IVF助孕中卵母细胞成熟率对ICSI临床结局的影响

Influence of oocyte maturation status on HCG day clinical outcomes in ICSI

目的研究影响HCG日卵母细胞成熟度的临床因素,及卵母细胞成熟度对胚胎发育潜能及妊娠结局的影响。方法回顾性分析本院生殖中心2014年3月至2015年4月行ICSI治疗的不孕患者427例,根据取卵日脱颗粒细胞后卵母细胞成熟度(成熟卵母细胞数与卵母细胞数的比例)分为A、B、C三组,A组为成熟度≥80%,283例;B组成熟度为60%~79%,124例;C组成熟度<60%,20例。比较三组患者的年龄、不育年限、促性腺激素(Gn)天数、Gn用量、人绒毛膜促性腺激素(HCG)注射日血清LH,E_2,孕激素(P)、每成熟卵母细胞E_2水平、每卵母细胞E_2水平、成熟卵母细胞数、获卵数、MⅡ卵数、获卵率;2PN受精率、卵裂率、可移植胚胎率、优胚率、囊胚形成率、累积妊娠率、卵巢过度刺激综合征(OHSS)发生率。结果三组的年龄、不育年限无统计学差异(P>0.05)。A组和B组Gn天数、用量[(12.46±2.27)d,(2 713.96±976.55)U][(12.23±1.78)d,(2 779.23±1 098.21)U]少于C组[(13.65±3.08)d,(3 365.00±1 125.93)U],差异有统计学意义(P<0.05)。HCG日血清E_2:A组[(14 662.80±1 157.38)pmol/L]>B组[(13 556.60±1 200.66)pmol/L]>C组[(10 560.56±1 338.43)pmol/L],两两比较有统计学差异(P<0.05)。HCG日血清LH、P水平、每成熟卵母细胞E_2水平、每卵母细胞E_2水平,三组无统计学差异(P>0.05)。成熟卵泡数、获卵数、MⅡ卵数:A组>B组>C组,差异有统计学意义(P<0.05)。A组获卵率(获卵数/≥14mm卵泡数):(99.28%)大于B组(96.24%)、C组(95.21%),差异有统计学意义(P<0.05)。正常受精率、卵裂率:A组(86.55%;99.17%)大于B组(78.19%;97.91%)和C组(79.82%;95.60%),有统计学差异(P<0.05)。优胚率、累积妊娠率:A组(48.03%;51.59%)和B组(44.58%;48.38%)大于C组(39.62%;35.00%),有统计学差异(P<0.05)。三组中重度OHSS发生率间无统计学差异(P>0.05)。结论卵母细胞成熟率低可能与卵巢反应不良或对Gn敏感性下降有关;卵母细胞成熟率低可能影响受精及胚胎发育潜能,导致可供移植的胚胎数减少,妊娠率下降。

Objectives：To explore the clinical factors related with the oocyte maturity and the influence of oocyte maturation on embryo development and clinical outcomes in ICSI. Methods： The data of 427 ICSI cycles in the ART Department of the Forth Hospital of Shijiazhuang from March 2014 to April 2015 were retrospectively analyzed. The cycles were divided into four groups according to oocyte maturation rate： oocyte maturation rate ≥80% in group A（n=283）,60%-79% in group B（n=124）,〈 60% in group C（n= 20）. The age,duration of infertility,total doses ＆ duration of gonadotropin（Gn） used, hormones levels on HCG day, E2 level/mature oocyte, number of mature oocytes, number of oocytes retrieved, number of M II oocytes and oocytes retrieved rate; 2PN fertilization rate, cleavage rate, transferable embryos rate, good quality embryo rate, blastocyst formation rate, cumulativepregnancy rate, and ovarian hyperstimulation syndrome （OHSS）rate were compared among the three groups. Results. There were no significant differences in age,duration of infertility（P〉0. 05）. The days and dosed of Gn used in group A [（12. 46±2.27）days, （2 713.96±976.55）U] and group BE（12.23±1.78） days,（2 779.23±1 098.21）U] were significantly less than those in group C [（13.65±3.08）days, （3 365. 00±1 125.93）U]（P〈0.05）. The E2 levels on HCG day in group A [（14 662. 80±1 157.38）pmol/L] were significantly higher than those in group B [（13 556.60 ± 1 200. 66）pmol/L] and group C [（10 560. 56± 1 338.43）pmol/L]（P〈0. 05）. The levels of LH ± P, E2 level/mature oocyte and E2 level/oocyte were not significantly different among the three groups（P〉0.05）. The number of mature oocytes,the number of ooeytes retrieved and the number of M II oocytes in group A were significantly more than those in group B and group C（P〈0. 05）. The retrieval oocyte rate（number of retrieval oocytes/ number of ≥14mm ooeytes） in group A（99.28%）was significantly higher than that in group B（96.24% ）and group C （95.21%）（P〈0. 05）. The normal fertilization rate and cleavage rate in group A（86.55%,99.17%）were significantly higher those in group B（78.19%, 97.91%）and group C（79.82%,95.60%）（P〈0.05）. The good quality embryo rate and cumulative pregnancy rate in group A（48.03%,51.59%）and group B （44.58%,48.38%） were significantly higher than those in group C（39.62%, 35.00%） （P〈0.05）. The incidence of moderate-severe OHSS was not significantly different among the three groups（P〉 0.05）. Conclusions. Low oocyte maturation rate may be related to poor ovarian response or decreased sensitivity to Gn, and may affect fertilization and embryonic development potential, resulting in reduced numbers of embryos available for transplantation and reduced pregnancy rates.