不同来源精子行卵胞浆内单精子注射妊娠结局的比较

Pregnancy outcomes of intracytoplasmic sperm injection with sperm from different sources

目的比较前次常规体外受精(In vitro fertilization,IVF)周期不受精/低受精的射出精子、重度少弱畸精子症患者的射出精子,以及梗阻性无精子症患者的睾丸精子,3种不同来源精子行卵胞浆内单精子注射(ICSI)后的妊娠结局。方法前次常规IVF周期不受精/低受精患者(A组,n=45)和重度少弱畸精子症患者(B组,n=345)采用射出精子获取精子,梗阻性无精子症患者(C组,n=110)采用睾丸穿刺抽吸术(TESA)获取精子,比较ICSI后的受精率、妊娠率和种植率等。结果A组女方年龄及不孕年限显著高于B、C组(均P<0.05)。C组的受精率和卵裂率显著低于A、B组(均P<0.05);3组间2PN(2 pronucleus)受精率(72.11%、73.85%、63.02%)差异均有统计学意义,其中B组的2PN受精率最高。3组间优质胚胎率(61.50%、66.09%、67.96%)和可利用囊胚率(25.77%、26.27%、27.67%)差异均无统计学意义(均P>0.05)。3组间临床妊娠率(68.42%、71.97%、69.89%)、胚胎种植率(49.30%、50.17%、45.78%)、分娩率(55.26%、60.83%、53.76%)、单胎率(42.86%、52.36%、68.00%)、多胎率(57.14%、47.64%、32.00%)、异位妊娠率(0.00%、0.88%、1.54%)、流产率(7.69%、8.41%、12.31%)及早产率(33.33%、28.80%、26.00%)差异均无统计学意义(均P>0.05)。结论不同来源的精子行ICSI,对卵母细胞受精率有影响,其中B组患者正常受精率最高,C组患者的受精率和卵裂率最低,提示睾丸精子对受精率和早期胚胎发育有负面影响,但3组均可获得较好的妊娠结局。

Objective To compare the pregnancy outcomes after intracytoplasmic sperm injection(ICSI)of three different sources of spermatozoa in the previous conventional In vitro fertilization IVF cycle,including ejaculated spermatozoa from patients with severe oligoasthenozoospermia and those with testicular spermatozoa and from patients with obstructive azoospermia.Methods Sperms were obtained by ejaculation of patients with non-or low-fertilization(group A,n=45)and those with severe oligoasthenospermia(group B,n=345)in the previous routine IVF cycle.Sperm were obtained by testicular aspiration(TESA)from patients with obstructive azoospermia(group C,n=110).The fertilization,pregnancy,and implantation rates after ICSI were compared.Results The age of the woman and the number of years of infertility in group A were significantly higher than those in groups B and C(all P<0.05).The fertilization rate and cleavage rate in group C were significantly lower than those in groups A and B(all P<0.05).The fertilization rate of 2PN(2 pronucleus)among the three groups was statistically different,and the fertilization rate of 2PN in group B was the highest(72.11%,73.85%,63.02%).There were no statistical differences between the three groups in the high quality embryo rate(61.50%,66.09%,67.96%)and available blastocyst rate(25.77%,26.27%,27.67%)(all P>0.05).The clinical pregnancy rate(68.42%,71.97%,69.89%),embryo implantation rate(49.30%,50.17%,45.78%),delivery rate(55.26%,60.83%,53.76%),single pregnancy rate(42.86%,52.36%,68.00%),multiple pregnancy rate(57.14%,47.64%,32.00%),ectopic pregnancy rate(0.00%,0.88%,1.54%),abortion rate(7.69%,8.41%,12.31%)and premature delivery rate(33.33%,28.80%,26.00%)were not statistically different between the 3 groups(all P>0.05).Conclusion ICSI performed by sperm from different sources has an impact on the fertilization rate of oocytes.group B had the highest normal fertilization rate,and group C had the lowest fertilization rate and cleavage rate,suggesting that testicular sperm has a negative impact on the fertilization rate and early embryo development,but all three groups could achieve good pregnancy outcomes.