卵母细胞成熟率降低的相关因素及其对胚胎发育与临床结局的影响

Factors inducing decreased oocyte maturation rate and the effect on pregnancy outcome in vitro fertilization

目的探讨卵细胞质内单精子注射(ICSI)周期中卵母细胞成熟率降低的相关因素及其对胚胎发育及临床结局的影响。方法对2015年1月至2018年12月在北京妇产医院生殖医学中心行卵细胞质内单精子注射助孕并新鲜周期移植的患者758例,按卵子成熟比例分为三组:A组:卵子成熟比例≥80%,B组:卵子成熟比例在80-50%之间,C组:卵子成熟比例≤50%。比较三组的一般情况、促排卵及妊娠相关指标,多因素logistic回归分析卵母细胞成熟率下降的危险因素。结果不成熟卵子所占比率与正常受精率负相关,(A组与C组比较P<0.05),C组ICSI注射后卵子退化率明显高于A组(8.9±11 vs 5.4±9 P<0.05);三组优质胚胎率(50.0%vs44.51%vs23.60%)、种植率(36.33%vs29.32%vs17.90%)和临床妊娠率(57.21%vs49.45%vs37.50%)呈现逐步降低的趋势,A组优质胚胎率、种植率及临床妊娠率明显高于C组,差异具有统计学意义(P<0.001)。HCG日E2水平及卵母细胞数是卵母细胞成熟率下降的危险因素(P<0.05)。结论HCG日较高的E2浓度及卵母细胞数目与卵母细胞的成熟率降低有关,卵母细胞成熟率降低可能影响胚胎发育潜能及临床妊娠结局。

Objective:This study aimed to explore the factors infuencing the incidence of decreased OMR in ICSI cycle and its efects on clinical outcomes.Methods:758 patients treated by intracytoplasmic sperm injection and embryo transfer(ICSI-ET)from January 2015 to December 2018.Cycles were divided into three groups according to proportion of MII oocytes at the time of retrieval:A group:(proportion of MII oocytes≥80%),B group:(proportion of MII oocytes:80-50%),C group:(proportion of MII oocytes≤50).The general conditions,the indicators of ovulation induction and pregnancy outcome were compared among the three groups.A multivariate logistic regression analysis was used to estimate the risk factors on decreased oocyte maturation rate.Results:MI and GV/oocyte rates were negatively correlated to normal fertilization(two pronuclei)(A group vs C group,P<0.05),A increase in degenerated oocyte after ICSI that rose from 5.4±9 in the A group to 8.9±11 in the C group(P<0.05).High quality embryos rate(50.0%vs44.51%vs23.60%),clinical pregnancy rate(57.21%vs49.45%vs37.50%)and embryo implantation rate(36.33%vs29.32%vs17.90%)were affected by the decreasing proportion of MII oocytes.The level of high quality embryos rate,clinical pregnancy rate and embryo implantation rate in group A were obviously higher than those of group group C,These differences were significant(P<0.001).Estradiol level at hCG trigger day and more oocytes retrieved were risk factors for decreased oocyte maturation rate(P<0.05).Conclusion:Estradiol level at hCG trigger day and number of oocytes retrieved were found to be factors inducing decreased oocyte maturation rate.Oocytes derived from a cohort with high incidence of maturation in ICSI cycles may have detrimental clinical outcomes.