辅助生殖技术中短时受精失败结合早期补救ICSI与常规ICSI的临床结局分析
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摘要
目的探讨短时受精失败结合早期补救卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)的临床应用价值。方法回顾性分析2012-01～2016-10在山西医科大学第一医院生殖中心首次接受体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)或ICSI助孕的540对夫妇病历资料,按照是否实施早期补救性ICSI进行分组,分为2组,研究组76个周期,为短时受精失败结合早期补救ICSI周期,对照组464个周期,为常规ICSI周期。比较两组受精率、卵裂率、优质胚胎率、冷冻胚胎率、胚胎种植率、临床妊娠率、流产率、新生儿出生情况等指标。结果研究组受精率、多精受精率和优质胚胎率均明显高于对照组(85. 28%vs 71. 23%,6. 57%vs 1. 58%,38. 74%vs 30. 74%),差异有统计学意义(P <0. 05)。两组间卵裂率、可利用胚胎率、冷冻胚胎率、周期取消率和胚胎种植率等差异均无统计学意义(P> 0. 05)。两组间生化和临床妊娠率、异位妊娠率、早期和晚期流产率、早产率、活产率、双胎出生率、低体重儿出生率、新生儿胎龄等差异均无统计学意义(P>0. 05)。结论短时受精失败结合早期补救ICSI可以获得较高的受精率和优质胚胎率,可预防受精失败的发生,改善临床妊娠结局。
Objective To explore the clinical value of short-term fertilization failure combined with early rescue intracytoplasmic sperm injection( ICSI). Methods The medical records of 540 couples who received IVF or ICSI assisted pregnancy for the first time in the Reproductive Center of the First Hospital of Shanxi Medical University from January 2012 to October 2016 were retrospectively analyzed,and 540 couples were divided into two groups according to the implementation of early rescue ICSI. The 76 cycles in study group were short-term fertilization failure combined with early rescue ICSI cycles,and the 464 cycles in control group were routine ICSI cycles. The fertilization rate,cleavage rate,high quality embryo rate,rate of frozen embryos,embryo implantation rate,clinical pregnancy rate,miscarriage rate and birth status of the newborn were compared between the two groups. Results The fertilization rate,polyspermy rate and high quality embryo rate were higher in study group than in control group( 85. 28% vs 71. 23%,6. 57% vs1. 58%,38. 74% vs 30. 74%,P < 0. 05). There was no significant difference in the cleavage rate,available embryo rate,rate of frozen embryos,cycle cancellation rate and embryo implantation rate between the two groups( P > 0. 05). There was no significant difference in the biochemical pregnancy rate,clinical pregnancy rate,rate of ectopic pregnancy,early miscarriage rate,late miscarriage rate,preterm birth rate,live birth rate,twin birth rate,low birth weight baby rate,and neonatal gestational age between the two groups( P >0. 05). Conclusion Short-term fertilization failure combined with early rescue ICSI can achieve a high rate of fertilization and embryo quality,prevent the occurrence of fertilization failure,and ameliorate the clinical pregnancy outcome.
Objective To explore the clinical value of short-term fertilization failure combined with early rescue intracytoplasmic sperm injection( ICSI). Methods The medical records of 540 couples who received IVF or ICSI assisted pregnancy for the first time in the Reproductive Center of the First Hospital of Shanxi Medical University from January 2012 to October 2016 were retrospectively analyzed,and 540 couples were divided into two groups according to the implementation of early rescue ICSI. The 76 cycles in study group were short-term fertilization failure combined with early rescue ICSI cycles,and the 464 cycles in control group were routine ICSI cycles. The fertilization rate,cleavage rate,high quality embryo rate,rate of frozen embryos,embryo implantation rate,clinical pregnancy rate,miscarriage rate and birth status of the newborn were compared between the two groups. Results The fertilization rate,polyspermy rate and high quality embryo rate were higher in study group than in control group( 85. 28% vs 71. 23%,6. 57% vs1. 58%,38. 74% vs 30. 74%,P < 0. 05). There was no significant difference in the cleavage rate,available embryo rate,rate of frozen embryos,cycle cancellation rate and embryo implantation rate between the two groups( P > 0. 05). There was no significant difference in the biochemical pregnancy rate,clinical pregnancy rate,rate of ectopic pregnancy,early miscarriage rate,late miscarriage rate,preterm birth rate,live birth rate,twin birth rate,low birth weight baby rate,and neonatal gestational age between the two groups( P >0. 05). Conclusion Short-term fertilization failure combined with early rescue ICSI can achieve a high rate of fertilization and embryo quality,prevent the occurrence of fertilization failure,and ameliorate the clinical pregnancy outcome.
