ICSI退化对同胞卵母细胞正常受精后发育潜能及临床结局的影响  

Effect of oocyte degeneration after ICSI on the developmental potential and clinical outcomes of sibling oocytes

作　　者：郑爱燕[1] 孟庆霞[1] 蒲艳[1] 廖桂芝 李培培 丁洁[1] Zheng Aiyan;Meng Qingxia;Pu Yan;Liao Guizhi;Li Peipei;Ding Jie(Reproductive and Genetic Center,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Gusu School,Nanjing Medical University,Suzhou215002,China)

机构地区：[1]南京医科大学附属苏州医院、苏州市立医院生殖与遗传中心、南京医科大学姑苏学院,苏州215002

出　　处：《中华生殖与避孕杂志》2025年第1期67-76,共10页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划(2022YFC2702901);姑苏卫生人才科研资助项目(GSWS2023012);南京医科大学-西脉临床研究基金(2022NMUS0204)。

摘　　要：目的探讨卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)后发生的卵母细胞退化现象对患者同胞卵母细胞正常受精后的胚胎发育潜能及临床治疗结局的影响。方法采用回顾性队列研究,分析2019年1月至2023年6月期间在苏州市立医院生殖与遗传中心行ICSI,且使用时差培养箱培养的患者的临床资料,共收集到242个周期3119枚卵母细胞,信息收集截至2024年2月5日最后1例纳入统计的患者分娩。按ICSI后是否发生卵母细胞退化分为退化组(140个周期)和对照组(102个周期),比较两组胚胎的生长发育情况及移植后的临床结局,并进一步分析两组胚胎形态动力学参数之间的差异。结果两组的女方年龄、不孕年限、体质量指数、基础卵泡刺激素、基础黄体生成素、基础雌二醇、窦卵泡计数、抗苗勒管激素、不孕因素及精液来源组间差异均无统计学意义(均P>0.05)。退化组人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日雌二醇水平[2513.00(1842.20,3638.50)ng/L]、获卵数[(13.56±4.80)枚]和成熟卵率[84.35%(1601/1898)]显著高于对照组[2270.50(1472.00,3044.20)ng/L,P=0.019;(11.97±4.71)枚,P=0.011;81.08%(990/1221),P=0.017],但其正常受精率[69.33%(1103/1591)]、第3天(day 3,D3)优质胚胎率[57.85%(634/1096)]、囊胚形成率[50.87%(469/922)]以及胚胎利用率[58.30%(643/1103)]均显著低于对照组[85.56%(847/990),P<0.001;65.72%(556/846),P<0.001;61.26%(446/728),P<0.001;66.12%(560/847),P<0.001]。进一步分析显示,退化组的D3低细胞数(<7)胚胎比例[33.76%(370/1096)]和D3高碎片率(碎片率≥50%、碎片率20%~50%)胚胎比例[10.01%(109/1089)、18.64%(203/1089)]显著高于对照组[27.19%(230/846),P=0.002;6.06%(51/841),P=0.002;14.15%(119/841),P=0.009],异常分裂DC1和CC的发生率[5.98%(66/1103)、2.45%(27/1103)]亦显著高于对照组[2.48%(21/847),P<0.001;0.94%(8/847),P=0.013]。而对于可利用胚胎而言,退化组的tPNf[22.82(21.13,24.84)h]�Objective To compare the embryo development potential and clinical outcomes between the patients with and without oocyte degeneration.MethodsThis retrospective cohort study included a total of 242 cycles underwent ICSI that cultured in time-lapse incubator from January 2019 to June 2023 at the Reproductive and Genetic Center of Suzhou Municipal Hospital and all 3119 oocytes were evaluated.Data collection continued to February 5th,2024 until the last birthing of the study.Patients were divided into degenerated group(140 cycles)and control group(102 cycles)according to whether oocyte degenerated after ICSI.Then the embryo developmental potential and clinical outcomes were compared.Furthermore,we also investigated whether embryo morphokinetics could be different between the two groups.ResultsFemale age,duration of infertility,body mass index,basal follicle sitmulating hormone,basal luteinizing hormone,basal estrogen(E 2),antral follicle count,anti-Müllerian hormone,factors of infertility and source of semen were similar between the two groups(P>0.05).E 2 on human chorionic gonadotropin triggered day[2513.00(1842.20,3638.50)ng/L],number of oocytes retrieved(13.56±4.80)and oocyte maturation rate[84.35%(1601/1898)]were significantly higher in degenerated group than those in control group[2270.50(1472.00,3044.20)ng/L,P=0.019;11.97±4.71,P=0.011;81.08%(990/1221),P=0.017],while normal fertilization rate[69.33%(1103/1591)],day 3(D3)good-quality embryos[57.85%(634/1096)],blastocyst formation rate[50.87%(469/922)]and embryo utilized rate[58.30%(643/1103)]were significantly lower in degenerated group than those in control group[85.56%(847/990),P<0.001;65.72%(556/846),P<0.001;61.26%(446/728),P<0.001;66.12%(560/847),P<0.001].In addition,the proportion of low cell number(<7)of D3 embryos[33.76%(370/1096)]and high fragmentation(fragmentation≥50%,fragmentation 20%-50%)of D3 embryos[10.01%(109/1089),18.64%(203/1089)]in degenerated group were significantly higher than those in control group[27.19%(230/846),P=0.002;6.06%(51/841),

关 键 词：卵母细胞 细胞膜 胚胎发育 延时成像 精子注射 细胞质内 

分 类 号：R714.8[医药卫生—妇产科学]