人工辅助激活卵母细胞同周期对照研究

A control study of artificial oocyte activation in the same period

目的观察使用钙离子载体A23187对同周期同胞卵子进行人工辅助激活，对比正常受精率及胚胎结局。方法2015年1至12月在郑州大学第三附属医院生殖医学中心行卵胞质内单精子显微注射（ICSI）助孕周期，经过郑州大学第三附属医院伦理委员会批准，符合纳入研究周期病例标准至少符合以下之一：前次ICSI周期2PN（即正常受精）率≤30%；前次ICSI周期第3天无优质胚胎；诊断为圆头精子症患者。将卵母细胞随机分为对照和人工辅助激活（AOA）两组。对照组卵母细胞完全按照常规ICSI操作进行处理，AOA组卵母细胞在进行ICSI后使用钙离子载体A23187进行激活。对比两组正常受精率、卵裂率、妊娠及出生结局。结果AOA组2PN受精率65.93%（60/91）明显高于对照组46.67%（41/89），差异有统计学意义，P〈0.05；符合纳入标准1（2PN≤30%）患者AOA组2PN受精率79.59%（39/49）明显高于对照组57.14%（28/49），差异有统计学意义（P〈0.05）；符合纳入标准3（圆头精子症）患者AOA组2PN受精率75%（6/8）明显高于对照组0（0/5），差异有统计学意义（P〈0.05）。结论使用钙离子载体A23187对卵母细胞进行人工辅助激活有助于提高ICSI后正常受精率，但对于早期胚胎发育影响及子代安全性还有待于进一步研究。

ObjectiveTo compare the fertility rate and embryo outcome between normal fertilization and the use of Calcium ionophore A23187 on the same period of the same cycle of human ovum for artificial activation.MethodsPatients who conducted the intracytoplasmic sperm injection （ICSI） cycle in vitro fertilization assisted reproductive from January 2015 to December in reproductive center of the Third Affiliated Hospital of Zhengzhou University were enrolled.The protocol of this study was approved by the ethics committee of The Third Affiliated Hospital of Zhengzhou University.The subjects must met at least one of the inclusion criteria： （1）the normal fertilization rate was less than 30% ICSI in the previous ICSI cycle; （2）no good quality embryos in a previous period of third days in ICSI; （3）patients with globozoospermia.The ovum were randomly divided into two groups, control group and artificial oocyte activation （AOA） group. In the control group, the eggs were treated with routine ICSI operation, and the AOA group was activated by A23187 after ICSI. Normal fertilization rate, cleavage rate, pregnancy and birth outcome of two groups were compared.ResultsThe 2PN fertilization rate in the AOA group 65.93% （60/91） was significantly higher than that in the control group 46.67% （41/89） （P〈0.05）. In addition, in patients who met the inclusion criteria of 1 categories （2PN≤30%）, the 2PN fertilization rate was significantly higher （P〈0.05） in the AOA group [79.59% （39/49）] compared with the control group [57.14% （28/49）]. In patients who met the inclusion criteria of 3 categories （globozoospermia）, the 2PN fertilization rate was significantly higher （P〈0.05） in the AOA group [75% （6/8）] compared with the control group [0% （0/5）].ConclusionsThe use of calcium ionophore A23187 assisted activation could be helpful to improve the normal fertilization rate of ICSI. But the effects of early embryonic development and the safety of generation need to be further studied.