Association between accurate size of follicles and fertilization and embryo quality
-
摘要:
背景 胚胎质量是影响生育结局的决定性因素。目前，临床上依靠超声下卵泡测量径线间接评估卵母细胞发育成熟度，但在多卵泡发育情况下超声测量难度大、精准度低。临床上广泛使用的经验值、扳机时机均需要准确的数据支持。 目的 本文通过直接测定卵泡液体积、计算卵泡径线以获得卵泡真实大小，用更精确的指标探究其与受精及胚胎质量的关系。 方法 选取2022年9月 - 2023年1月于解放军总医院第一医学中心生殖中心行辅助生殖助孕的42例女性，在超声下对单个卵泡进行穿刺取卵，测量所获卵泡液体积，根据体积公式V=4/3πR3换算为卵泡直径。每个卵泡按换算后直径分为7组：＜13 mm、13 ~ 15 mm、15 ~ 17 mm、17 ~ 19 mm、19 ~ 21 mm、21 ~ 23 mm、≥23 mm。每个卵泡对应的卵母细胞、受精卵及胚胎均单独处置，并观察胚胎的发育情况。 结果 42例辅助生殖女性平均年龄为(36.27 ± 4.34)岁。共获卵277枚，形成受精卵122枚，形成胚胎122枚(其中优质胚胎97枚)。＜13 mm卵泡中卵母细胞受精率最高(83.3%)，但不同体积卵泡组间的受精率差异无统计学意义(P＞0.05)。不同体积卵泡的优胚率不同，13 ~ 15 mm卵泡优胚率最高(87.5%)， 13 ~ 21 mm卵泡较更大卵泡优胚率更高(P=0.017)，其中15 ~ 17 mm卵泡的胚胎评级最好(P=0.034)。 结论 卵泡大小与胚胎潜能和胚胎质量显著相关。较小的卵泡不易于产生优质胚胎，但卵泡过大也会降低胚胎质量，15 ~ 17 mm卵泡具有更高的优胚率，胚胎潜能和质量更佳。 Abstract:Background Embryo quality is a determinant factor affecting reproductive and birth outcomes. Oocyte maturation is usually assessed indirectly using the diameters of follicles measured by ultrasound. However, ultrasound measurement is difficult and has low accuracy in the condition of multiple follicles development. More accurate data are needed to support the widely used empirical value and trigger time in clinical practice. Objective To explore the relationship between follicle size and fertilization and embryo quality using more accurate indexes by directly measuring follicular fluid volume and average diameter. Methods From September 2022 to January 2023, a total of 42 infertile couples who received assisted reproductive technology at the Reproductive Center of the First Medical Center of Chinese PLA General Hospital participated in the study. Each follicle was individually punctured and removed under ultrasound, and the follicular fluid volume was measured. Follicle diameter was calculated by measuring the volume formula V=4/3πR3. The follicles were divided into 7 groups according to the converted diameter: <13mm, 13-15 mm, 15-17 mm, 17-19 mm, 19-21 mm, 21-23 mm, ≥23 mm. The oocytes, zygotes and embryos corresponding to each follicle were operated separately, and the development of the embryos was observed. Results The mean age of 42 assisted reproductive women was 36.27 ± 4.34 years old. A total of 277 oocytes were collected, 122 zygotes were formed, and 122 embryos were obtained (including 97 high-quality embryos). Follicles < 13 mm had the highest fertility rate of oocyte (83.3%). However, there was no significant difference between follicle size and fertility rate (P>0.05). There were statistical differences in the rate of excellent embryos among follicles of different sizes (P<0.05). Excellent embryo rate of follicles with the diameter of 13-15mm was the highest (87.5%). The excellent embryo rate of follicles with the diameter of 13-21 mm was significantly higher than other larger follicles (P=0.017), and follicles with the diameter of 17-19 mm were the best (P=0.033). Conclusion Follicle size is significantly correlated to the quality of zygote and embryo. Smaller follicles are difficult to form high-quality embryos, but oversized follicles will also reduce embryo quality. The embryos obtained from follicles with the diameter of 17-19 mm have higher quality and better viability. -
