常规体外受精中受精障碍相关因素的回顾性分析
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摘要
目的回顾性分析在常规体外受精中发生受精障碍的病历资料,探讨与完全受精失败和低受精率密切相关的临床和实验室因素。方法选择首次在河北医科大学第二医院生殖医学科行常规体外受精(in vitrofertilization,IVF)的2 046个周期进行回顾性分析,根据IVF的受精情况分为A组(完全受精失败,受精率=0)56周期、B组(低受精率,受精率<30%)91周期、C组(受精率≥30%)1 899周期,对短时受精后行补救单精子注射周期、部分行卵胞浆内单精子注射周期,根据卵子常规受精情况分别归入A组、B组和C组。比较3组女方的年龄、不孕年限、基础卵泡刺激素(follicle stimulating hormorne,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)水平以及原发继发不孕比例、不孕原因构成比;比较3组应用促性腺激素(gonadotropin,Gn)天数、Gn用量以及人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日LH、E2、孕酮(progesterone,P)、每卵血清E2水平和获卵数;比较3组治疗方案、成熟卵子比例、不正常卵子和获得1～4枚卵子比例;比较取卵日处理前后精液参数。结果 A组、B组和C组年龄及基础激素FSH、LH、E2水平差异均无统计学意义(P>0.05);A组、B组不孕年限、原发不孕比例、男性因素、不明原因不孕比例高于C组,差异均有统计学意义(P<0.05);A组、B组输卵管因素比例低于C组,差异均有统计学意义(P<0.05);A组、B组和C组应用Gn天数、Gn用量以及HCG注射日LH、E2、P水平和每卵E2水平差异均无统计学意义(P>0.05);3组获卵数目比较,A组少于B组和C组,差异有统计学意义(P<0.05);A组、B组和C组治疗方案比较,差异无统计学意义(P>0.05);获卵数1～4枚的比例,A组高于C组,同时高于B组,差异均有统计学意义(P<0.05);A组、B组和C组成熟卵和不正常卵子的比例分别为46.4%、60.4%、89.2%和16.1%、8.8%、0.5%,差异均有统计学意义(P<0.05);A组、B组和C组取卵日精子浓度A组、B组低于C组,精子活动率、处理前的前向运动精子比例、前向运动精子中A级精子比例A组低于B组和C组,差异均有统计学意义(P<0.05);3组处理后的前向运动精子比例、前向运动精子中A级精子比例A组、B组低于C组,差异均有统计学意义(P<0.05)。结论 IVF受精时受精障碍的影响因素很多,高风险因素可能有原发不孕、较长的不孕时间、原因不明及男方因素的不孕等;卵子成熟程度差、卵子形态不正常、精子运动参数降低可能与IVF受精障碍有关。
Objective To retrospectively analyze the medical records of fertilization disorders in conventional in vitro fertilization(IVF)and to explore the clinical and laboratory factors that are closely related to complete fertilization failure and low fertilization rate.Methods The clinical and laboratory information of conventional IVF cycles from the Second Hospital of Hebei Medical University was retrospectively analyzed.According to the situation of IVF fertilization they were divided into group A(complete fertilization failure,fertilization rate= 0)56 cycles,group B(low fertilization rate,fertilization rate< 30%)91 cycles,group C(fertilization rate≥30%)1 899 cycles.According to the conventional fertilization rate,the rescue intracytoplasmic sperm injection and half intracytoplasmic sperm injection cycles were divided respectively into group A,B and C.The following contents among the three groups were compared.The female age,duration of infertility,basic follicle stimulating hormorne(FSH),luteinizing hormone(LH),estradiol(E2)levels and proportion of primary and secondary infertility and the proportion of causes of infertility were compared.The days of gonadotropin(Gn),Gn dosage,LH,E2,progesterone(P)levels and per eggs E2 level at human chorionic gonadotropin(HCG)injection day and the number of obtained oocytes were compared.The treatment regimen,the proportion of mature eggs,abnormal eggs and the proportion of 1-4 eggs obtained in the three groups were compared.The semen parameters before and after on the day of oocyte retrievaled were compared.Results There were no significant differences in age,basal hormones FSH,LH and E2 levels between groups A,B and C(P>0.05).The infertility years,the proportion of primary infertility,male factors and the proportion of unexplained infertility in group A and group B were higher than that in group C,and the differences were statistically significant(P<0.05).The proportion of tubal factors in group A and group B was lower than that in group C,and the difference was statistically significant(P<0.05).There were no significant differences in the days of Gn,Gn dosage,LH,E2,P level and E2 level per egg at HCG injection day between groups A,B and C(P>0.05).The number of oocytes obtained in group A was lower than that in group B and C,and the difference was statistically significant(P<0.05).Comparison of treatment protocol among groups A,B and C showed no statistical significance(P>0.05).The proportion of oocytes number 1-4 was higher in group A than in group C and B,and the difference was statistically significant(P<0.05).The proportions of mature oocytes and abnormal oocytes in the three groups were 46.4%,60.4%,89.2% and 16.1%,8.8%,0.5%,with statistically significant differences(P<0.05).The sperm concentration of group A,B and C on the day of egg collection was lower than that of group C.The sperm motility rate,the proportion of forward motile sperm before treatment and the proportion of A-class sperm in forward motile sperm in group A were lower than those in group B and C,the differences were statistically significant(P<0.05).The proportion of forward motile sperm and the proportion of A-class sperm in forward motile sperm in group A and B were lower than those in group C after treatment,and the differences were statistically significant(P<0.05).Conclusion There are many factors affecting fertilization disorder during IVF fertilization.High risk factors may include primary infertility,longer infertility time,unknown causes and male infertility.Immature oocytes and low semen parameters or poor sperm quality may be associated with the fertilization failure.
