取卵日连续2次取精在辅助生殖技术中的应用效果  

Results of requesting a second consecutive sperm ejaculate on the day of oocyte pick-up in assisted reproductive technology

作　　者：翟丹梅[1] 李慕军[1] 江莉[1] 覃爱平[1] 李柳铭 杭馥[1] 

机构地区：[1]广西医科大学第一附属医院生殖医学研究中心,广西南宁530021

出　　处：《中华男科学杂志》2011年第5期418-421,共4页National Journal of Andrology

基　　金：美国增进人类健康项目(PSBH200514);广西科学基金项目(桂科青0447034)~~

摘　　要：目的：评价取卵日连续2次取精而减少ICSI特别是经皮附睾穿刺抽吸术（PESA）/睾丸细针抽吸术（TESE）周期数在辅助生殖技术中的应用效果。方法：收集取卵日连续2次射精的精液样本（34例68份）。比较前后2次取出的精液分析参数,总结2次精液处理后混合用于授精的实验室结果和临床妊娠结局。结果：34例男性均在4 h内连续手淫取出2次精液。第1和第2次射精时间间隔[94.9±39.8（26~183）]m in。第1次射出精液的量[（2.0±1.4）m l]显著高于第2次射出的量[（1.5±0.9）m l]（P=0.007）,而第1次射出精液的精子活动率和a＋b级精子百分率[（40.8±25.3）%、（30.9±22.4）%]显著低于第2次的[（52.2±21.1）%、（39.9±17.5）%]（P〈0.05）;但是2次取出精液的精子浓度和精子总计数比较差异无统计学意义（P〉0.05）。34例男性的精液处理后行IVF、ICSI和IVF＋ICSI周期分别为28、3、3。其中IVF、ICSI、IVF＋ICSI周期的平均获卵数、正常受精率、优质胚胎率、冷冻周期数/新鲜移植周期数分别为15.5±8.7、57.0%（247/433）、58.7%（145/247）、20/24;21.7±8.3、61.5%（40/65）、67.5%（27/40）、3/2;10.0±2.6、72.4%（21/29）、66.7%（14/21）、3/3。新鲜胚胎移植临床妊娠率和冷冻胚胎冻融移植（FET）临床妊娠率分别为34.5%、30.7%。在妊娠例数中14例活产6男9女的健康小孩。结论：取卵日连续2次取精以收集更多数量和/或活动力更好的精子用于辅助生殖技术中可以获得30%以上的临床妊娠率,也可以避免微创取精术和其他不必要的显微受精方式。Objective： To evaluate the results of requesting a second consecutive sperm ejaculate in order to reduce ICSI cycles by PESA or TESE on the day of oocyte pick-up in assisted reproductive technology（ART）.Methods： We collected 68 semen samples as a second consecutive ejaculate from 34 men,compared the semen volume and sperm concentration,motility and total count between the first and the second ejaculation,and analyzed the laboratory results and clinical outcomes of fertilization with the mixed sperm.Results： The 34 males ejaculated twice within 4 hours by masturbation,with an interval of 26-183（94.9±39.8） minutes between the first and second ejaculation.The volume of the first ejaculate was（2.0±1.4） ml,significantly higher than that of the second（[1.5±0.9] ml）（P=0.007）,although the numbers of motile sperm and grade a＋b sperm of the first（[40.8±25.3]% and [30.9±22.4]%） were significantly lower than those of the second（[52.2±21.1]% and [39.9±17.5]%）（P0.05）.There were no statistically significant differences in the sperm concentration or total sperm count between the two ejaculates（P0.05）.The ICSI,IVF＋ICSI,and IVF cycles were 3,3 and 28 respectively among the 34 couples undergoing ART.The number of retrieved oocytes,normal fertilization rate,high quality embryo rate and frozen cycles/fresh transfer cycles ratio were 15.5±8.7,57.0%（247/433）,58.7%（145/247） and 20/24 for the IVF cycle,21.7±8.3,61.5%（40/65）,67.5%（27/40） and 3/2 for the ICSI cycle,and 10.0±2.6,72.4%（21/29）,66.7%（14/21） and 3/3 for the IVF＋ICSI cycle.Fourteen live births were achieved out of the 18 pregnancies,including 6 healthy boys and 9 healthy girls.Conclusion： A clinical pregnancy rate of 30% can be achieved by requesting a second consecutive sperm ejaculate on the day of oocyte pick-up in order to collect more sperm and/or increase the total number of motile sperm for ART.And this method can avoid other invasive sperm processing techniques and the need of unnecessary

关 键 词：连续射精 辅助生殖技术 取卵日 

分 类 号：R714.8[医药卫生—妇产科学]