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대한생식의학회지 제26권 제3호 2010년
체외수정시술의 결과를 예측할 수 있는 인자로서 난구세포의 활용에 관한 연구
부산대학교 의과대학 산부인과학교실
김광대, 김기형, 나용진, 이규섭,
Application of Cumulus Cells as Factors to Predict the Outcome of IVF-ET
Kim kd, Kim kh, Na yj, Lee ks
Since in vitro fertilization and embryo transfer(IVF-ET) was firstly applied to humans by Edwards et al. at 1965, it has been discussed that many factors such as ovarian stimulation protocol, quality of spermatozoa and oocyte, culture condition, status of embryo, embryo replacement method and uterine receptivity might influence to its success rate. Among them, the following two factors have been suggested as being the most important in IVF-ET. One is to obtain and evaluate good quality oocytes/embryos, the other is to enhance the implantation ability of embryos. At present the most convenient system to evaluate oocytes/embryos is based on their morphological analysis and the status of oocytes-cumulus cell complexes. However, this evaluation method may be unreasonable because morphological analyses largely depend on an individual basis and there is no complete correlation between quality of oocytes/embryos and the outcomes of IVF-ET. It has been well known that apoptosis is programmed cell death for homeostasis and is closely involved in most reproductive processes including follicular atresia. Seifer et al. reported that apoptosis can be used as a means of estimating ovarian reserve in women undergoing in vitro fertilization. On the other hand, co-culture has been applied to improve the culture conditions and implantation ability of the embryo. Therefore, this study was performed to establish the evaluation methods of oocytes on the basis of the incidence of apoptosis in cumulus cells and to understand the relationships between the status of cumulus cell and the outcome of co-culture. The results were as follows : 1. The incidence of apoptosis in cumulus cells markedly increased in patients aged 40 or over, while the fertilization rate was greatly decreased in those age group. 2. Apoptosis in cumulus cells was found in both the fertilized oocytes and unfertilized oocytes, but the incidence of apoptosis was higher in unfertilized oocytes. 3. There is no clear correlation between apoptosis in cumulus cells and the number of oocytes retrieved. However, the incidence of apoptosis was increased when the number of oocytes retrieved was 5 and fewer in comparison with 6-10. 4. Embryo grade was significantly affected by the incidence of apoptosis in cumulus cells. 5. Pregnancy rate of IVF-ET per cycle was 29.4%, and the pregnant group had the higher fertilization rate and a significantly lower incidence of apoptosis in cumulus cells compared with the nonpregnant group. 6. When cumulus cells were used as helper cells in the co-culture of the embryo, in vitro activity of cumulus cells based on morphological change and proliferation did not influence the quality of embryo, but was closely associated with the implantation rate and pregnancy rate, which was enhanced when morphological changes and proliferation of cumulus cells was more active. 7. This difference in the outcome of IVF-ET according to in vitro activity of cumulus cells used for co-cultue was not associated with the incidence of apoptosis in cumulus cells, but rather had likely relations with the different secretion pattern of protein, which may be an embryotrophic factor by cumulus cells. These results suggest that the incidence of apoptosis in cumulus cells can be used in predicting oocyte qualities and the outcomes of IVF-ET. And the effect of co-culture largely depends on the in vitro activity of cumulus cells as well.
키워드 : IVF-ET, Cumulus cell, Apoptosis, Co-culture
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