Objective To retrospectively analyze the medical records of fertilization disorders in conventional in vitro fertilization(IVF)and to explore the clinical and laboratory factors that are closely related to complete fertilization failure and low fertilization rate.Methods The clinical and laboratory information of conventional IVF cycles from the Second Hospital of Hebei Medical University was retrospectively analyzed.According to the situation of IVF fertilization they were divided into group A(complete fertilization failure,fertilization rate= 0)56 cycles,group B(low fertilization rate,fertilization rate< 30%)91 cycles,group C(fertilization rate≥30%)1 899 cycles.According to the conventional fertilization rate,the rescue intracytoplasmic sperm injection and half intracytoplasmic sperm injection cycles were divided respectively into group A,B and C.The following contents among the three groups were compared.The female age,duration of infertility,basic follicle stimulating hormorne(FSH),luteinizing hormone(LH),estradiol(E2)levels and proportion of primary and secondary infertility and the proportion of causes of infertility were compared.The days of gonadotropin(Gn),Gn dosage,LH,E2,progesterone(P)levels and per eggs E2 level at human chorionic gonadotropin(HCG)injection day and the number of obtained oocytes were compared.The treatment regimen,the proportion of mature eggs,abnormal eggs and the proportion of 1-4 eggs obtained in the three groups were compared.The semen parameters before and after on the day of oocyte retrievaled were compared.Results There were no significant differences in age,basal hormones FSH,LH and E2 levels between groups A,B and C(P>0.05).The infertility years,the proportion of primary infertility,male factors and the proportion of unexplained infertility in group A and group B were higher than that in group C,and the differences were statistically significant(P<0.05).The proportion of tubal factors in group A and group B was lower than that in group C,and the difference was statistically significant(P<0.05).There were no significant differences in the days of Gn,Gn dosage,LH,E2,P level and E2 level per egg at HCG injection day between groups A,B and C(P>0.05).The number of oocytes obtained in group A was lower than that in group B and C,and the difference was statistically significant(P<0.05).Comparison of treatment protocol among groups A,B and C showed no statistical significance(P>0.05).The proportion of oocytes number 1-4 was higher in group A than in group C and B,and the difference was statistically significant(P<0.05).The proportions of mature oocytes and abnormal oocytes in the three groups were 46.4%,60.4%,89.2% and 16.1%,8.8%,0.5%,with statistically significant differences(P<0.05).The sperm concentration of group A,B and C on the day of egg collection was lower than that of group C.The sperm motility rate,the proportion of forward motile sperm before treatment and the proportion of A-class sperm in forward motile sperm in group A were lower than those in group B and C,the differences were statistically significant(P<0.05).The proportion of forward motile sperm and the proportion of A-class sperm in forward motile sperm in group A and B were lower than those in group C after treatment,and the differences were statistically significant(P<0.05).Conclusion There are many factors affecting fertilization disorder during IVF fertilization.High risk factors may include primary infertility,longer infertility time,unknown causes and male infertility.Immature oocytes and low semen parameters or poor sperm quality may be associated with the fertilization failure.
引文
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[6]王娜,李澎涛,邢鹏,等.短时受精失败或低受精率周期不同受精来源卵母细胞发育潜能比较[J].河北医科大学学报,2017,38(12):1464-1467.
[7]赵芳,吕玉珍,王娟,等.常规IVF完全/部分受精失败后行早期补救ICSI的应用价值[J].生殖医学杂志,2015,24(2):87-92.
