卵母细胞授精前剥除部分卵丘细胞对体外受精-胚胎移植结局的影响

Effect of removal of cumulus cell prior to sperm-oocyte co-incubation on clinical outcome of in vitro fertilization

目的研究授精前剥除部分卵丘细胞的卵母细胞的受精、胚胎发育和临床结局。方法授精前用机械法剥除卵母细胞外包裹的部分卵丘细胞,每个卵母细胞采用微滴法单独受精(A组)。对照组(B组)采用常规体外受精-胚胎移植(IVF-ET)受精方式进行。比较两组受精率(2PN、1PN和3PN)、卵裂率(2PN、1PN和3PN)、优胚率、临床妊娠率、种植率和流产率。结果 A组和B组的受精率分别是76.51%和73.74%(2PN受精率分别是60.64%,61.62%;1PN受精率分别是1.61%,0.86%;3PN受精率分别是10.44%,9.69%)、卵裂率分别是98.95%和99.17%(2PN卵裂率分别是97.02,98.01%;1PN卵裂率分别是100%,85.71%;3PN卵裂率分别是100%,100%)、优质胚胎率分别是60.75%,62.68%、临床妊娠率分别是63.89%,61.76%、种植率分别是48.00%,38.78%、流产率分别是9.09%,11.90%。所有指标均无统计学意义。结论卵母细胞授精前剥除部分卵丘细胞不会影响IVF-ET的临床结局,为利用卵丘细胞进行非侵入性种植前遗传学诊断提供临床依据。

Objective： To identify the effect of removal of cumulus cells prior to sperm-oocyte co-incubation on fertilization,cleavage and clinical outcome of in vitro fertilization（IVF）. Methods： The oocytes denuded by mechanical method were inseminated with 20,000 sperms per oocyte in 20 μ1 drops of IVF-30 covered by oil in group A. Two to five oocytes were fertilized with 100,000 sperms in 100 μ1 drops of IVF-30 covered by oil in group B. The fertilization rate including 2PN,1PN and 3PN, embryo cleavage rate including 2PN, 1PN and 3PN, high-quality embryo rate, clinical pregnancy rate, embryo implantation rate and abortion rate were compared between the two groups. Results： The fertilization rate was 76.51% vs. 73.74%（2PN fertilization rate is 60.64% vs. 61.62%, 1PN fertilization rate 1.61% vs. 0.86% ,3PN fertilization rate 10.44% vs. 9.69%） ,embryo cleavage rate 98.95% vs. 99.17% （2PN embryo cleavage rate 97.02% vs. 98.01% ,1PN embryo cleavage rate 100% vs. 85.71%,3PN embryo cleavage rate 100% vs. 100%）, high-quality embryo rate 60.75% vs. 62.68%,clinical pregnancy rate 63.89 % vs. 61.76 %, embryo implantation rate 48.00 % vs. 38.78 %, and abortion rate 9.09% vs. 11.90% in group A and group B respectively. The parameters were no statistically differences between the two groups. Conclusions. Removal of cumulus cellsprior to IVF has no adversely effect on the IVF-ET clinical outcome. The results provide the clinical basis for using cumulus cells to do non-invasive preimplantation genetic diagnosis.