不同来源精子对卵胞浆内单精子显微注射助孕结局影响研究  

Effects of sperm from different sources on the outcomes of intracytoplasmic sperm injection

作　　者：程兰兰 冯宗刚[1] 马丽影[1] 谭丽[1] CHENG Lan-lan;FENG Zong-gang;MA Li-ying;TAN-Li(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院生殖医学部,河南郑州450014

出　　处：《中国实用妇科与产科杂志》2018年第9期1042-1046,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：河南省科技厅/郑州市科技局项目(161202310207/153pkjgg163)

摘　　要：目的探讨不同来源精子对卵胞浆内单精子显微注射(ICSI)助孕结局的影响。方法回顾性分析自2015年1月至2017年3月在郑州大学第二附属医院生殖中心行ICSI治疗的584个新鲜取卵移植周期,依据精子来源分为射精组(392个周期)、经皮附睾穿刺取精(PESA)组(86个周期)、睾丸穿刺取精(TESA)组(68个周期)和供精组(38个周期)。分别比较各组相关指标和妊娠结局。结果射精组、PESA组、TESA组的女方年龄、男方年龄、不孕年限、女方体重指数、MⅡ卵数和移植胚胎数间差异均无统计学意义(P>0.05)。射精组受精率高于PESA组(P=0.013)和TESA组(P=0.005),卵裂率高于TESA组(P=0.001);3组间优质胚胎率、新鲜移植周期胚胎种植率、临床妊娠率及流产率差异均无统计学意义(P>0.05)。TESA组累计妊娠率低于PESA组(P=0.003);射精组与供精组间受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率、流产率及累计妊娠率差异均无统计学意义(P>0.05)。结论不同来源的精子可影响ICSI的受精率和卵裂率,但对胚胎发育无显著影响,可获得相似的助孕结局;PESA是治疗梗阻性无精子症的有效方法;对非梗阻性无精症患者,用供精助孕是很好的选择,即使供精解冻后质量欠佳也不影响ICSI助孕结局。Objective To compare the effects of sperm from different sources on the outcomes of intracytoplasmic sperm injection（ICSI）.Methods We analyzed 584 fresh ICSI cycles retrospectively,which were from January 2015 to March 2017 in the Second Affiliated Hospital of Zhengzhou University.According to sperm sources,all samples were categorized into ejaculation group（n1=392）,percutaneous epididymal puncture（PESA）group（n2=86）,testicular puncture（TESA）（n3=68）and donor sperm group（n4=38）.The related indicators and clinical outcomes were compared among these groups.Results There were no statistical difference in age,infertility year,body mass indexes,number of MⅡ egg and transplanted embryos among the three groups.The fertilization rate of ejaculation sperm group was higher than that of PESA group,and the difference was statistically significant（P=0.013）.The fertilization rate of ejaculation sperm group was also higher than that of TESA group,and the difference was statistically significant（P=0.005）.The cleavage rate of ejaculation group was remarkably higher than that of TESA group（P=0.001）.The three groups had no statistical difference in the quality of embryos（P〉0.05）.Additionally,the three groups demonstrate no significant difference in the implantation rate of fresh cycle,,clinical pregnancy rate or abortion rate（P〉0.05）.Besides,the cumulative pregnancy rate of TESA group was significantly lower than that of PESA group（P=0.003）.There was no significant difference in the fertilization rate,cleavage rate,high quality embryo rate,implantation rate of fresh cycle,clinical pregnancy rate,miscarriage rate,cumulative pregnancy rate and delivery rate between the ejaculation group and the donor group（P〉0.05）.Conclusion Sperm from different sources can affect the fertilization rate and cleavage rate of ICSI,but have no significant effect on the quality of embryonic development.Similar clinical outcomes can be obtained by using ICSI obtained from different sources.PESA

关 键 词：卵胞浆内单精子显微注射 经皮附睾穿刺取精术 睾丸穿刺取精术 妊娠结局 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]