引文
[1]黄国宁,孙海翔.体外受精-胚胎移植实验室技术[M].北京:人民卫生出版社,2012:95-115,163-178.
[2]方伟芬,牛向丽,孙燕萍,等.短时受精后补救ICSI的临床应用研究[J].中国计划生育学杂志,2010,18(11):681-682.
[3] Kattera S,Chen C. Normal birth after microsurgical enucleation of tripronuclear human zygotes:case report[J]. Hum Reprod,2003,18(6):1319-1322.
[4] Liu DY,Garrett C,Baker HW. Acrosome-reacted human sperm in insemination medium do not bind to the zona pellucida of human oocytes[J]. Int J Androl,2006,29(4):475-481.
[5] Liu DY,Baker HWG. Humam sperm bound to the zona pellucid have Normal nuclear chromatin assessed by acridine orange flurescence[J]. Hum Reprod,2007,22:1597-1602.
[6]戴菁,黄增辉,张硕屏,等.体外受精-胚胎移植中完全受精失败的原因分析[J].现代生物医学进展,2017,17(27):5389-5391.
[7]罗海宁,朱桂金,胡娟,等.体外受精失败MII期人卵母细胞的免疫荧光研究[J].生殖医学杂志,2005,14(2):75-77.
[8]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.
[9]王凤英,俞炽阳,何畏,等.常规IVF中受精失败相关因素及后续处理结果分析[J].生殖与避孕,2009,29(10):648-653.
[10]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,2016,48(7):108-109.
[11] Mishra V,Chirumamilla L. Unexpected repeat immature oocyte response after IVF stimulation:a case report[J]. Gynecol Endocrinol,2018,34(2):100-102.
[12]李蓉,庄广伦.体外培养24小时受精失败卵母细胞单精子显微注射再授精的观察[J].中华妇产科杂志,2000,35(7):404-405.
[13]黄亚.常规体外受精失败后行补救卵胞浆内单精子注射在冻融胚胎移植中的应用价值[J].中国妇幼保健,2017,32(8):1731-1733.
[14] Chen C,Kattera S. Rescue ICSI of oocytes that failed to extrude the second polar body 6 h post-insemination in conventional IVF[J]. Hum Reprod,2003,18(10):2118-2121.
[15]孙凯,王建业,唐宁.早期或晚期补救ICSI对IVF-ET早期胚胎发育和临床妊娠结局的影响[J].中国优生与遗传杂志,2017,25(9):103-106.
[16]彭鹏,樊桂玲,李宜学,等.短时受精失败后行早补救ICSI的临床应用研究[J].中国妇幼保健,2012,27(35):5751-5753.
[17]于洪君,孙晓玲,李彩虹,等.短时受精失败后补行ICSI的临床结局[J].中国当代医药,2016,23(11):88-91.
[18]李晓红,王嵩,张晓,等.短时受精与卵胞浆内单精子注射的临床应用研究[J].中华泌尿外科杂志,2004,25(7):485-487.
[19]赵杰,刘芳,陈秀娟,等.既往不孕类型及早期补救ICSI对IVF临床结局的影响[J].中国妇产科临床杂志,2017,18(1):43-45.
[20]金华,丁家怡,邵骏.常规IVF受精失败周期中行早补救性卵胞浆内单精子注射的临床结局分析[J].齐齐哈尔医学院学报,2015,36(31):4726-4727.
[21]刘辉,吴克良,赵海滨,等.卵母细胞成熟率与ICSI临床结局的关系分析[J].生殖医学杂志,2016,25(2):129-134.
[22]宋明哲,熊风,孙青,等.分析卵母细胞MII率对ICSI受精及胚胎发育的预测价值[J].中国优生与遗传杂志,2017,25(12):102-105+84.
[23]李明昭,施文浩,李伟,等.体外受精-胚胎移植多精受精的发生与妊娠结局的关系[J].生殖医学杂志,2015,24(6):461-464.
[24]杨伟娜,孔风云,孙伟.原发不孕患者行短时受精、half-ICSI与常规长时受精结果的比较[J].中国优生与遗传杂志,2014,22(2):127-129.
[25] Kim NH,Funahashi H,Abeydeera LR,et al. Effects of oviductal fluid on sperm penetration and cortical granule exocytosis during fertilization of pig oocytes in vitro.[J]. J Reprod Fertil,1996,107(1):79-86.
[26]郑娟,周黎明,史海跃,等.早期补救性卵胞浆内单精子注射的临床应用研究[J].生殖医学杂志,2013,22(9):673-676.
[27]吴丽敏,金仁桃,刘雨生,等.常规体外受精失败周期早补救卵胞浆内单精子注射与部分-卵胞浆内单精子注射受精方式的回顾性分析[J].生殖医学杂志,2011,20(5):377-381.
