棕色卵子形成原因及在体外受精胚胎移植中对妊娠结局的影响

Causes of Brown Oocyte Formation and the Impact on the Pregnancy Outcome in In Vitro Fertilization and Embryo Transfer

目的:探讨棕色透明带卵子形成的可能原因以及对受精、胚胎质量、妊娠结局的影响。方法:回顾性分析2011-2012年在本中心接受体外受精胚胎移植助孕治疗的703例患者资料,根据透明带的色泽分为棕色透明带组(A组)74例,正常卵子组(B组)629例。比较两组一般临床特征、促性腺激素(Gn)使用天数、Gn用量、人绒毛膜促性腺激素(hCG)日血清激素水平、卵子透明带厚度、受精率、补救胞浆内单精子注射(ICSI)率、优质胚胎率、妊娠率。结果:两组的平均年龄、不孕年限、不孕原因、基础内分泌、hCG日血清雌二醇(E2)、孕激素(P)、黄体生成激素(LH)以及卵子受精率、卵裂率、补救ICSI率、可利用胚胎率差异均无统计学意义(P>0.05);A组的卵子透明带厚度大于B组,差异有统计学意义(P<0.05);A组Gn用量、hCG日血清卵泡刺激素(FSH)水平高于B组,优质胚胎率和妊娠率低于B组,差异均有统计学意义(P<0.05)。结论:棕色透明带的卵子与正常卵子相比受精率、补救ICSI率、卵裂率没有明显变化,透明带厚度有明显差异,但优质胚胎率和妊娠率明显下降,可能与患者Gn用量较多和hCG日血清高FSH水平有关。

Objective： To explore the possible causes of oocyte with brown pellucid zone and the effect to fertilization, embryo quality, fertilization outcome of in vitro fertilization and embryo transfer （IVF ET）. Methods： According to the pellucid zone color, a total of 703 patients from 2010 to 2012 were divided into normal egg group （group B） with 629 cases and brown oocytes group （group A） with 74 cases. The clinical characteristics, gonadotropin （Gn） days, Gn dosage, ser- um hormone levels on the day of human chorionic gonadotrophin（HCG）injection, the zona pellu- cida thickness （ZPT）of eggs, the fertilization rate, rescue intracytoplasmic sperm injection （rlC- SI） rate, good quality embryo rate and pregnancy rate were compared between the two groups. Results： There was no difference between the two groups in duration of infertility, mature oo- cytes rate, infertility reasons, basis endocrine levels, and the serum estradiol （E2）, progesterone （P）, luteinizing hormone （LH） in the day of HCG injection （P〉0. 05）, and also there was no statistical significance in ooeyte fertilization rate and rICSI rate （P~〉0.05）. But the ZPT value of group A was higher than that in group B （P〈0.05）. Meanwhile, the Gn dosage and FSH levels on the day of HCG injection in group A were significantly higher than those of group B （P〈 0. 05）, as well as the good quality embryo rate and pregnancy rate in group A were lower than those in group B （P〈0.05）. Conclusion： The oocytes with brown pellucid zone have lower em- bryo quality and pregnancy rate and higher zona pellucida thickness value, which may be caused by the high Gn dosage injection and serum FSH levels in the day of HCG injection.