钙离子载体辅助卵母细胞激活在卵胞浆内单精子注射中的应用

Application of calcium ionophore assisted oocyte activation in intracytoplasmic sperm injection

目的探讨钙离子载体辅助卵母细胞激活(AOA)对因受精不良或精子因素行卵胞浆内单精子注射(ICSI)患者临床结局的影响。方法回顾性分析2012年1月至2020年12月在我中心行ICSI助孕时采用钙离子载体AOA患者的临床资料(共115个周期)。根据采用钙离子载体AOA的时间不同分为2组,第1个ICSI周期采用钙离子载体AOA助孕的为A组(n=66)和第2个ICSI周期采用钙离子载体AOA助孕的为B组(n=49)。同时,A组患者根据不同精子来源分为2个亚组:采用手术穿刺取精的为手术组(n=14),采用手淫法取精的严重少弱精子症组(n=52);以同期于我中心就诊的未使用激活剂的不同精子来源ICSI周期为A组的对照组。B组患者根据第1次ICSI受精情况不同分为3个亚组:前次ICSI助孕受精失败(非精子因素)的为未受精组(n=12),前次ICSI助孕受精率低的为受精低下组(n=31)和前次ICSI助孕因精子质量差导致受精失败的为精子因素组(n=6);并分别以自身既往未采用激活剂的ICSI周期为B组的对照组,比较各组患者的一般资料、实验室指标和临床结局。结果A、B两组患者的一般资料比较均无显著性差异(P>0.05)。A组患者中,严重少弱精子症组和手术组的激活周期2PN受精率均显著高于同组对照周期(P<0.05)。在B组患者中,未受精组和受精低下组的激活周期2PN受精率和2PN卵裂率均显著高于同组对照周期(P<0.05),而获卵数、MⅡ卵数、临床妊娠率和活产率比较均无显著差异(P>0.05);在精子因素组中,激活周期2PN卵裂率显著高于对照周期(P<0.05),而获卵数、MⅡ卵数、2PN受精率、优质胚胎率、临床妊娠率和活产率比较均无显著差异(P>0.05)。采用钙离子载体AOA的115个周期中,共有24例健康婴儿分娩(20例单胎和2例双胎),且未见先天缺陷和畸形。结论钙离子载体AOA可以显著提高严重少弱精子症、手术取精、既往ICSI未受精和受精低下患者的受精率,改善前次因精子因素不育患者的卵裂率。

Objective:To explore the effect of calcium ionophore assisted oocyte activation(AOA)on the clinical outcomes of patients with intracytoplasmic sperm injection(ICSI)due to poor fertilization or sperm factors.Methods:The clinical data of 115 patients(115 cycles)who were conducted ionophore-AOA during ICSI assisted pregnancy in our reproductive center from January 2012 to December 2020 were retrospectively analyzed.According to the time of AOA,they were divided into two groups.The patients in the group A received AOA in the first ICSI cycle(n=66),and the patients in the group B received AOA in the second ICSI cycle(n=49).According to different sperm sources,the patients in group A was subdivided into surgical sperm acquisition group(n=14)and severe oligospermia group(n=52).The cycles of different sperm sources without AOA during ICSI in our center were used as the control group.According to fertilization outcome in the first ICSI cycle,the patients in group B was subdivided into three groups:unfertilized group(n=12),low fertilization rate group(n=31)and fertilization failure caused by poor sperm quality(sperm factor group,n=6).The ICSI cycles without AOA were used as the control group.The general clinical data and clinical outcomes of patients in each group were compared.Results:In patients of group A,the 2PN fertilization rate of the severe oligospermia group and the surgical sperm acquisition group was significantly higher than that in the control group(P<0.05).In group B,the 2PN fertilization rate and 2 PN cleavage rate of the AOA cycle in unfertilized group and low fertilization group were significantly higher than those of the control cycle in the same group(P<0.05).There were no significant differences in the number of oocytes retrieved,number of MⅡoocytes,clinical pregnancy rate and live birth rate among the groups(P>0.05).In sperm factor group,the 2PN cleavage rate of AOA cycle was significantly higher than the control cycles(P<0.05).There were no significant differences in the number of oocytes retrieved,number of MⅡoocytes,clinical pregnancy rate and live birth rate among the groups(P>0.05).A total of 24 healthy babies were delivered in 115 AOA cycles(20 singles and 2 twins),and all babies had no birth defects or deformities.Conclusions:Calcium ionophore-AOA can significantly increase the fertilization rate of patients with severe oligospermia,surgical sperm acquisition,previous ICSI fertilization failure and low fertilization rate,and improve the cleavage rate of patients with previous fertilization failure due to poor sperm quality.