精子空泡对ICSI患者胚胎发育及临床结局的影响  

Impact of sperm vacuole on embryos development and clinical outcome in patients with ICSI

作　　者：孟祥黔[1] 曾泳梅 刘思瑶[1] 黄军[1] 周建明[1] 钟影[1] 

机构地区：[1]四川省成都市锦江区妇幼保健院生殖医学中心,成都610016

出　　处：《生殖医学杂志》2015年第7期525-531,共7页Journal of Reproductive Medicine

基　　金：四川省科技厅基础医学研究项目(2012JY0066);四川省卫生厅基础研究项目(100064)

摘　　要：目的利用精子放大系统观察精子空泡位置和大小,探讨不同类型精子行卵胞浆内单精子注射（ICSI）后对患者胚胎发育及临床结局的影响。方法选取57例行ICSI患者,于注射前利用精子放大系统对已在低倍镜下选定的精子进行放大观察,并拍照测量空泡直径,最后注射入卵,注射后单独培养并观察受精结局。结果空泡组和无空泡组比较,除胚胎冷冻率（10.6%vs.25.0%）和临床妊娠率（22.7%vs.77.3%）有显著性差异（P〈0.05）外,两组的2PN率分别为71.4%、74.1%,D3优胚率为28.3%、33.2%,可用囊胚率为11.1%、23.8%,胚胎利用率为44.6%、47.3%,胚胎着床率为22.2%、40.3%,两组间比较均无显著性差异（P〉0.05）;同时比较空泡组中空泡位置（顶体或顶体＋核）对临床结局的影响,结果显示正常受精率分别为75.7%、44.4%,D3优胚率为34.7%、0%,可用囊胚率为7.1%、12.5%,胚胎冷冻率为13.3%、12.5%,胚胎利用率为49.0%、25.0%,空泡组空泡位置间受精结局亦均无显著性差异（P〉0.05）;观察精子空泡大小（直径：〈1μm、1~1.5μm、〉1.5~2μm）对ICSI结局影响,结果显示3组正常受精率分别为71.0%、68.0%、76.9%,D3优胚率为25.0%、30.0%、54.5%,可用囊胚率为7.7%、7.1%、20.0%,胚胎冷冻率为14.3%、35.7%、20.0%,胚胎利用率为29.4%、40.0%、63.6%,3组间比较均无显著性差异（P〉0.05）。结论精子空泡有无对胚胎发育和胚胎着床并无显著影响,但因本研究样本量较少、精子空泡直径较小,故后期需扩大样本量来进一步验证。本结果仅为精子空泡的相关研究提供一定参考。Objective： To investigate the impact of sperm vacuole with different size and location on the embryo development and ICSI outcomes. Methods： Fifty seven patients were performed ICSI. The sperm morphology was observed under microscope with 6 000 times magnification for motile sperm organelle morphology examination（MSOME） before ICSI. The sperm samples were divided into the vacuole and non-vacuole group. Results. The percentage of embryo cryopreservation rate（10.6 % vs. 25.0%）and clinical pregnancy rate（22.7% vs. 77.3%）in the vacuole group were significantly lower than those in the non-vacuole group （P〈0.05）. There were no significant differences in fertilization rate（71.4% vs. 74.1%）,the rate of top quality embryo on Day 3 （28.3% vs. 33.2%）, blastocyst formation rate（11.1% vs. 23.8%）, embryo utility rate（44.6M vs. 47.3%）and implantation rate（22.2% vs. 40.3%）between the two groups（P〈 0.05）. There were no significant differences in fertilization rate（75.7% vs. 44. 4%） ,the rate of top quality embryo on Day 3（34. 7% vs. 0%） ,available embryo rate（7.1% vs. 12.5%） ,embryo cryopreservation rate （13.3% vs. 12.5%）, embryo utility rate（49.0% vs. 25.0%） between the vacuole located at acrosome group and the acrosome plus nuclear group （P〈0.05）. There were also no significant differences in fertilization rate（71.0% vs. 68.0% vs. 76.9%）,the rate of top quality embryo on Day 3（25.0% vs. 30.0% vs. 54. 5%）, available embryo rate（7.7% vs. 7.1% vs. 20.0%）, embryo cryopreservation rate （14.3% vs. 35.7% vs. 20.0%）,embryo utility rate（29.4% vs. 40.0% vs. 63. 6%） among the three groups with different size of vacuoles（〈1μm,1~l. 5 μm,〉1. 5~2 μm）（P〈0. 05）.

关 键 词：卵胞浆内单精子注射 精子 空泡 胚胎 

分 类 号：R[医药卫生]