表 1 患者一般情况
Table 1. Characteristics of patients
指标 结果 年龄/岁 36.27 ± 4.34 BMI/(kg·m-2) 22.67 ± 3.84 AMH/[ng·mL-1，Md(IQR)] 1.57(0.52，3.12) AFC/[个，Md(IQR)] 7.00(3.00，9.00) E2/[pmol·L-1，Md(IQR)] 2308.00(1196.85，5120.55) 
下载: 导出CSV
表 2 不同大小卵泡获卵及胚胎发育情况
Table 2. Embryological outcome according to follicular size
变量 总例数 ＜13 mm 13 ~ 15 mm 15 ~ 17 mm 17 ~ 19 mm 19 ~ 21 mm 21 ~ 23 mm ≥23 mm 获卵数/枚 175 12 25 57 30 25 16 10 受精数/(枚，%) 122 10(83.3) 16(64.0) 43(75.4) 18(60.0) 16(64.0) 12(75.0) 7(70.0) 优胚数/(枚，%) 97 7(70.0) 14(87.5) 37(86.0) 15(83.3) 13(81.3) 9(75.0) 2(28.6) 养囊胚胎/枚 96 7 11 31 16 14 10 7 冷冻胚胎/枚 15 0 4 8 1 2 0 0 移植胚胎/枚 8 1 1 2 0 2 2 0 丢弃胚胎/枚 3 2 0 0 1 0 0 0 囊胚/(枚，%) 47 3(42.9) 6(54.5) 16(51.6) 10(62.5) 7(50.0) 3(30.0) 2(28.6) 优质囊胚/(枚，%) 31 2(66.7) 3(50.0) 11(68.8) 8(80.0) 2(28.6) 3(100) 2(100)
下载: 导出CSV
表 3 不同大小卵泡(合并分组)优胚数(率)比较
Table 3. High-quality embryo rate for oocytes with different sizes
直径分组 受精总数/枚 优胚数/(枚，%) χ2值 P值 ＜13 mm 10 7(70.0) 7.691 0.021 13 ~ 21 mm 93 79(84.9) ≥21 mm 19 11(57.9)a aP＜0.05，vs 13 ~ 21 mm。
下载: 导出CSV
表 4 不同大小卵泡形成的胚胎评级情况
Table 4. Embryo ratings for embryo obtained from follicles with different sizes
直径分组 受精数/枚 胚胎评级/Md(IQR) H值 P值 ＜13 mm 10 2(1，4) 12.703 0.048 13 ~ 15 mm 16 2(1，2) 15 ~ 17 mm 43 2(1，2) 17 ~ 19 mm 18 2(1.75，2) 19 ~ 21 mm 16 1.5(1，2) 21 ~ 23 mm 12 1(1，3.5) ≥23 mm 7 3(2，3)a aP＜0.05，vs 15 ~ 17 mm。
下载: 导出CSV
-
[1] Esencan E,Beroukhim G,Seifer DB. Age-related changes in Folliculogenesis and potential modifiers to improve fertility outcomes - A narrative review[J]. Reprod Biol Endocrinol,2022,20(1): 156. doi: 10.1186/s12958-022-01033-x [2] Han L,Tian HC,Guo XX,et al. Regulation of ovarian function by growth hormone:potential intervention of ovarian aging[J]. Front Endocrinol (Lausanne),2022,13: 1072313. [3] Krajnik K,Mietkiewska K,Skowronska A,et al. Oogenesis in women:from molecular regulatory pathways and maternal age to stem cells[J]. Int J Mol Sci,2023,24(7): 6837. doi: 10.3390/ijms24076837 [4] Rodríguez-Fuentes A,Rouleau JP,Vásquez D,et al. Volume-based follicular output rate improves prediction of the number of mature oocytes:a prospective comparative study[J]. Fertil Steril,2022,118(5): 885-892. doi: 10.1016/j.fertnstert.2022.07.017 [5] Cadenas J,la Cour Poulsen L,Mamsen LS,et al. Future potential of in vitro maturation including fertility preservation[J]. Fertil Steril,2023,119(4): 550-559. doi: 10.1016/j.fertnstert.2023.01.027 [6] Mohr-Sasson A,Orvieto R,Blumenfeld S,et al. The association between follicle size and oocyte development as a function of final follicular maturation triggering[J]. Reprod Biomed Online,2020,40(6): 887-893. doi: 10.1016/j.rbmo.2020.02.005 [7] Orvieto R,Mohr-Sasson A,Blumenfeld S,et al. Does a large (>24 mm) follicle yield a competent oocyte/embryo?