卵子激活剂A23187对睾丸精子卵胞浆内单精子显微注射后妊娠结局的影响  

Effect of oocyte activator A23187 on pregnancy outcome after intracytoplasmic sperm injection

作　　者：闫学花 陈文楠 朱雅婷 刘小华 师娟子 YAN Xuehua;CHEN Wennan;ZHU Yating;LIU Xiaohua;SHI Juanzi(The Reproductive Center,Northwest Women's and Children's Hospital,Shaanxi Xi'an 710003,China;Shaanxi Province Gynecological Disease Clinical Research Center,Shaanxi Xi'an 710003,China)

机构地区：[1]西北妇女儿童医院生殖中心,陕西西安710003 [2]陕西省妇科疾病临床研究中心,陕西西安710003

出　　处：《中国妇幼健康研究》2023年第9期35-40,共6页Chinese Journal of Woman and Child Health Research

基　　金：陕西省科技厅一般项目-社会发展领域(2020-SF-305)。

摘　　要：目的评估卵子激活剂在临床中能否改善睾丸取精患者行卵胞浆内单精子显微注射(ICSI)后的妊娠结局。方法本研究选取2014年1月至2020年4月期间在西北妇女儿童医院生殖中心睾丸取精术(TESA)后行ICSI的374对不孕夫妇作为研究对象,按照ICSI后是否采用卵子激活剂A23187行人工卵子激活术(AOA)随机分为卵子激活组(n=47)和常规对照组(n=327)。以女方年龄、促排卵方案、移植的胚胎类型、胚胎质量、胚胎数量作为匹配条件,按照1∶3进行倾向评分匹配后,对两组的实验室指标和妊娠结局进行比较。结果匹配前,卵子激活组女方年龄较小,成熟卵子数较多,差异有统计学意义(t值分别为2.72、-2.56,P<0.05);匹配后,两组间基线资料均无显著性差异(P>0.05);匹配前,两组间在受精率、优质胚胎率、可用胚胎率和囊胚形成率之间无显著性差异(P>0.05);匹配后,卵子激活组的可用胚胎率低于对照组(χ^(2)=47.68,P<0.05);采用Logistic回归模型评估卵子激活处理对临床妊娠率的独立作用,结果发现匹配后未调整模型、调整模型均无统计学差异,其OR值及95%CI分别为1.26(0.63~2.52)、1.55(0.67~3.56),P>0.05。结论卵子激活剂A23187可能对新鲜睾丸精子取精后行ICSI的患者临床妊娠率没有影响,可以用于临床。Objective To study whether artificial oocyte activation can improve pregnancy outcomes after intracytoplasmic sperm injection(ISCI)in patients with testicular sperm retrieval.Methods In this study,374 infertile couples who underwent ICSI after testicular sperm extraction(TESA)at the reproductive cCenter of Northwest Women's and Children's Hospital Reproductive Center from January 2014 to April 2020 were selected as research objects.According to whether they underwent artificial oocyte activation(AOA)with oocyte activator A23187 after ICSI,randomly divided into AOA group(n=47)and a conventional control group(n=327).Female's age,ovulation promotion protocol,type of embryo transferred,quality of embryo and number of embryo were used as matching conditions,and the laboratory indexes and pregnancy outcomes of the two groups were compared according to 1:3 propensity score matching.Results Before matching,the women in AOA group were younger and had more mature ovum,and the differences was statistically significant(t=2.72 and-2.56,respectively,P<0.05).After matching,there was no significant difference in baseline characteristics between the two groups(P>0.05).Before matching,There was no significant difference between the two groups in fertilization rate,high quality embryo rate,usable embryo rate and blastocyst formation rate(P>0.05).After matching,the usable embryo rate was lower than that in the control group(χ^(2)=47.68,P<0.05).Logistic regression model was used to evaluate the independent effect of ovulation activation treatment on clinical pregnancy rate.The results found that there was no statistical difference between unadjusted and adjusted models after matching,the OR and 95%CI were 1.26(0.63-2.52)and 1.55(0.67-3.56),P>0.05.Conclusion Oocyte activator A23187 may have no effect on the clinical pregnancy rate in patients undergoing ICSI with fresh testicular sperm,which can be used clinically.

关 键 词：卵子激活 睾丸穿刺 卵胞浆内单精子注射 倾向评分匹配 临床妊娠率 

分 类 号：R173[医药卫生—妇幼卫生保健]