卵母细胞大极体对ICSI周期受精、胚胎发育及临床结局的影响  

Effect of oocytes with large polar bodies on fertilization,embryo development and clinical outcomes in ICSI cycle

作　　者：李丹[1] 任新玲 江亚萍 张思佳 LI Dan;REN Xinling;JIANG Yaping;ZHANG Sijia(Reproductive Medicine Center,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430000)

机构地区：[1]华中科技大学同济医学院附属同济医院生殖医学中心,武汉430000

出　　处：《中国生育健康杂志》2023年第5期440-444,共5页Chinese Journal of Reproductive Health

基　　金：国家自然科学基金资助项目(81801443)。

摘　　要：目的评估卵母细胞大极体对胞浆内单精子注射(ICSI)周期结局的影响。方法回顾性分析2017年1月至2021年12月行辅助生殖助孕的不孕症患者的临床资料,将ICSI中含有大极体卵母细胞的112个新鲜周期作为研究对象,并将ICSI注射的880枚成熟卵母细胞(MII)根据第一极体大小分为大极体组和正常极体组,分别比较两组胚胎的受精、发育潜能和临床结局。结果大极体组卵泡刺激素(FSH)高于正常极体组(P<0.05),两组其余的基本资料均无统计学差异(P>0.05)。大极体组2原核(2PN)受精率显著低于正常极体组(P<0.05);≥3PN率显著高于正常极体组(P<0.001);1PN率和退化(DA)率呈升高趋势,但均无统计学差异(P>0.05)。与正常极体组相比,大极体组2PN卵裂率呈下降趋势,D3优胚率、囊胚形成率、可利用囊胚率、优质囊胚率均明显降低,但仅囊胚形成率有统计学差异(P<0.01)。Logistic回归分析显示,与正常极体组相比,大极体组2PN受精率显著降低(OR:0.63,95%CI:0.44~0.91,P<0.05);≥3PN率显著增高(OR:3.99,95%CI:1.95~8.16,P<0.001);D3优胚率(OR:0.54,95%CI:0.31~0.93,P<0.05)和囊胚形成率(OR:0.42,95%CI:0.23~0.78,P<0.01)显著降低。大极体组单个胚胎新鲜周期移植共4例,临床妊娠1例,流产1例;大极体组+正常极体组各一个胚胎新鲜周期联合移植8例,均未妊娠。复苏移植大极体来源的囊胚共6例(大极体组3例,大极体组+正常极体组3例),2例(大极体组1例,大极体组+正常极体组1例)临床妊娠并活产2个健康婴儿。结论在ICSI周期中,卵母细胞大极体会影响受精、胚胎发育及临床结局,可以将卵母细胞大极体作为选择胚胎移植的指标之一,建议将大极体来源的胚胎培养至囊胚,移植后可能会改善其临床结局。Objective To evaluate the effect of oocytes with large polar bodies on intracytoplasmic sperm injection(ICSI)outcomes.Methods We retrospective analyzed the clinical data of infertile patients undergoing assisted reproductive technology treatment from January 2017 to December 2021.A total of 112 fresh cycles of ICSI containing oocytes with large polar bodies were involved as the research objects,and 880 mature oocytes(MII)from ICSI were divided into large polar body group and normal polar body group according to the size of the first polar body.The fertilization,developmental potential and clinical outcomes of the two groups were compared.Results The follicle-stimulating Hormone in large polar body group was higher than that in normal polar body group(P<0.05),and the remaining basic data of the two groups showed not statistical differences(P>0.05).The fertilization rate of 2 pronucleus was significantly lower than that in normal polar body group(P<0.05);the≥3PN rate was significantly higher than normal polar body group(P<0.001);the 1PN rate and degradation rate(DA)increased,but there was no significant difference between them(P>0.05).Compared with the normal polar body group,the 2PN cleavage rate of Day 2 in large polar body group showed a decreasing trend,the good quality embryo rate of Day 3,blastocyst formation rate,usable blastocyst rate and high-quality blastocyst rate in large polar body group were significantly decreased,but only the blastocyst formation rate was significantly different(P<0.01).Logistic regression analysis indicated that compared with the normal polar body group,large polar body group had a significantly lower rate of 2PN(OR:0.63,95%CI:0.44-0.91,P<0.05)and a significantly higher rate of≥3PN(OR:3.99,95%CI:1.95-8.16,P<0.001);the good quality embryo rate of Day 3(OR:0.54,95%CI:0.31-0.93,P<0.05)and the rate of blastocyst formation(OR:0.42,95%CI:0.23-0.78,P<0.01)were significantly decreased.Among the four cases of single embryo fresh cycle transfer in large polar body group,one case had clin

关 键 词：ICSI周期 大极体卵母细胞 受精 胚胎发育 临床结局 

分 类 号：R71[医药卫生—妇产科学]