不同氧浓度对单精子卵浆内注射技术胚胎发育及妊娠结局的影响

Effect of Oxygen Concentration on Outcome of Women Undergoing ICSI and Embryo Transfer

【目的】探讨取卵后第1-3天体外培养时不同氧浓度对于单精子卵浆内注射技术(ICSI)胚胎发育和妊娠结局的影响。【方法】回顾性分析了645例于2011年1-12月期间中山大学附属第一医院生殖中心行ICSI授精后第3天(D3)胚胎移植的周期的胚胎发育情况和临床结局,根据体外培养的氧浓度将其分为5%低氧浓度组和20%高氧浓度组。【结果】低氧组D3可用胚胎率(72.02%与68.73%)和移植胚胎评分(22.53与20.10)较高氧组更高,但新鲜胚胎移植的临床结局没有显著性差异。累积妊娠率低氧浓度组(60.44%与51.67%)显著高于高氧浓度组。在预后差如高龄和/或取卵数少的病人中,低氧组移植胚胎评分(20.66与16.71)、可利用胚胎率(76.11%与64.55%)和胚胎植入率(22.27%与10.08%)更高。【结论】低氧培养环境对于ICSI授精短期体外培养胚胎优于高氧培养环境。

[ Objective ] To investigate the effect of incubator oxygen concentration on the embryo development and outcome of women undergoing ICSI and embryo transfer. [Methods] A total of 645 ICSI cycles with fresh embryo transfer conducted in the First Affiliated Hospital of Sun Yat-sen University during January 2011 to December 2011 were retrospectively analyzed. According to the oxygen concentration during day 1-3 in vitro culture, cycles were classified as 5% oxygen concentration group and 20% oxygen concentration group. Day 3 （D3） transfer embryo score and clinical outcomes were measured. [ Result] Viable embryo rate （72.02% versus 68.73） and mean score of transfer embryo （22.53 versus 20.10） in D3 culture were higher in low oxygen group while all clinical outcomes were similar. Cumulative pregnancy rate （60.44% versus 51.67% ） was higher in lower oxygen group. To subgroup cycles with poor prognosis, mean score of transfer embryo （20.66 versus 16.71）, viable embryo rate （76.11% versus 64.55%） and implantation rate （22.27% versus 10.08% ） was significantly higher in low oxygen group. [Conclusion] In vitro culture of embryos deriving from ICSI in 5% oxygen concentration during the first 3 days is superior to culture in 20% oxygen concentration.