补救ICSI联合人工辅助激活对IVF失败卵母细胞发育影响的研究

Effects of rescue intracytoplasmic sperm injection with an assisted activation on the development of fertilization-failure oocytes in IVF

目的探讨常规体外受精(IVF)完全失败的卵母细胞应用补救性单精子卵胞浆内注射(ICSI)联合人工辅助激活方法的临床价值。方法对常规体外受精完全失败的17枚人卵母细胞进行补救性ICSI并采用7%无水乙醇人工辅助激活处理,于ICSI后的24h观察卵母细胞的受精情况,于48h及第5天观察胚胎的分裂及后期发育,并在实施移植后了解患者的临床妊娠结局。结果 17枚IVF失败卵母细胞行补救ICSI并联合人工辅助激活,24 h后镜下观察可见13枚卵母细胞受精为双原核(2PN),继续培养24h后分裂,于当天挑出3枚处于4细胞阶段的优质胚胎实施移植,未获妊娠。剩余10枚胚胎行进一步的囊胚培养,于ICSI后的第5天获得2枚囊胚,1枚致密桑葚胚。随后该名患者在冻融胚胎移植周期中获得了临床妊娠及分娩。结论 IVF受精失败的卵母细胞采用补救ICSI联合人工辅助激活的处理,能够提高卵子的受精率,并在一定程度上改善胚胎的发育潜能,使得获得临床妊娠及分娩成为可能。

Objective To evaluate the efficiency of the combination of rescue intracytoplasmic sperm injection（ IC- SI） with an assisted activation applied to a total failure of conventional in vitro fertilization （IVF）. Methods Seventeen unfertilized oocytes from an IVF cycle with a total fertilization failure were reinseminated by rescue ICSI and subsequently activated with ethanol for 6 min after informing the patient and obtaining their consent. Then, that fertilization of these oocytes 24 h after ICSI, the followed cleavage and development of embryos derived from these oocytes from 48 h to day 5 after ICSI were observed and recorded in detail. Then the pregnancy outcome of this patient was registered. Results Thirteen of seventeen oocytes from IVF total failure cycle were fertilized with the existence of two pronuclei 24 h after rescue ICSI with assisted activation. All the fertilized oocytes achieved normal cleavage. We subsequently chose three top quality embryos at a 4-cell stage to transfer after ICSI on day 2, but with no prcs2 ence of pregnancy. The remaining embryos were continued to culture until day 5 after ICSI. Two blastocysts and one compact morula occurred in these embryos. In a subsequent frozen-thawed cycle, the patient became pregnant and delivered a healthy baby. Conclusion The combination of rescue ICSI with assisted activation appears to improve the fertilization rate of oocytes in a total failure of IVF cycle and improve the potential development of ensuing embryos so that it is possible to get a good outcome of clinical pregnancy and delivery.