脱颗粒到单精子注射时间对ICSI周期临床结局的影响

Effect of the time interval between oocyte denudation and intracytoplasmic sperm injection on clinical outcomes

目的探索ICSI周期卵丘复合物脱颗粒到单精子注射时间对妊娠结局的影响。方法回顾性分析2016年10月至2019年12月于华中科技大学同济医学院附属同济医院生殖医学中心行ICSI周期的患者夫妇的临床资料。将卵丘复合物脱颗粒到单精子注射的时间定义为T,按照四分位数分为T1(T≤120 min,n=1303)、T2(120 min<T≤160 min,n=641)、T3(160 min<T≤210 min,n=1037)和T4(T>210 min,n=846)4组。分析比较各组间的受精率、胚胎发育情况和妊娠结局。结果本研究共纳入3827个ICSI周期的临床数据,各组的获卵数和卵裂率均无显著差异(P>0.05),但T1组的MⅡ卵率、2PN率和多PN率均低于其他组,其中T1组与T4组的MⅡ卵率(79.88%vs.81.21%,P<0.05),T1组及其他各组的2PN率(69.10%vs.71.51%,71.63%,72.56%,P<0.05),T1组与T3组的多PN率(1.10%vs.1.52%)有显著差异(P<0.05)。在临床妊娠结局方面,各组在生化妊娠率、流产率以及临床妊娠率各方面均无显著差异(P>0.05),但T1组的胚胎种植率显著高于T3组(49.30%vs.43.11%,P<0.05)。结论ICSI周期中卵丘复合物脱颗粒到单精子注射时间会影响胚胎的种植潜能,合理地把握ICSI操作时机有利于提高胚胎种植机会,优化ICSI周期助孕结局。

Objective:To explore the effect of the time interval between oocyte denudation and intracytoplasmic sperm injection(ICSI)on clinical outcomes of ICSI cycles.Methods:The clinical data of infertility couples undergoing fresh ICSI cycles from Oct.2016 to Dec.2019 in Reproductive Medicine Center of Tongji Hospital were retrospectively studied.The time interval between oocyte denudation and ICSI was defined as T,and the patients were divided into 4 groups:T1 group(T≤120 min,n=1303),T2 group(120 min<T≤160 min,n=641),T3 group(160 min<T≤210 min,n=1037)and T4 group(T>210 min,n=846).The main outcomes of ICSI cycles(fertilization rate,embryo development and pregnancy outcomes)were compared among 4 groups.Results:A total of 3827 ICSI cycles were included in this study.There was no significant difference between the groups in terms of the number of oocytes retrieved and the cleavage rate(P>0.05),but the MⅡoocyte rate in T1 group was significantly lower than that in T4 group(79.88%vs.81.21%,P<0.05),2PN rate in T1 group was significantly lower than that in other groups(69.10%vs.71.51%,71.63%,72.56%,respectively,P<0.05)and the multiple PN rate in T1 group were significantly lower than that in T3 group(1.10%vs.1.52%,P<0.05).There was no significant difference between 4 groups in terms of the chemical pregnancy rate,miscarriage rate and clinical pregnancy rate(P>0.05),but the embryo implantation rate in T1 group was significantly higher than that in the T3 group(49.30%vs.43.11%,P<0.05).Conclusions:The time interval between oocyte denudation and ICSI may affect the implantation potential of embryos.The reasonable timing of denudation to ICSI may improve the implantation rate and optimize the clinical pregnancy outcome of ICSI cycles.