[8]Liu DY,Liu ML,Baker HW.Defective protein kinase A and C pathways are common causes of disordered zona pellucida(ZP)--induced acrosome reaction in normozoospermic infertile men with normal sperm-ZP binding[J].Fertil Steril,2013,99(1):86-91.
[9]宋岳强,沙艳伟,丁露,等.影响常规IVF体外受精的相关因素探讨[J].中国妇幼保健杂志,2014,29(22):3619-3622.
[10]van Beirs N,Shaw-Jackson C,Rozenberg S,et al.Policy of IVF centres towards oocytes affected by smooth endoplasmic reticulum aggregates:a multicentre survey study[J].J Assist Reprod Genet,2015,32(6):945-950.
[11]郝大勇,杨晓娜,刘景,等.人卵母细胞胞浆形态与卵胞浆内单精子显微注射受精率与胚胎质量的关系[J].中国优生与遗传杂志,2016,24(7):108-109.
[12]李征,陈美佳,钟惠芝,等.不同精液参数对体外受精结局的影响及预测价值[J].广西医学,2017,39(6):885-887.
[13]邓唐,李尚为.部分卵母细胞胞浆内单精子注射周期中影响其常规体外受精受精率的相关因素分析[J/CD].中华妇幼临床医学杂志:电子版,2016,12(5):530-534.
[14]廖宏庆,聂玉林,赵魁,等.精子形态对体外受精结局的影响[J].中国男科学杂志,2015,29(8):44-47.
[15]马兰,刘洋,镡颖,等.精子因素对体外受精-胚胎移植术中受精率的影响[J].实用医学杂志,2016,32(8):1271-1274.
[2]Yu M,Zhao H,Chen T,et al.Mutational analysis of IZUMO1Rin women with fertilization failure and polyspermy after in vitro fertilization[J].J Assist Reprod Genet,2018,35(3):539-544.
[3]宋成,曾勇,万才云,等.正常形态精子百分率对IVF临床结局的影响[J].中国优生与遗传杂志,2013,21(7):119-121,123.
[4]Zuckerman S,Zeevi DA,Gooldin S,et al.Acceptable applications of preimplantation genetic diagnosis(PGD)among Israeli PGD users[J].Eur J Hum Genet,2017,25(10):1113-1117.
[5]Braga DP,Setti AS,Figueira Rde C,et al.Contributing factors for the incidence of aneuploidy in older patients undergoing intracytoplasmic sperm injection cycles[J].JAssist Reprod Genet,2012,29(9):911-916.
[6]王娜,李澎涛,邢鹏,等.短时受精失败或低受精率周期不同受精来源卵母细胞发育潜能比较[J].河北医科大学学报,2017,38(12):1464-1467.
[7]赵芳,吕玉珍,王娟,等.常规IVF完全/部分受精失败后行早期补救ICSI的应用价值[J].生殖医学杂志,2015,24(2):87-92.
[8]Liu DY,Liu ML,Baker HW.Defective protein kinase A and C pathways are common causes of disordered zona pellucida(ZP)--induced acrosome reaction in normozoospermic infertile men with normal sperm-ZP binding[J].Fertil Steril,2013,99(1):86-91.
[9]宋岳强,沙艳伟,丁露,等.影响常规IVF体外受精的相关因素探讨[J].中国妇幼保健杂志,2014,29(22):3619-3622.
[10]van Beirs N,Shaw-Jackson C,Rozenberg S,et al.Policy of IVF centres towards oocytes affected by smooth endoplasmic reticulum aggregates:a multicentre survey study[J].J Assist Reprod Genet,2015,32(6):945-950.
[11]郝大勇,杨晓娜,刘景,等.人卵母细胞胞浆形态与卵胞浆内单精子显微注射受精率与胚胎质量的关系[J].中国优生与遗传杂志,2016,24(7):108-109.
[12]李征,陈美佳,钟惠芝,等.不同精液参数对体外受精结局的影响及预测价值[J].广西医学,2017,39(6):885-887.
[13]邓唐,李尚为.部分卵母细胞胞浆内单精子注射周期中影响其常规体外受精受精率的相关因素分析[J/CD].中华妇幼临床医学杂志:电子版,2016,12(5):530-534.
[14]廖宏庆,聂玉林,赵魁,等.精子形态对体外受精结局的影响[J].中国男科学杂志,2015,29(8):44-47.
[15]马兰,刘洋,镡颖,等.精子因素对体外受精-胚胎移植术中受精率的影响[J].实用医学杂志,2016,32(8):1271-1274.