短时体外受精过程中切除部分卵丘颗粒细胞对后续胚胎发育及临床结局的影响  

Effects of partial removal of cumulus granulosa cells during short-term in vitro fertilization on subsequent embryo development and clinical outcomes

作　　者：王功发 狄春光 王毅 王慧[1] 毛珊珊 丁洁[1] 付伟平[1] WANG Gongfa;DI Chunguang;WANG Yi;WANG Hui;MAO Shanshan;DING Jie;FU Weiping(Reproductive Center,Jiaxing Maternal and Child Health Hospital,Jiaxing 314000,China)

机构地区：[1]嘉兴市妇幼保健院生殖医学中心,314000

出　　处：《浙江医学》2025年第3期274-278,289,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023KY336)。

摘　　要：目的探讨短时体外受精过程中切除部分卵丘颗粒细胞对胚胎发育及临床结局的影响。方法回顾性选取2020年1月至2022年12月在嘉兴市妇幼保健院生殖医学中心行体外短时受精助孕的1360例女性不孕患者为研究对象。其中取卵时未切除卵丘颗粒细胞的680例患者为未切除组,切除部分卵丘颗粒细胞的680例患者为切除组。比较两组患者受精及胚胎发育结局和临床结局,采用二元logistic回归分析切除部分卵丘颗粒细胞对临床妊娠和活产结局的影响。进一步根据卵丘-卵母细胞复合体(COC)数量,分为低密度COC(1~6枚卵子)、中密度COC(7~12枚卵子)和高密度COC(13~18枚卵子),比较不同COC密度时两组患者受精及胚胎发育结局和临床结局指标。结果两组患者总受精率、两原核(2PN)受精率、多精受精率、单原核(1PN)受精率、2PN卵裂率、优胚率和囊胚形成率比较,差异均无统计学意义(均P>0.05);校正女方年龄、不孕类型、不孕年限、体重指数、促性腺激素总量等相关混杂因素后,二元logistic回归分析显示切除部分卵丘颗粒细胞对临床妊娠和活产结局不构成影响(OR=1.091,95%CI:0.838~1.421,P=0.516;OR=1.000,95%CI:0.765~1.306,P=0.999)。当COC增加到中密度时,切除组1PN受精率低于未切除组(P<0.01);当COC增加到高密度时,切除组多精受精率低于未切除组(P<0.05);不同COC密度时两组患者生化妊娠率、临床妊娠率、着床率、活产率和流产率比较,差异均无统计学意义(均P>0.05)。结论在短时体外受精过程中,获卵较多时切除部分卵丘颗粒细胞能降低异常受精率,且不会影响患者的临床结局。Objective To investigate the effects of partial removal of cumulus granulosa cells during short-term in vitro fertilization(IVF)on embryo development and clinical outcomes.Methods Retrospectively,1360 female infertility patients who underwent short-term in vitro fertilization at the Reproductive Center of Jiaxing Maternal and Child Health Hospital from January 2020 to December 2022 were selected as the study subjects.Among them,680 patients who did not have their cumulus granulosa cells removed at the time of oocyte retrieval were assigned to the non-removal group,while the other 680 patients who had partial removal cumulus granulosa cells removed were assigned to the removal group.The fertilization,embryo development,and clinical outcomes were compared between the two groups.The binary logistic regression analysis was used to evaluate the effects of partial removal of cumulus granulosa cells on clinical pregnancy and live birth outcomes.Furthermore,based on the number of cumulus-oocyte complex(COC),the subjects were divided into low-density COC group(1-6 eggs),medium density COC group(7-12 eggs),and high-density COC group(13-18 eggs),and the fertilization,embryo development,and clinical outcomes were compared between the two groups at different COC densities.Results There were no significant differences between the two groups in total fertilization rate,two pronucleus(2PN)fertilization rate,polyspermic fertilization rate,1PN fertilization rate,2PN cleavage rate,fine embryo rate and blastocyst formation rate(all P>0.05).After adjusting for confounding factors such as female age,infertility type,infertility years,BMI,and total gonadotropin,binary logistic regression analysis showed that partial removal of cumulus granulosa cells had no effects on clinical pregnancy and live birth outcomes(OR=1.091,95%CI:0.838-1.421,P=0.516;OR=1.000,95%CI:0.765-1.306,P=0.999).When COC increased to medium density,the 1PN fertilization rate in the removal group was lower than that of the non-removal group(P<0.01);when COC increased t

关 键 词：短时受精 卵丘卵母细胞复合物 卵母颗粒细胞 

分 类 号：R714.8[医药卫生—妇产科学]