人合子原核构型及早期卵裂与胚胎发育潜能的关系

The Relationship between Human Zygotes Pronuclear Orientation、 Early Cleavage and Embryonic Developmental Potential

目的:探讨胚胎早期卵裂及原核构型能否指导移植胚胎的选择及与胚胎发育潜力之间的关系。方法:根据早期卵裂时间及原核构型不同进行筛选而移植的129个体外受精(IVF)、卵胞浆内单精子注射(ICSI)周期,共1 032个正常受精卵为资料。根据受精卵原核构型的不同分为四组,结合构型类型及早期卵裂与否进行选择性移植,通过观察优质胚胎率、囊胚形成率、种植率和怀孕率,来评估合子原核构型和早期卵裂与胚胎发育潜力的关系。结果:最常见的原核构型为PN1(29.58%)及PN2(27.67%),接着是PN3(22.38%)和PN4(20.37%),而且这些构型与受精方式及精子穿卵的位点无关;与其它种类的原核构型相比,源于PN1和PN4原核构型的合子发育到优质胚胎及囊胚的比例显著增高(P<0.05);PN1和PN4原核构型的合子发育成的胚胎,其种植率和怀孕率亦显著升高(P<0.05);早期卵裂胚胎与晚卵裂胚胎相比,发育到优质胚及囊胚的胚胎数与种植率、怀孕率均显著增高(P<0.05)。结论:合子原核构型与胚胎早期卵裂时间能够指导移植胚胎的选择,对种植率及怀孕率的提高有一定的临床意义。

Objective：To evaluate the relationship between embryo early cleavage,pronuclei orientation and embryo development potential,and investigate whether it is useful to select the embryo that will be transfered.Methods：In this retrospective study,a total of 1 032 normal zygotes（two pronuclei）from 129 treatment cycles with IVF/ICSI were analyzed.These zygotes were divided into four groups according to the different zygote pronuclei orientation and the developmental potential.Early cleavage rate,embryo quality,the rate of blastocyst,implantation and pregnant rates from these zygotes were observed,and the transferred embryos were selected according to the pronuclei orientation and early cleavage time.Results：The most common types of pronuclei were PN1（29.58%）and PN2（27.67%）,followed by PN3（22.38%）and PN4（20.37%）,and this was independent from the fertilizing spermatozoon or its entry point into the oocytes;A significantly higher proportion of zygotes with PN1 and PN4 types of pronuclei orientation underwent early cleavage and developed into grade Ⅰ embryos and blastocysts compared with other types（P〈0.05）;the implantation and pregnancy rates among patients who received embryos developed from PN1 and PN4-types oocytes were higher significantly（P〈0.05）.Compared was that of later cleavaged embryo,the number of development into grade Ⅰ,the blastocyst rates,implantation and pregnant rates of early cleavaged embryo were higher significantly（P〈0.05）.Conclusion：The zygote pronuclei orientation and the time of embryo early cleavage are useful for the selection of embryo to transfer,it may provide a better guide to the improvement of implantation and pregnancy rates.