ICSI操作中增加显微操作皿对妊娠结局的影响
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摘要
目的探讨在ICSI过程中增加显微操作对ICSI助孕妊娠结局的影响。方法选取2016年1月至2017年7月在我中心行ICSI治疗的获卵数>6枚的患者,共363个周期。本研究分为实验组(121个周期)和对照组(242个周期)。实验组:在ICSI操作中应用两个操作皿,注射5枚卵母细胞更换一次操作皿,替换下来的操作皿置37℃培养箱内复温,两个操作皿交替使用。对照组:在ICSI操作中应用一个操作皿,每次注射5枚卵母细胞,操作皿重复使用。比较两组人群的正常受精率、卵裂率、优质胚胎率、囊胚形成率、种植率、临床妊娠率等。结果实验组囊胚形成率显著高于对照组(27.82%vs.21.36%,P<0.05);新鲜周期移植,实验组种植率比对照组高,但差异无显著性(40.00%vs.32.28%,P>0.05);实验组临床妊娠率显著高于对照组(65.38%vs.51.52%,P<0.05)。结论两个ICSI操作皿的交替平衡使用可以增加囊胚形成率,改善妊娠结局。因此获卵数过多时建议配备两个ICSI皿,以期获得更好的妊娠结局。
Objective:To observe the effect of increasing manipulation dishes on pregnancy outcome in ICSI.Methods:A total of 363 cycles of ICSI treatment with more than 6 oocytes retrieved in our center from January 2016 to July 2017 were included.The cycles were divided into 2 groups:the control group(n=242)and the experimental group(n=121).In the experimental group,two manipulation dishes were applied and the manipulation dish was replaced once for every 5 oocytes manipulated.The replaced manipulation dish was re-warmed in an incubator with 37℃,and the two manipulation dishes were used alternately.In the control group,only one manipulation dish was used,five oocytes for each time,and the dish reused.The normal fertilization rate,cleavage rate,high quality embryo rate,blastocyst formation rate,implantation rate and clinical pregnancy rate were compared between the two groups.Results:The rate of blastocyst formation in the experimental group was significantly higher than that in the control group(27.82%vs.21.36%,P<0.05).The implantation rate in the experimental group was higher than that in group A,but there was no statistical significance(40.00%vs.32.28%,P>0.05).The clinical pregnancy rate in the experimental group was significantly higher than that in the control group(65.38% vs.51.52%,P<0.05).Conclusions:The alternately use of the two ICSI manipulation dishes is beneficial to increase the blastocyst formation rate and improve the pregnancy outcome.Therefore,it is recommended to have two ICSI dishes when the number of oocytes is too high for obtaining a better pregnancy outcome.
Objective:To observe the effect of increasing manipulation dishes on pregnancy outcome in ICSI.Methods:A total of 363 cycles of ICSI treatment with more than 6 oocytes retrieved in our center from January 2016 to July 2017 were included.The cycles were divided into 2 groups:the control group(n=242)and the experimental group(n=121).In the experimental group,two manipulation dishes were applied and the manipulation dish was replaced once for every 5 oocytes manipulated.The replaced manipulation dish was re-warmed in an incubator with 37℃,and the two manipulation dishes were used alternately.In the control group,only one manipulation dish was used,five oocytes for each time,and the dish reused.The normal fertilization rate,cleavage rate,high quality embryo rate,blastocyst formation rate,implantation rate and clinical pregnancy rate were compared between the two groups.Results:The rate of blastocyst formation in the experimental group was significantly higher than that in the control group(27.82%vs.21.36%,P<0.05).The implantation rate in the experimental group was higher than that in group A,but there was no statistical significance(40.00%vs.32.28%,P>0.05).The clinical pregnancy rate in the experimental group was significantly higher than that in the control group(65.38% vs.51.52%,P<0.05).Conclusions:The alternately use of the two ICSI manipulation dishes is beneficial to increase the blastocyst formation rate and improve the pregnancy outcome.Therefore,it is recommended to have two ICSI dishes when the number of oocytes is too high for obtaining a better pregnancy outcome.