[28] Matt DW,Ingram AR,Graff DP,et al. Normal birth after singleembryo transfer in a patient with excessive polypronuclear zygote formation following in vitro fertilization and intracytoplasmic sperm injection[J]. Fertil Steril,2004,82(6):1662-1665.
[29]刘景,王兴玲,孙丽君,等.短时受精联合早期补救ICSI与非补救ICSI治疗结局比较[J].中国男科学杂志,2013,9(11):35-38.
[30]李小平,郝朝亮.不同时间行补救l CSI的结局分析[J].医学信息,2015,56(12):43-44.
[31]苏丹,毕星宇,武学清.不同纺锤体观察情况的卵母细胞的ICSI结局[J].生殖医学杂志,2015,24(4):322-324.
[32]张曦倩,董云巧,周娜,等.短时受精联合早期补救性ICSI与重复周期直接ICSI的临床数据分析[J].南方医科大学学报,2015,35(8):1219-1220.
[33]罗平,罗江霞,杨冠群.早期补救卵胞浆内单精子注射在常规体外受精中的临床应用价值探讨[J].中国优生与遗传杂志,2017,49(6):118-120.
[34]李蕾,李尚为,靳松,等.应用颗粒细胞部分剥除法提高行体外受精-胚胎移植后胚胎质量及临床妊娠率的研究[J].中华妇产科杂志,2006,41(3):201-202.
[35]赵杰,陈秀娟.颗粒细胞与卵母细胞关系研究进展[J].国际生殖健康/计划生育杂志,2015,34(5):406-409.
[36]谭秀文,谭景和.胚胎体外共培养:影响因素及作用机理[J].生物工程学报,2003,19(4):502-505.
[37] Asgharzadeh S,Mirshokraei P,Hassanpour H,et al. The effect of mesenchymal stem cells as co-culture in in vitro nuclear maturation of ovine[J]. Anim Sci Pap Rep,2015,33(3):223-232.
[38] Bonduelle M,Van AE,Joris H,et al. Prenatal testing in ICSI pregnancies:incidence of chromosomal anomalies in 1586 karyotypes and relation to sperm parameters[J]. Hum Reprod,2002,17(10):2600-2614.
[39]谭艳,龙文香,李娟娟,等.早期补救性ICSI新生儿近期安全性的Meta分析[J].生殖医学杂志,2017,26(10):983-988.
[2]方伟芬,牛向丽,孙燕萍,等.短时受精后补救ICSI的临床应用研究[J].中国计划生育学杂志,2010,18(11):681-682.
[3] Kattera S,Chen C. Normal birth after microsurgical enucleation of tripronuclear human zygotes:case report[J]. Hum Reprod,2003,18(6):1319-1322.
[4] Liu DY,Garrett C,Baker HW. Acrosome-reacted human sperm in insemination medium do not bind to the zona pellucida of human oocytes[J]. Int J Androl,2006,29(4):475-481.
[5] Liu DY,Baker HWG. Humam sperm bound to the zona pellucid have Normal nuclear chromatin assessed by acridine orange flurescence[J]. Hum Reprod,2007,22:1597-1602.
[6]戴菁,黄增辉,张硕屏,等.体外受精-胚胎移植中完全受精失败的原因分析[J].现代生物医学进展,2017,17(27):5389-5391.
[7]罗海宁,朱桂金,胡娟,等.体外受精失败MII期人卵母细胞的免疫荧光研究[J].生殖医学杂志,2005,14(2):75-77.
[8]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.
[9]王凤英,俞炽阳,何畏,等.常规IVF中受精失败相关因素及后续处理结果分析[J].生殖与避孕,2009,29(10):648-653.
[10]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,2016,48(7):108-109.
[11] Mishra V,Chirumamilla L. Unexpected repeat immature oocyte response after IVF stimulation:a case report[J]. Gynecol Endocrinol,2018,34(2):100-102.
[12]李蓉,庄广伦.体外培养24小时受精失败卵母细胞单精子显微注射再授精的观察[J].中华妇产科杂志,2000,35(7):404-405.
[13]黄亚.常规体外受精失败后行补救卵胞浆内单精子注射在冻融胚胎移植中的应用价值[J].中国妇幼保健,2017,32(8):1731-1733.
[14] Chen C,Kattera S. Rescue ICSI of oocytes that failed to extrude the second polar body 6 h post-insemination in conventional IVF[J]. Hum Reprod,2003,18(10):2118-2121.
[15]孙凯,王建业,唐宁.早期或晚期补救ICSI对IVF-ET早期胚胎发育和临床妊娠结局的影响[J].中国优生与遗传杂志,2017,25(9):103-106.
