卵胞质内单精子显微注射受精失败卵子早期补救性人工激活技术体系的建立及其效率分析  

Establishment and efficiency analysis of rescue artificial activation system for intracytoplasmic sperm injection fertilization failed oocytes

作　　者：薛林涛[1] 王世凯[1] 毛献宝[1] 李政达 黄悦悦[1] 张小慧[1] 韦娉嫔 陈良师 谭卫红[1] Xue Lintao;Wang Shikai;Mao Xianbao;Li Zhengda;Huang Yueyue;Zhang Xiaohui;Wei Pinpin;Chen Liangshi;Tan Weihong(Reproductive Medical and Genetic Center,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院生殖医学与遗传中心,南宁530021

出　　处：《中华生殖与避孕杂志》2020年第11期887-892,共6页Chinese Journal of Reproduction and Contraception

基　　金：广西卫计委科研项目(Z2015305);南宁市青秀区重点研发计划(2018025)。

摘　　要：目的建立一个能够对卵胞质内单精子显微注射(ICSI)卵子受精失败进行早期判断进而实施早期补救性人工激活的技术体系,并探讨其激活效率及应用价值。方法首先回顾性分析2017年1月至2018年3月期间广西壮族自治区人民医院生殖医学与遗传中心150个采用时差胚胎动态监测系统(Time-lapse)系统培养的ICSI周期第二极体(Pb2)释放时间分布及其与受精及胚胎发育结局的关系,探讨Pb2释放作为ICSI受精失败早期判断指标的可行性。其次采用随机对照试验,收集2018年3月至2019年6月期间93个ICSI助孕周期的225个受精失败卵子,根据人工激活方式不同分为未激活组(NAOA组)、早期激活组(RAOA组)、晚期激活组(LAOA组),同时将其余ICSI注射卵子作为对照组,比较4组受精及胚胎发育参数,探讨ICSI受精失败早期补救性人工激活的效率和应用价值。结果Time-lapse监测ICSI注射后卵子有Pb2释放组的受精率(99.91%)、双原核(2PN)受精率(97.76%)显著高于无Pb2释放组(0.03%、0.00%)且差异均具有统计学意义(P均<0.001);ICSI注射后卵子Pb2释放时间为(3.04±1.45)h,Pb2释放时间分布及占比分别为0~3 h(58.58%)、3~5 h(36.29%)、5~8 h(3.92%)、>8 h(1.21%);NAOA组Pb2释放率、受精率、2PN受精率均为0%,LAOA组2PN受精率(36.00%)、第3日(D3)优质胚胎率(8.00%)、第5日(D5)囊胚转化率(0%)、D5优质囊胚转化率(0%)均显著低于RAOA组(60.00%、44.19%、51.16%、25.58%)且差异均有统计学意义(P=0.005,P=0.002,P<0.001,P=0.005),同时均显著低于对照组(97.63%、48.62%、63.23%、37.94%)且差异均有统计学意义(P均<0.001);RAOA组Pb2释放率(84.00%)、受精率(81.33%)、2PN受精率(60.00%)、2PN卵裂率(95.56%)均显著低于对照组(100.00%、99.68%、97.63%、99.51%)且差异均具有统计学意义(P<0.001,P<0.001,P<0.001,P=0.04),但D3优质胚胎率、D5囊胚转化率、D5优质囊胚转化率2组间差异均无统计学意义(P均>0.05)。结论Time-lapse监�Objective To establish a technical system for early judgment and rescue artificial oocyte activation of oocytes after fertilization failed,intracytoplasmic sperm injection(ICSI)and to explore the activation efficiency and application value.Methods Firstly,a retrospective analysis was performed in 150 ICSI cycles cultured by Time-lapse system during January 2017 to March 2018 from Reproductive Medical and Genetic Center,the People's Hospital of Guangxi Zhuang Autonomous Region,the time distribution of the second polar body(Pb2)exclusion and its relationship with fertilization and embryo development outcomes,the feasibility of Pb2 exclusion as an early indicator of fertilization failure in ICSI was discussed.Secondly,225 fertilization failed oocytes from 93 ICSI cycles during March 2018 to June 2019 were collected for randomized controlled trials according to different artificial activation modes.They were divided into three groups including non-activation group(NAOA group),rescue activation group(RAOA group)and late activation group(LAOA group).At the same time,the rest of injected oocytes from ICSI cycles include in this study were used as control group.Fertilization and embryo development parameters were used to explore the efficiency and application value of rescue artificial activation for after fertilization failure oocytes ICSI.Results Time-lapse monitoring showed that the fertilization rate and 2PN fertilization rate were 99.91%and 97.76%in the Pb2-exclusion group,0.03%and 0%in the without Pb2-exclusion group after ICSI,with significant differences between the two groups(P<0.001);the exclusion time of Pb2 after ICSI was(3.04±1.45)h,and the distribution and proportion of Pb2 exclusion time were 0-3 h(58.00%),3-5 h(36.29%),5-8 h(3.92%)and>8 h(1.21%).The Pb2 exclusion rate,the fertilization rate and the 2PN fertilization rate in NAOA group were all 0%,and the 2PN fertilization rate(36.00%),day 3(D3)high-quality embryo rate(8.00%),day 5(D5)blastocyst formation rate(0%)and D5 high-quality blastocyst formation r

关 键 词：延时成像 受精 极体 卵胞质内单精子注射 人工激活 

分 类 号：R714.8[医药卫生—妇产科学]