MⅡ期卵子分级对卵母细胞胞浆内单精子注射临床妊娠率的影响

RELATIONSHIP BETWEEN OOCYTE MORPHOLOGY BASED ON FIRST POLAR BODY, PERIVITELLINE SPACE AND CYTOPLASM AND THE OUTCOME AFTER INTRACYTOPLASMIC SPERM INJECTION

①目的 从MⅡ期卵子的第一极体、卵周隙和胞浆形态三方面综合探讨卵子质量对卵母细胞胞浆内单精子注射 (ICSI)后胚胎种植率、临床妊娠率的影响 ,从而将卵子质量作为胚胎移植选择优质胚胎的重要依据。②方法 对ICSI中去除颗粒细胞后的MⅡ期卵子在光镜下从第一极体、卵周隙和胞浆形态三方面按形态综合表现进行分级。分别比较由各级卵子发育来的胚胎种植率和临床妊娠率。③结果 移植全部由Ⅰ级卵子发育来的胚胎组与移植由至少含有 1个Ⅰ级卵子发育的胚胎组比较 ,胚胎种植率和临床妊娠率差异有显著性 (χ2 =4 .2 9、5 .4 0 ,P <0 .0 5 )。移植全部由Ⅰ级卵子发育来的胚胎组与全部由异常形态卵子发育来的胚胎组相比 ,胚胎种植率和临床妊娠率比较差异有极显著性 (χ2 =11.2 2、15 .10 ,P <0 .0 1)。④结论 根据MⅡ期卵子的第一极体、卵周隙及胞浆形态三方面综合因素进行的卵子分级方法可预测ICSI后胚胎种植率以及临床妊娠率。胚胎移植时选择Ⅰ级卵子发育的优质胚胎进行移植 ,可获得较高的胚胎种植率和临床妊娠率。

Objective A comprehensive study was made in terms of first polar body, perivitelline space and cytoplasm to evaluate the influence of intracytoplasmic sperm injection on the implantation rate and pregnancy so as to provide the evidence of selecting quality embryos for implantation. Methods Oocyte morphology at metaphase Ⅱ(MⅡ) was evaluated based on first polar body, perivitelline space and cytoplasm. MⅡ oocytes were graded into five groups. The implantation rate and clinical pregnancy rate were compared between the groups. Results The implantation rate and clinical pregnancy rate of embryos which developed from all gradeⅠoocytes were significantly higher than those from at least one gradeⅠoocyte(χ 2=4.29,5.40;P<0.05). The implantation rate and clinical pregnancy rate of embryos which developed from at least one gradeⅠoocyte were significantly higher than those from all oocytes with abnormal morphology (χ 2=11.22,15.10; P<0.01). Conclusion Human oocytes grading based on first polar body, perivitelline space and cytoplasmic morphology is effective to increase the implantation rate and pregnancy rate.