[16]彭鹏,樊桂玲,李宜学,等.短时受精失败后行早补救ICSI的临床应用研究[J].中国妇幼保健,2012,27(35):5751-5753.
[17]于洪君,孙晓玲,李彩虹,等.短时受精失败后补行ICSI的临床结局[J].中国当代医药,2016,23(11):88-91.
[18]李晓红,王嵩,张晓,等.短时受精与卵胞浆内单精子注射的临床应用研究[J].中华泌尿外科杂志,2004,25(7):485-487.
[19]赵杰,刘芳,陈秀娟,等.既往不孕类型及早期补救ICSI对IVF临床结局的影响[J].中国妇产科临床杂志,2017,18(1):43-45.
[20]金华,丁家怡,邵骏.常规IVF受精失败周期中行早补救性卵胞浆内单精子注射的临床结局分析[J].齐齐哈尔医学院学报,2015,36(31):4726-4727.
[21]刘辉,吴克良,赵海滨,等.卵母细胞成熟率与ICSI临床结局的关系分析[J].生殖医学杂志,2016,25(2):129-134.
[22]宋明哲,熊风,孙青,等.分析卵母细胞MII率对ICSI受精及胚胎发育的预测价值[J].中国优生与遗传杂志,2017,25(12):102-105+84.
[23]李明昭,施文浩,李伟,等.体外受精-胚胎移植多精受精的发生与妊娠结局的关系[J].生殖医学杂志,2015,24(6):461-464.
[24]杨伟娜,孔风云,孙伟.原发不孕患者行短时受精、half-ICSI与常规长时受精结果的比较[J].中国优生与遗传杂志,2014,22(2):127-129.
[25] Kim NH,Funahashi H,Abeydeera LR,et al. Effects of oviductal fluid on sperm penetration and cortical granule exocytosis during fertilization of pig oocytes in vitro.[J]. J Reprod Fertil,1996,107(1):79-86.
[26]郑娟,周黎明,史海跃,等.早期补救性卵胞浆内单精子注射的临床应用研究[J].生殖医学杂志,2013,22(9):673-676.
[27]吴丽敏,金仁桃,刘雨生,等.常规体外受精失败周期早补救卵胞浆内单精子注射与部分-卵胞浆内单精子注射受精方式的回顾性分析[J].生殖医学杂志,2011,20(5):377-381.
[28] Matt DW,Ingram AR,Graff DP,et al. Normal birth after singleembryo transfer in a patient with excessive polypronuclear zygote formation following in vitro fertilization and intracytoplasmic sperm injection[J]. Fertil Steril,2004,82(6):1662-1665.
[29]刘景,王兴玲,孙丽君,等.短时受精联合早期补救ICSI与非补救ICSI治疗结局比较[J].中国男科学杂志,2013,9(11):35-38.
[30]李小平,郝朝亮.不同时间行补救l CSI的结局分析[J].医学信息,2015,56(12):43-44.
[31]苏丹,毕星宇,武学清.不同纺锤体观察情况的卵母细胞的ICSI结局[J].生殖医学杂志,2015,24(4):322-324.
[32]张曦倩,董云巧,周娜,等.短时受精联合早期补救性ICSI与重复周期直接ICSI的临床数据分析[J].南方医科大学学报,2015,35(8):1219-1220.
[33]罗平,罗江霞,杨冠群.早期补救卵胞浆内单精子注射在常规体外受精中的临床应用价值探讨[J].中国优生与遗传杂志,2017,49(6):118-120.
[34]李蕾,李尚为,靳松,等.应用颗粒细胞部分剥除法提高行体外受精-胚胎移植后胚胎质量及临床妊娠率的研究[J].中华妇产科杂志,2006,41(3):201-202.
[35]赵杰,陈秀娟.颗粒细胞与卵母细胞关系研究进展[J].国际生殖健康/计划生育杂志,2015,34(5):406-409.
[36]谭秀文,谭景和.胚胎体外共培养:影响因素及作用机理[J].生物工程学报,2003,19(4):502-505.
[37] Asgharzadeh S,Mirshokraei P,Hassanpour H,et al. The effect of mesenchymal stem cells as co-culture in in vitro nuclear maturation of ovine[J]. Anim Sci Pap Rep,2015,33(3):223-232.
[38] Bonduelle M,Van AE,Joris H,et al. Prenatal testing in ICSI pregnancies:incidence of chromosomal anomalies in 1586 karyotypes and relation to sperm parameters[J]. Hum Reprod,2002,17(10):2600-2614.
[39]谭艳,龙文香,李娟娟,等.早期补救性ICSI新生儿近期安全性的Meta分析[J].生殖医学杂志,2017,26(10):983-988.