卵母细胞胞质内单精子注射的形态学观察

Analysis of the Relevant Morphological Characteristics Observed in Intracytoplasmic Sperm Injection

目的 了解卵母细胞胞质内单精子注射 (intracytoplasmicsperminjection ,ICSI)过程中配子及卵裂球期胚胎各种异常形态与ICSI结果的相关性。方法 对 1998年 11月至 1999年 8月在我中心接受ICSI治疗的 43个周期进行观察、分析。促性腺激素释放激素激动剂降调节长方案进行超促排卵 ,ICSI常规操作 ,比较配子及卵裂球期胚胎正常与各种异常形态同ICSI结果的相关性。结果 精子形态严重畸形、卵母细胞胞浆内大块颗粒样暗区等异常形态影响ICSI结果 ;卵周隙大小不影响ICSI结果 ;注射过程中胞浆膜呈无弹性类的卵母细胞注射后存活率较低 (P <0 .0 1) ;移植胚胎平均分数 3分以上和 3分以下者的临床妊娠率为 5 2 .2 %和 10 .0 % (P <0 .0 1)。结论 部分形态学改变影响ICSI临床治疗效果 。

Objective To analyze the morphological characteristics of oocyte,sperm and blastomere stage embryo and correlate with intracytoplasmic sperm injection (ICSI) embryo score. Methods ICSIs were done in MⅡ oocytes harvested after superovulation with long protocol gonadotropin releasing homone agonist. Various morphological characteristics of oocyte, sperm and blastomere stage embryo were identified and correlated with the embryo score. Results Forty three ICSI cycles were completed. Twelve out of 31 male factor infertile couples and 2 out of 12 with fertilization failure during previous standard in vitro fertilization embryo transfer cycles achieved clinical pregnancy, resulting in a pregnancy rate of 38.7% and 16.7% per transfer respectively. Severe teratospermia and abnormal cytoplasm of the oocytes, such as cytoplasmic central dark granulas, inclusions, had significantly low embryo score ( P <0.01). The size of perivitelline space had no influence on the result. The oocytes without oolemma elasticity during ICSI process had a lower oocyte survival rate compared with those with oolemma elasticity ( P <0.01). The clinical pregnancy rate per transfer between transferred embryo with average score higher and lower than 3 was significantly different (52% vs 10%, P <0.001). Conclusion Some morphological characteristics of gamates correlate with the embryo quality and clinical pregnancy rate. They can be used to assess and improve the clinical management during ICSI.