卵母细胞滑面内质网聚集对早期胚胎及妊娠结局的影响

Effect of smooth endoplasmic reticulum aggregation in human oocytes on the early embryo development and pregnancy outcomes

目的:研究卵胞浆内精子注射(ICSI)周期卵母细胞滑面内质网(sER)聚集对早期胚胎体外发育及妊娠结局的影响并分析其原因。方法:99例患者ICSI治疗107个周期,于HCG日测定血清激素E2、P、LH浓度以及子宫内膜厚度。根据所获MⅡ期卵母细胞是否出现sER聚集分为A、B两组,A组为所获MⅡ期卵母细胞均未出现sER聚集周期共90例;B组为有至少一枚MⅡ期卵母细胞出现sER聚集周期,共17例。比较A、B两组HCG日E2、P、LH水平、子宫内膜厚度,及治疗周期数、年龄、病程、Gn总量、Gn天数、获卵数、受精率、可用胚胎率、优质胚胎率、移植胚胎数、周期临床妊娠率、种植率、流产率和原发、继发不孕患者比例的差异。并且对比B组sER聚集阳性[sER(+)]与sER聚集阴性[sER(-)]卵母细胞的受精率、可用胚胎率和优质胚胎率。结果:B组HCG日E2水平明显高于A组(P<0.05,3141.18±604.47 vs 2635.12±825.46),而两组间P和LH水平以及子宫内膜厚度均无显著差异(P>0.05)。B组优质胚胎率显著低于A组(P<0.05,47.83%vs 57.67%),而B组Gn天数(P<0.01,13.35±1.66 vs 11.83±2.4)和流产率(P<0.05,100%vs 17.86%)均明显高于A组,两组在年龄、治疗周期数、病程、Gn总量、获卵数、受精率、可用胚胎率、移植胚胎数、临床妊娠率、种植率以及原发、继发不孕患者比例等各方面均无显著差异(P>0.05)。B组sER(+)卵母细胞的优质胚胎率显著低于sER-卵母细胞(P<0.01,20.69%vs 52.9%),而受精率和可用胚胎率无显著性差异(P>0.05)。结论:ICSI周期卵母细胞sER聚集对早期胚胎体外发育及妊娠结局均有不良影响,sER聚集可能与HCG日高E2水平及长时间Gn刺激有关。

Objective：To investigate the effect of smooth endoplasmic reticulum（sER） aggregation in human oocytes on the early embryo development and pregnancy outcomes during ICSI cycles and discuss the reason for it.Methods：One hundred and seven ICSI cycles were divided into two groups：90 cycles in which no sER aggregation occurred in any MⅡ oocyte as group A,while 17 cycles in which at least one MⅡ oocyte was found with sER aggregation in each cycle as group B.The concentrations of estradiol,progesterone and luteinizing hormone as well as thickness of endometrium were measured on HCG day.Comparisons were made on the concentrations of hormones,thickness of endometrium,the number of treatment cycles,patient age,disease course,dose of Gn,duration of stimulation,the number of oocytes retrieved,fertilization rates,usable embryo formation rates,good quality embryo formation rates,the number of embryo transfered,clinical pregnancy rates per cycle,implantation rates,miscarriage rates and primary or secondly infertility.The fertilization rates,usable embryo formation rates and good quality embryo formation rates between sER aggregation-positive[sER（＋）]and sER aggregation-negative[sER（-）] oocytes were also compared within group B.Results：The concentration of estradiol in group B was significantly higher than that in group A（P〈0.05,3141.18±604.47 vs 2635.12±825.46）,while no significant differences were found on endometrium thickness as well as the concentrations of progesterone and luteinizing hormone（P〉0.05）.Additionally,there were a significantly lower good quality embryo formation rate（P〈0.05,47.83% vs 57.67%）,a significantly longer duration of stimulation（P〈0.01,13.35±1.66 vs 11.83±2.4） and higher miscarriage rate（P〈0.05,100% vs 17.86%） in group B than those in group A while no significant difference on the number of treatment cycles,age,disease course,dose of Gn,the number of oocytes retrieved,fertilization rates,usable embryo formation rates,the number of embryo transfered,clinical pregnancy rates per cycle,implantation rates and primary or secondly infertility（P〉0.05） were found.Furthermore,within group B,the good quality embryo formation rate from sER（＋） oocytes was significantly lower than that from sER（-） oocytes（P〈0.01,20.69% vs 52.9%）,however,no significant differences were found on fertilization rates and usable embryo formation rates（P〉0.05）.Conclusion：sER aggregation in human oocytes adversely influents the early embryo development and pregnancy outcomes during ICSI cycles,and the occurrence of sER aggregation may be affected by high estradiol level on HCG day and long stimulating period.