因素,而单个卵泡卵泡液中脂溶性维生素水平均与胚胎形态学等级评分无关。
Objective To investigate the correlations of lipid-soluble vitamins levels in follicular fluid of a single follicle with embryo development and clinical outcomes of fresh embryo cycle in infertile patients with polycystic ovarian syndrome(PCOS).Methods Ninety-seven infertile patients with PCOS who needed in vitro fertilization-embryo transfer were selected as research subjects.A treatment protocol of ovarian stimulation was conducted on the second or third day of the menstrual cycle.Thirty-six hours after a subcutaneous injection of recombinant human chorionic gonadotropin,transvaginal ultrasound-guided egg(mature oocyte)retrieval was performed and follicular fluid of a single follicle was collected.The levels of vitamins A and E in follicular fluid of a single follicle were detected by high performance liquid chromatography,and the levels of vitamins D and K in follicular fluid of a single follicle were detected by enzyme-linked immunosorbent assay.The quality of the embryo on day 3(D_(3))and day 5(D_(5))of culture was evaluated,and the morphology grade scoring on the embryo was performed.The correlations of lipid-soluble vitamins levels in follicular fluid of a single follicle with oocyte fertilization,embryo development,and clinical outcomes of fresh embryo cycle were analyzed.Results In total,the follicular fluid of 1036 mature oocytes was collected.In follicular fluid of a single follicle,the level of vitamin A was 656.27(628.50,688.00)ng/mL,the level of vitamin D was 21.39(17.22,22.91)ng/mL,the level of vitamin E was 3129.55(3052.26,3193.00)ng/mL,and the level of vitamin K was 0.72(0.71,0.73)ng/mL.A total of 831 mature oocytes were successfully fertilized,718 developed into D_(3) embryos,and 397 into D_(5) embryos.In fresh embryo cycle(single embryo transfer),there were 82 D_(3) embryo transfers,15 D_(5) embryo transfers and 42 cases of clinical pregnancy.The levels of vitamins A and E in follicular fluid of a single follicle correlated with the successful fertilization of their corresponding oocytes(all P<0.05);the level of vitamin D in follicular fluid of a single follicle correlated with its corresponding oocytes′development into D_(3) or D_(5) embryo as well as clinical pregnancy of fresh embryo cycle(all P<0.05);there were no correlations between the levels of lipid-soluble vitamins in follicular fluid of a single follicle and the morphological grade scores of their corresponding D_(3) and D_(5) embryos(all P>0.05).Conclusion Among lipid-soluble vitamins in follicular fluid of a single follicle of infertile women with PCOS,elevated levels of vitamins A and E are protective factors for successful fertilization of oocytes,and an elevated vitamin D level is a protective factor for embryo development and clinical pregnancy of fresh embryo cycle;however,the levels of lipid-soluble vitamins in follicular fluid of a single follicle are not correlated to embryos′morphological grade scores.
作者
贾新转
刘二缓
王聪敏
张娜
魏兰
JIA Xin-zhuan;LIU Er-huan;WANG Cong-min;ZHANG Na;WEI Lan(Department of Reproductive Medicine,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Operating Room,Shenzhou City Hospital,Shenzhou 053800,China;Department of Thoracic Surgery,Hebei Provincial Chest Hospital,Shijiazhuang 050041,China)
出处
《广西医学》
CAS
2022年第7期706-711,共6页
Guangxi Medical Journal
基金
河北省医学科学研究课题计划(20170706)。
关键词
多囊卵巢综合征
不孕
卵泡液
脂溶性维生素
受精
胚胎发育
临床结局
Polycystic ovarian syndrome
Infertility
Follicular fluid
Lipid-soluble vitamin
Fertilization
Embryo development
Clinical outcome
