不同精子来源及授精方式对剩余胚胎继续囊胚培养结局的影响  

Blastocyst formation in in vitro fertilization versus intracytoplasmic sperm injection cycles of surplus embryo:influence of sperm sources and fertilization method

作　　者：郑炜炜 谭玉梅 祝晓丽 陈瑞玲 谭颖 姜荣华 刘善文 吴铮 宋革 

机构地区：[1]广东省计划生育专科医院生殖医学中心,广州510060

出　　处：《生殖与避孕》2016年第10期845-851,共7页Reproduction and Contraception

基　　金：广东省人口计生委科研项目(项目编号:20132023)

摘　　要：目的:探讨不同精子来源及不同授精方式对胚胎继续发育能力的影响。方法:分析499例患者499个取卵周期剩余胚胎继续培养形成囊胚的情况,按精子来源不同分为供精IVF(D-IVF)组和夫精IVF(H-IVF)组,按授精方式不同分为IVF组和ICSI组,ICSI组按精子来源分为新鲜精液组、附睾精子和睾丸精子组,比较不同精子来源及授精方式获得剩余胚胎的囊胚形成率、胚胎利用率和无囊胚移植率。结果:① D-IVF组和H-IVF组受精率、卵裂率、优质胚胎率、第3日和第5日胚胎种植率、临床妊娠率和流产率均无统计学差异(P>0.05),组间剩余胚胎囊胚形成率、胚胎利用率和无囊胚移植率亦无统计学差异(P>0.05);②ICSI组与IVF组比较,其受精率较高(P<0.05),但优质胚胎率显著下降,有统计学差异(55.11%vs 61.30%,P<0.05),组间第3日卵裂期胚胎和剩余胚胎囊胚种植率、临床妊娠率无统计学差异(P>0.05),但ICSI组与IVF组比较,其剩余胚胎囊胚形成率、胚胎利用率稍低,无囊胚移植率较IVF组稍高,差异有统计学意义(56.13%vs 65.32%,48.18%vs 55.39%,21.68%vs 13.20%,P<0.05)。③新鲜精液组的优质胚胎率、胚胎利用率显著低于附睾精子和睾丸精子组(P<0.05),各组囊胚移植的种植率和临床妊娠率无统计学差异(P>0.05)。结论:D-IVF可获得H-IVF相似的结局,其剩余胚胎都有较高的发育潜能,ICSI获得的剩余胚胎发育潜能低于IVF组。附睾精子和睾丸精子ICSI后获得的胚胎比新鲜精液精子ICSI后胚胎发育潜能高。针对不同的授精方式可能需要制定相应的剩余胚胎囊胚培养标准。Objective： To explore the effects of different sperm sources and different fertilization methods on the outcomes of blastocyst culture of surplus embryos. Methods： We retrospectively analyzed the outcomes of blastocyst culture of surplus embryo for 281 cycles of IVF by donor sperm （D-IVF） and 75 cycles of IVF by husband sperm （H-IVF） and 143 cycles of ICSI. According to sperm sources, ICSI groups were divided into ejaculated sperm group （n=38）, epididymal sperm group （n=63） and testicular sperm group （n=42）. Results： 1） The rates of fertilization, cleavage, good-quality embryo, implantation, pregnancy and abortion showed no significant differences between D-IVF and H-IVF （P〉0.05）, and blastocyst formation rate, utilization of embryo, no blastocyst for implantation rate had no difference between the two groups （P〉0.05）. 2） ICSI group had a higher fertilization rate, but lower good-quality embryo rate compared with IVF group, and the blastocyst formation rate, utilization rate of embryo were lower than those in IVF group as well （56.13% vs 65.32%, 48.18% vs 55.39%,P〈0.05）. In ICSI group the no blastocyst for implantation rate was significantly higher than those in IVF group （21.68% vs 13.20%, P〈0.05）, however, the rates of implantation and pregnancy had no significant difference in both D3 and DS. 3） In ICSI group, the good-quality embryo rate and the utilization rate of embryo in ejaculated sperm group were statistically lower than those in epididymal sperm group and testicular sperm group （P〈0.05）. The rate of implantation and pregnancy had no significant difference among three groups （P〉0.05）. Conclusion： The developmental potential of surplus embryos in D-IVF and H-IVF were similar, and in ICSI the developmental potential is lower than that in IVF. The embryos derived from ICSI using epididymal sperm or testicular sperm have a better developmental potential than that using ejaculated sperm. Our study suggested that appropriate inclusion crite

关 键 词：剩余胚胎 囊胚 供精 体外受精(IVF) 卵胞质内单精子注射(ICSI) 

分 类 号：R714.8[医药卫生—妇产科学]