卵母细胞内滑面内质网聚集现象对其发育潜能及临床结局的影响  

Effect of smooth endoplasmic reticulum clusters in human oocytes on the embryo development and pregnancy outcomes

作　　者：赵静[1] 赵骏达 胡泊[1] 巩晓芸[1] 王鹏[1] 王致辉[1] 朱玥洁[1] 腊晓琳[1] 

机构地区：[1]新疆医科大学第一附属医院生殖医学中心,乌鲁木齐830054

出　　处：《中华生殖与避孕杂志》2018年第1期23-27,共5页Chinese Journal of Reproduction and Contraception

基　　金：公益性行业科研专项:人类辅助生殖技术质量控制体系建立的相关研究(201402004)~~

摘　　要：目的探讨卵胞质内单精子注射(ICSI)周期中卵母细胞滑面内质网聚集体(SERC)对胚胎发育的影响及移植后的妊娠结局,判断是否有移植价值。方法回顾性分析2014年1月—2015年12月期间768个ICSI周期。根据所获MⅡ期卵母细胞是否出现SERC分为A组(n=681,所获MⅡ期卵母细胞均未出现SERC)和B组(n=87,至少有1枚MⅡ期卵母细胞出现SERC)。比较A、B两组患者的一般临床情况、Gn使用总量、Gn使用时间、h CG注射日雌激素(E2)、孕酮(P)、黄体生成素(LH)水平、子宫内膜厚度以及获卵数、受精率、优质胚胎率、囊胚形成率、多囊卵巢综合征(PCOS)患者比例、中重度卵巢过度刺激综合征(OHSS)发生率、临床妊娠率、种植率、流产率、活产率和胎儿畸形率。将B组再分为3个亚组,SERC(+)组(n=7),所移植的胚胎均为SERC(+)卵子来源;SERC(+/-)组(n=14),所移植的胚胎1枚为SERC(+)卵子来源的,1枚为SERC(-)卵子来源的;SERC(-)组(n=25),所移植的胚胎均为非SERC卵子来源的。比较其受精率、优质胚胎率和囊胚形成率。结果 B组h CG注射日E2水平[(2 976.6±1 246.3)ng/L]明显高于A组[(2 323.4±871.4)ng/L](P<0.05),而P和LH水平以及子宫内膜厚度均无统计学差异(P>0.05);B组受精率(65.9%)、优质胚胎率(28.6%)、囊胚形成率(44.2%)显著低于A组(74.9%、33.4%和50.4%)(P<0.05),而B组Gn用量[(2 643.6±1 087.5)IU]明显高于A组[(2 256.6±976.4)IU](P<0.05)。患者的年龄、Gn使用时间、不孕年限、获卵数、PCOS患者比例、中重度OHSS发生率、临床妊娠率、种植率、流产率、活产率和胎儿畸形率方面组间均无统计学差异(P>0.05)。3个亚组间一般临床情况无统计学有差异。SERC(+)亚组卵母细胞的受精率(59.6%)、囊胚形成率(35.7%)显著低于SERC(-)亚组(68.6%,48.1%)(P<0.05)。结论卵母细胞SERC会影响早期胚胎的体外发育,但本研究未观察到SERC胚胎对妊娠结局有不良影响,故需慎重对待SERC来源的胚Objective To investigate the effect of smooth endoplasmic reticulum clusters（SERC） in human oocytes on the embryo development and pregnancy outcomes during intracytoplasmic sperm injection（ICSI） cycles and discuss the reason for it and the value of SERC-positive [SERC（＋）] embryos. Methods Seven hundred and sixty-eight ICSI cycles during January 2014 to December 2015 were retrospectively analyzed and were divided into two groups： 681 cycles in which no SERC occurred in any MII oocyte as group A, while 87 cycles in which at least one MII oocyte was found with SERC in each cycle as group B. The concentrations of estradiol（E2）, progesterone（P） and luteinizing hormone（LH） as well as thickness of endometrium were measured on h CG injection day. Comparisons were made on the patients＇ age, disease course, the concentrations of basal hormones, dosage of Gn used, duration of stimulation, the number of oocytes retrieved, fertilization rates, goodquality embryo rates, available blastocyst rates, the occurrence of polycystic ovary syndrome（PCOS） patients, occurrence rate of moderate and severe ovarian hyperstimulation sydrome（OHSS）, clinical pregnancy rate per cycle, implantation rate, miscarriage rate, live-birth rate and malformation rate. Group B was further divided into three subgroups： group SERC（＋）（n=7） with all SERC（＋） oocytes, group SERC（＋/-）（n=14） consisting of one SERC（＋） oocyte and one SERC（-） oocyte, group SERC（-）（n=25） with all SERC（-） oocytes. The comparison of fertilization rates, good-quality embryo rate and available blastocyst rate were made among these three subgroups. Results The concentration of E2 in group B [（2 976.6±1 246.3） ng/L] was significantly higher than that in group A [（2 323.4±871.4） ng/L]（P〈0.05）, while no significant differences were found on endometrium thickness as well as the concentrations of P and LH（P〈0.05）. Additionally, there were significantly lower fertilization rates（65.

关 键 词：卵母细胞 滑面内质网 卵胞质内单精子注射(ICSI) 

分 类 号：R714.8[医药卫生—妇产科学]