引文
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[18]Heitmann RJ,Hill MJ,James AN,et al.Live births achieved via IVF are increased by improvements in air quality and laboratory environment[J].Reprod Biomed Online,2015,31:364-371.
[19]Boone WR,Johnson JE,Locke AJ,et al.Control of air quality in an assisted reproductive technology laboratory[J].Fertil Steril,1999,71:150-154.
[20]Esteves SC,Bento FC.Air quality control in the ART laboratory is a major determinant of IVF success[J].Asian J Androl,2016,18:596-599.
[2]Petersen BM,Boel M,Montag M,et al.Development of a generally applicable morphokinetic algorithm capable of predicting the implantation potential of embryos transferred on Day 3[J].Hum Reprod,2016,31:2231-2244.
[3]Chinchilla-Vargas J,Jahnke MM,Dohlman TM,et al.Climatic factors affecting quantity and quality grade of in vivo derived embryos of cattle[J].Anim Reprod Sci,2018,192:53-60.
[4]Gardner DK,Kelley RL.Impact of the IVF laboratory environment on human preimplantation embryo phenotype[J].J Dev Orig Health Dis,2017,8:418-435.
[5]Nastri CO,Nóbrega BN,Teixeira DM,et al.Low versus atmospheric oxygen tension for embryo culture in assisted reproduction:a systematic review and meta-analysis[J].Fertil Steril,2016,106:95-104.e17.
[6]Wang WH,Keefe DL.Spindle observation in living mammalian oocytes with the polarization microscope and its practical use[J].Cloning Stem Cells,2002,4:269-276.
[7]Younis JS,Radin O,Izhaki I,et al.Does first polar body morphologypredictoocyteperformanceduringICSI treatment?[J].J Assist Reprod Genet,2009,26:561-567.
[8]Kahraman S,Yakin K,D9nmez E,et al.Relationship between granular cytoplasm of oocytes and pregnancy outcome following intracytoplasmic sperm injection[J].Hum Reprod,2000,15:2390-2393.
[9]Gardner DK,Lane M,Stevens J,et al.Blastocyst score affects implantation and pregnancy outcome:towards a single blastocyst transfer[J].Fertil Steril,2000,73:1155-1158.
[10]靳镭,任新玲.实验室因素对胚胎发育和后代的影响[J].生殖医学杂志,2017,26:403-408.
[11]Laband K,Le Borgne R,Edwards F,et al.Chromosome segregation occurs by microtubule pushing in oocytes[J].Nat Commun,2017,8:1499.
[12]Bavister BD,Poole KA.Duration and temperature of culture mediumequilibrationaffectfrequencyofblastocyst development[J].Reprod Biomed Online,2005,10:124-129.
[13]Swain JE.Is there an optimal pH for culture media used in clinical IVF?[J].Hum Reprod Update,2012,18:333-339.
[14]Will MA,Clark NA,Swain JE.Biological pH buffers in IVF:help or hindrance to success[J].J Assist Reprod Genet,2011,28:711-724.
[15]朱亮,陈士岭,邢福祺,等.培养环境的温度变化与人MⅡ期卵母细胞纺锤体形态学变化的关系[J].医学争鸣,2005,26:1414-1416.
[16]崔龙波,周雪莹,崔志峰,等.不同因素对小鼠MII期卵母细胞纺锤体的影响[J].安徽农业科学,2008,36:14555-14557.
[17]宋姝君,韩宝生,易建平.体外受精及胚胎发育培养相关因素研究进展[J].中国优生与遗传杂志,2016,24:1-3.
[18]Heitmann RJ,Hill MJ,James AN,et al.Live births achieved via IVF are increased by improvements in air quality and laboratory environment[J].Reprod Biomed Online,2015,31:364-371.
[19]Boone WR,Johnson JE,Locke AJ,et al.Control of air quality in an assisted reproductive technology laboratory[J].Fertil Steril,1999,71:150-154.
[20]Esteves SC,Bento FC.Air quality control in the ART laboratory is a major determinant of IVF success[J].Asian J Androl,2016,18:596-599.