脆性卵膜卵母细胞卵胞浆内单精子注射的胚胎发育与临床结局分析  

Analysis of embryonic development and clinical outcome of intracytoplasmic sperm injection in oocyte with fragile oolemma

作　　者：戴旭 师娟子 薛侠 李伟[1] 施文浩 DAI Xu;SHI Juan-zi;XUE Xia;LI Wei;SHI Wen-hao(Graduate School of Xi’an Medical University,Northwest Women’s&Children’s Hospital,Xi’an 710003)

机构地区：[1]西安医学院,西北妇女儿童医院,西安710003

出　　处：《生殖医学杂志》2020年第4期443-448,共6页Journal of Reproductive Medicine

基　　金：陕西省科技厅一般项目-社会发展领域(NO.2018SF-260)。

摘　　要：目的探讨脆性卵膜卵母细胞在卵胞浆内单精子注射(ICSI)后的受精、胚胎发育及妊娠结局的差异。方法回顾性分析2015年1月至2019年3月在西北妇女儿童医院生殖中心的ICSI治疗周期。根据精子注射时卵细胞表现为脆性破膜即为脆性卵膜组共196个周期,通过倾向值匹配(匹配容差为0.05)进行1∶2匹配(匹配变量包括患者年龄、BMI、不孕因素、用药方案),产生对照组(无脆性破膜)392个周期。比较两组患者的受精率、卵细胞退化率、胚胎发育及妊娠结局情况。结果 (1)受精及胚胎情况:脆性卵膜组的成熟卵细胞率(73.59%vs. 86.15%)、正常受精率(66.52%vs. 73.90%)、可用胚胎率(72.95%vs. 78.87%)、优质胚胎率(39.85%vs. 46.18%)均显著低于对照组(P<0.05),而ICSI后卵细胞退化率显著高于对照组(9.18%vs. 4.28%,P<0.05);两组间卵裂率(98.86%vs. 98.32%)、囊胚形成率(52.09%vs. 51.80%)均无显著差异(P>0.05)。(2)临床妊娠结局:两组间胚胎种植率(37.43%vs. 46.53%)、临床妊娠率(52.88%vs. 59.24%)均无显著差异(P>0.05)。结论脆性卵膜卵母细胞成熟率低,ICSI后受精率、可用胚胎率、优胚率均降低,卵子退化率升高,但妊娠结局无明显差异。Objective:To investigate the difference of fertilization,embryonic development and pregnancy outcome of oocytes with fragile oolemma after intracytoplasmic sperm injection(ICSI).Methods:The data of ICSI treatment cycles in the Reproductive Center of Northwest Women’s&Children’s Hospital from January 2015 to March 2019 were analyzed retrospectively.According to the appearance of fragile oolemma of oocytes at the time of ICSI,196 cases in the fragile oolemma group were matched at 1:2 by propensity score matching(matching tolerance was 0.05)with 392 cases in the control group(no oocyte with fragile oolemma).Matching variables included patient age,BMI,infertility factors,and medication regimen.The fertility rate,oocyte degeneration rate,embryo development and pregnancy outcome were compared between the two groups.Results:Fertilization and embryonic development:the mature oocyte rate(73.59%vs.86.15%),fertilizing rate(66.52%vs.73.90%),available embryo rate(72.95%vs.78.87%)and quality embryo rate(39.85%vs.46.18%)in fragile oolemma group were significantly lower than those in control group(P<0.05).The oocyte degeneration rate after ICSI in fragile oolemma group was significantly higher than that in control group(9.18%vs.4.28%,P<0.05).There was no significant difference in cleavage rate(98.86%vs.98.32%)and blastocyst formation rate(52.09%vs.51.80%)between the two groups(P>0.05).Clinical pregnancy outcome:there was no significant difference in embryo implantation rate(37.43%vs.46.53%)and clinical pregnancy rate(52.88%vs.59.24%)between the two groups(P>0.05).Conclusions:In oocytes with fragile oolemma,the maturation rate of is low;the fertilizing rate,available embryo rate and quality embryo rate after ICSI are decreased;and the oocyte degeneration rate is increased.However,there is no significant difference in pregnancy outcome.

关 键 词：卵胞浆内单精子注射 脆性卵膜卵母细胞 受精率 卵细胞成熟度 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]