Die Cumulus-Oozyten-Regulationsschleife und deren Bedeutung für die Reproduktionsmedizin

Zusammenfassung

Die Interaktionen zwischen der Oozyte und den Follikelzellen sind Gegenstand der Forschung. Auf der Basis der Grundlagenforschung und erster klinischer Erfahrungen wird die Bedeutung der Cumuluszellen für die Oozyte im Rahmen einer IVF/ICSI Behandlung diskutiert. Durch die Verbindung der Cumuluszellen mit der Oozyte über Gap junctions ist ein bidirektionaler Austausch von Botenstoffen möglich, der zu einer optimalen Entwicklung der Oozyte beiträgt. Als Botenstoffe spielen bei der Oozytenentwicklung FSH, LH und EGF eine wesentliche Rolle. Außerdem produziert der Cumulus-Oozyten-Komplex Botenstoffe, die die Spermatozoen anlocken. Die Apoptose der Cumuluszellen und das Anti-Müller-Hormon können möglicherweise als prädiktive Faktoren für reproduktionsmedizinische Therapien genutzt werden. Es wird dargestellt, welche Rolle GnRH, FSH, LH und Estradiol (E₂) bei der Oozytenreifung im Rahmen der bidirektionalen Kommunikation zwischen Cumuluszellen und Oozyte spielen. FSH und LH sind wichtige Faktoren für die Follikulogenese und Oogenese. Für FSH und LH scheinen Schwellenwerte zu existieren, die die Oozytenqualität und letztendlich die Schwangerschaftsrate beeinflussen. Die retrospektive Subanalyse einer vergleichenden Studie, in der hMG-HP mit rFSH verglichen wurde, zeigte, dass die hMG-HP-stimulierten Zyklen nach vorhergehender Downregulation mittels GnRH-Agonisten in IVF-Patientinnen zu einer signifikant höheren Schwangerschaftsrate führte als mit rFSH. Weitere prospektiv, randomisierte Studien müssen jetzt klären, ob durch die Cumulus-Oozyten-Kommunikation IVF-Patientinnen stärker von einer Stimulationstherapie mit hMG-HP profitieren als von einer rFSH-Behandlung in Bezug auf die Schwangerschaftsrate.

Abstract

Interaction between oocyte and follicle cells, cumulus oophorus and theca cells is the subject of research. Based both on fundamental research and first clinical experience, the role of cumulus cells for the oocyte within the framework of IVF/ICSI treatment is discussed. The connection between cumulus cells and oocytes via gap junctions makes the bidirectional exchange of chemical messengers possible. This exchange, in turn, contributes to the optimal development of the oocytes. FSH, LH and EGF as chemical messengers play an important role with regard to the development of oocytes. Furthermore, the cumulus-oocyte complex produces chemical messengers which attract sperm. The extent to which both the apoptosis of cumulus cells and the anti Mullerian hormone can be used as predictive factors for ART is discussed. The role that GnRH, FSH, LH and estradiol (E2) play in oocyte maturation within the framework of the cumulus-oocyte complex is described. FSH and LH are important factors for folliculogenesis and oogenesis. Threshold effects appear to exist for FSH and LH which affect oocyte quality and ultimately also pregnancy rate. The retrospective subanalysis of a comparative trial with hMG-HP vs. rFSH in GnRH agonist downregulated ovarian stimulation cycles showed that the hMG-HP stimulated cycles led to a significantly higher pregnancy rate among IVF patients than did those with rFSH. Further prospective randomized studies must now clarify whether, as a result of cumulus-oocyte communication, IVF patients profit more from hMG-HP stimulation than from rFSH with respect to pregnancy rate.

Schlüsselwörter

Cumulus-Oozyten-Komplex - prädiktive Faktoren - Apoptose - Anti-Müller-Hormon - GnRH-Agonist - Gonadotropine - FSH - LH - IVF

Key words

Cumulus-oocyte complex - predictive factors - apoptosis - anti Mullerian hormone - GnRH agonist - gonadotrophins - FSH - LH - IVF

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