拮抗剂方案OPU-ICSI不同时机选择对新鲜胚胎移植周期临床结局的影响

Effects of Regimens OPU-ICSI with Different Intervals on the Clinical Outcomes of Fresh Embryo Transfer in GnRH Antagonist Cycle

目的:比较促性腺激素释放激素(GnRH)拮抗剂方案中选择不同的胞浆内单精子注射(ICSI)实施时机对新鲜胚胎移植周期中胚胎质量及妊娠结局的影响。方法:选择2016年1月—2018年5月在我科采用GnRH拮抗剂方案促排卵,行新鲜胚胎移植的531个周期,按不同取卵(OPU)-ICSI间隔时间分为2组:38~40h为组1(n=101),41~43h为组2(n=430),比较2组患者的卵母细胞成熟度、胚胎质量和妊娠结局。结果:组1患者的卵子成熟率低于组2,但组2的早期流产率低于组1,差异有统计学意义(均P<0.05)。2组患者的受精率、分裂率、可利用胚胎率、优胚率、种植率和临床妊娠率等比较,差异无统计学意义(均P>0.05)。结论:在GnRH拮抗剂方案新鲜胚胎移植周期中,ICSI时机选择在38~43h的窗口期均能达到比较一致的胚胎质量及临床妊娠率。关于OPU-ICSI间隔短(小于40h)早期流产率较高,需要更多的和细致分组的研究。

Objective:To compare the effects of two different ICSI insemination times on the reproductive outcomes of fresh embryo transfer (FET) in gonadotropin-releasing hormone (GnRH) antagonist cycles. Methods: 531 cycles of FET after the GnRH antagonist protocol were divided into two groups according to the interval time between OPU and ICSI, the group one (n=101) that the OPU-ICSI interval was ranged from 38~40 h and the group two (n=430) was 41~43 h. The differences of oocyte maturation rate, embryo quality and pregnancy outcomes between the two groups were analyzed retrospectively. Results:The oocyte maturation rate was significantly lower in the group one when compared with the group two (P<0.05), and the miscarriage rate in group one was significantly higher (P<0.05). There was no significant differences in the fertility rate, cleavage rate, available embryo rate, high -quality embryo rate, implant rate and pregnancy rate between the two groups (P>0.05). Conclusions:Our results indicate that there are relatively consistent embryo quality and clinical pregnancy rate in the timing of ICSI ranged from 38~43 h. As for the finding that the miscarriage rate could be higher if the ICSI time was earlier than 40 h in the FET cycle of GnRH antagonist protocol, we think that more studies with large samples and the detailed grouping may be necessary.