注射HCG后不同授精时间对IVF-ET患者胚胎发育和妊娠结局的影响  

Effects of different insemination times after HCG injection on embryonic development and clinical outcome of IVF-ET patients

作　　者：王宁 仲万霞[2] WANG Ning;ZHONG Wanxia(Reproductive Hospital Affiliated to Shandong University,Shandong Provincial Key Laboratory of Reproductive Medicine,Jinan 250001;Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics,Center for Reproductive Medicine,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University)

机构地区：[1]山东大学附属生殖医院,山东省生殖医学重点实验室,济南250001 [2]上海市辅助生殖与优生重点实验室,上海交通大学医学院附属仁济医院生殖中心

出　　处：《南通大学学报（医学版）》2023年第4期310-314,共5页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(32170817)。

摘　　要：目的:探讨常规的授精时间对胚胎发育及临床结局的影响,以掌握最佳的体外受精(in-vitro fertilization,IVF)时机。方法:回顾性分析山东大学附属生殖医院IVF-胚胎移植(embryo transfer,ET)助孕的5743个周期。根据人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射后授精时机的不同分为3组:38~39 h授精(A组,周期=474);>39~40 h授精(B组,周期=3834);>40~41 h授精(C组,周期=1435)。统计分析3组患者的临床资料、胚胎发育和临床结局情况,并分析在最佳授精时间内进行IVF-ET助孕患者的促排方案和培养体系对其胚胎发育和临床结局的影响。结果:3组间的正常受精率、多精受精率和卵子利用率差异有统计学意义(P<0.05),且随着授精时机的延迟正常受精率和卵子利用率逐渐提高,而多精受精率逐渐降低(P<0.05)。C组中长方案患者的优胚囊胚形成率和活产率均优于拮抗剂方案和短方案患者(均P<0.05)。C组患者使用Cook培养体系的优胚率、优胚囊胚形成率和卵子利用率均好于Vitrolife培养体系(均P<0.05)。结论:(1)IVF-ET助孕患者在一定时间范围内(38~41 h),延迟HCG注射后授精时机可以提高胚胎正常受精率和卵子利用率,降低多精受精率,但不影响临床结局。(2)HCG注射后>40~41 h授精,长方案患者的胚胎发育和妊娠结局更优,同时Cook胚胎培养体系仅促进胚胎发育并不影响妊娠结局。Objective:To investigate the effect of insemination timing on embryo development and clinical outcome,and to grasp the best timing of in-vitro fertilization(IVF)insemination.Methods:5743 cycles of IVF-embryo transfer(ET)assisted pregnancy in our center were retrospectively analyzed.They were divided into three groups according to the timing of insemination afterhuman chorionic gonadotropin(HCG)injection:38-39 h insemination(group A,cycles=474);>39-40 h insemination(group B,cycles=3834);>40-41 h insemination(group C,cycles=1435).The clinical data,laboratory embryo development and clinical outcome data of the three groups were statistically analyzed.The effects of the different promotion methods and the culture system on the embryo development and clinical outcome during the optimal insemination time were analyzed.Results:There were differences in normal fertilization rate,polysperm fertilization rate and ovum utilization rate among the three groups,and with the delay of insemination time,the normal fertilization rate and the ovum utilization rate gradually increased,while the polysperm fertilization rate gradually decreased(P<0.05).In group C,the high-quality blastocyst rate and live birth rate of the long protocol were better than those of the antagonist protocol and the short protocol(both P<0.05).In group C,the high-quality embryo rate,high-quality blastocyst rate and the ovum utilization rate of Cook culture system were superior to those of Vitrolife culture system(both P<0.05).Conclusions:(1)Within a certain time range(38-41 h),delaying the timing of fertilization after HCG injection could improve the normal fertilization rate and ovum utilization rate,and reduce the rate of polysperm fertilization,but did not affect the clinical outcome.(2)After HCG injection(40-41 h),patients with long protocol had better embryo development and pregnancy outcome.Meanwhile,Cook embryo culture system only promoted embryo development but did not affect the pregnancy outcome.

关 键 词：体外受精 胚胎移植 人绒毛膜促性腺激素 授精时机 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]