[J]. Gynecol Obstet Invest,2020,85(5): 416-419. doi: 10.1159/000510876 [8] Tamura I,Kawamoto-Jozaki M,Fujimura T,et al. Relationship between follicular size and developmental capacity of oocytes under controlled ovarian hyperstimulation in assisted reproductive technologies[J]. Reprod Med Biol,2021,20(3): 299-304. doi: 10.1002/rmb2.12382 [9] McCulloh DH,Kutchukhidze N,Charkviani T,et al. Follicle size indicates oocyte maturity and blastocyst formation but not blastocyst euploidy following controlled ovarian hyperstimulation of oocyte donors[J]. Hum Reprod,2020,35(3): 545-556. doi: 10.1093/humrep/dez291 [10] Eaton JL. Predicting the oocyte yield:is follicular volume superior to diameter?[J]. Fertil Steril,2022,118(5): 893. doi: 10.1016/j.fertnstert.2022.09.006 [11] Bessow C,Donato R,de Souza T,et al. Antral follicle responsiveness assessed by follicular output RaTe(FORT) correlates with follicles diameter[J]. J Ovarian Res,2019,12(1): 48. doi: 10.1186/s13048-019-0522-4 [12] Wirleitner B,Okhowat J,Vištejnová L,et al. Relationship between follicular volume and oocyte competence,blastocyst development and live-birth rate:optimal follicle size for oocyte retrieval[J]. Ultrasound Obstet Gynecol,2018,51(1): 118-125. doi: 10.1002/uog.18955 [13] Kahraman S,Cetinkaya CP,Cetinkaya M,et al. The effect of follicle size and homogeneity of follicular development on the morphokinetics of human embryos[J]. J Assist Reprod Genet,2017,34(7): 895-903. doi: 10.1007/s10815-017-0935-1 [14] Mehri S,Levi Setti PE,Greco K,et al. Correlation between follicular diameters and flushing versus no flushing on oocyte maturity,fertilization rate and embryo quality[J]. J Assist Reprod Genet,2014,31(1): 73-77. [15] Helmer A,Magaton I,Stalder O,et al. Optimal timing of ovulation triggering to achieve highest success rates in natural cycles-an analysis based on follicle size and oestradiol concentration in natural cycle IVF[J]. Front Endocrinol (Lausanne),2022,13: 855131. doi: 10.3389/fendo.2022.855131 [16] Akbariasbagh F,Lorzadeh N,Azmoodeh A,et al. Association among diameter and volume of follicles,oocyte maturity,and competence in intracytoplasmic sperm injection cycles[J]. Minerva Ginecol,2015,67(5): 397-403. [17] Re C, Mignini Renzini M, Rodriguez A, et al. From a circle to a sphere: the ultrasound imaging of ovarian follicle with 2D and 3D technology［J］. Gynecol Endocrinol, 2019, 35（3）: 184-189. [18] Noor N,Vignarajan CP,Malhotra N,et al. Three-dimensional automated volume calculation (sonography-based automated volume count) versus two-dimensional manual ultrasonography for follicular tracking and oocyte retrieval in women undergoing in vitro fertilization-embryo transfer:a randomized controlled trial[J]. J Hum Reprod Sci,2020,13(4): 296-302. doi: 10.4103/jhrs.JHRS_91_20 [19] Wertheimer A,Nagar R,Oron G,et al. Fertility treatment outcomes after follicle tracking with standard 2-dimensional sonography versus 3-dimensional sonography-based automated volume count:prospective study[J]. J Ultrasound Med,2018,37(4): 859-866. doi: 10.1002/jum.14421 [20] Revelli A,Martiny G,Delle Piane L,et al. A critical review of bi-dimensional and three-dimensional ultrasound techniques to monitor follicle growth:do they help improving IVF outcome?[J]. Reprod Biol Endocrinol,2014,12: 107. doi: 10.1186/1477-7827-12-107 -
下载: 
点击查看大图
表(4)
计量
- 文章访问数: 94
- HTML全文浏览量: 37
- PDF下载量: 2
- 被引次数: 0
