短时受精去除颗粒细胞对IVF-ET治疗周期的影响

Influence of cumulus cells removal after short co-incubation of gametes on outcomes of in vitro fertilization and embryo transfer cycles

目的分析体外受精-胚胎移植(IVF-ET)治疗中,去除颗粒细胞观察第二极体对胚胎质量及结局的影响。方法回顾性分析苏州市立医院生殖与遗传中心2011年1月至2013年1月IVF-ET治疗周期患者的数据,根据受精后3h是否观察第二极体将504个周期分为两组(组1,第二极体观察组;组2,非第二极体观察组),对数据进行比较。结果两组第2次减数分裂中期Ⅱ(MⅡ)卵率(组1:82.3%,组2:85.9%),2原核(2PN)率(组1:55.6%,组2:60.5%),1PN率(组1:3.2%,组2:5.3%),差异均有统计学意义(x^2值分别为0.000、0.000、0.000,均P<0.05);多精受精率、卵裂率、优质胚胎率、临床妊娠率及种植率差异均无统计学意义(均P>0.05)。组1中32个周期由于受精失败或者低受精,于受精后6h行补救性卵胞浆内单精子注射(resICSI);组2中1个周期完全受精失败,于受精后20h行res-ICSI。结论去除颗粒细胞观察第二极体的卵子受精后不影响多精受精率、卵裂率、优质胚胎率、临床妊娠率及种植率,而第二极体观察时间的提前,可能导致了组1MⅡ率、正常受精率及单原核受精率的降低。第二极体观察能够尽量避免患者由于受精失败取消IVF周期,并降低了ICSI技术的使用率,IVF不受精或低受精病例可以通过res-ICSI补救。

Objective To analyze the influence of cumulus cells removal after short co-incubation of gametes on quality and outcomes of embryo in in vitro fertilization-embryo transfer （IVF-ET） treatment.Methods Data of infertility patients receiving IVF-ET treatment in the reproductive center of Suzhou Municipal Hospital Affiliated to Nanjing Medical University from January 2011 to January 2013 were retrospectively analyzed.According to whether second polar body was detected , 504 cycles were divided into two groups：group 1（detected group）, group 2 （non-detected group）.The data were compared between two groups .Results The MⅡoocytes rate （group 1：82.3%, group 2：85.9%）, normal fertilization rate （group 1：55.6%, group 2：60.5%）, and 1PN rate （group 1：3.2%, group 2：5.3%） between two groups were significantly different （allχ2 value was 0.000, all P〈0.05）.There were no significant differences in polyspermy rate, cleavage rate, good quality embryo rate, clinical pregnancy rate and implantation rate （all P〉0.05）.There were 32 cycles receiving early res-ICSI 6h after insemination due to fertilization failure and low fertilization rate in group 1, and 1 cycle received late res-ICSI 20h after insemination in group 2.Conclusion Mechanical removal of cumulus cells to detect the second polar body does not affect polyspermy rate, cleavage rate, good quality embryo rate , clinical pregnancy rate and implantation rate .The lower MⅡ oocytes rate, normal fertilization rate and 1PN rate may be caused by the early detection time .With second polar body detection , cancellof IVF can be avoided because of fertilization failure .It also decreases ICSI rate obviously in IVF treatment .Fertilization failure and low fertilization cases can be rescued by res-ICSI.