辅助卵母细胞激活对经睾丸显微取精术获取活动精子患者卵胞浆单精子注射治疗结局的影响

Effect of Assisted Oocyte Activation on the Outcome of ICSI in Patients with Mobile Sperm Obtained by Micro-testicular Sperm Extraction

【目的】探讨辅助卵母细胞激活(AOA)对经睾丸显微取精术(micro-TESE)成功获得活动精子患者行卵母细胞胞质内单精子注射(ICSI)治疗的实验室和临床结局影响。【方法】回顾性分析2018年至2020年间经micro-TESE已获取活动精子的非梗阻性无精子症男性患者167人,配偶经常规超排卵获得成熟卵母细胞行ICSI治疗230个周期,比较分析ICSI后是否经钙霉素行AOA处理的实验室和临床结局差异。【结果】激活组(G1)和未激活组(G2)的女方平均年龄(29.96±4.61vs.30.59±4.50,P=0.297),平均移植胚胎数(1.51±0.50 vs.1.56±0.50,P=0.154),移植囊胚数占比(24.37%vs.25.00%,P=0.915),差异均无统计学意义。G1组的总受精率和2PN受精率、首次移植妊娠率高于G2组(72.77%vs.67.59%,P=0.005;64.33%vs.60.22%,P=0.036;67.09%vs.50.00%,P=0.039)差异有统计学意义。G1组的无可用胚周期发生率(10.85%vs.9.90%,P=0.815)、D3可用胚率(41.29%vs.40.74%,P=0.817)、种植率(34.87%vs.32.05%,P=0.533)和临床妊娠率(43.87%vs.41.00%,P=0.651)均高于G2组,但差异无统计学意义;G1组的优胚率(13.44%vs.15.44%,P=0.265)和持续妊娠率(36.13%vs.40.00%,P=0.533)却低于G2组,组间差异无统计学意义。【结论】AOA处理可以提高经micro-TESE获取活动精子患者ICSI治疗的2PN受精率,有增加Day3可用胚胎数的趋势,但未改善胚胎质量和持续发育能力。对于使用活动micro-TESE精子行ICSI之后的AOA处理应仅用在精子形态畸形可疑受精低下的情况。

【Objective】To investigate the effects of assisted oocyte activation(AOA)on the laboratory and clinical outcomes of intracytoplasmic sperm injection(ICSI)in patients who successfully obtained motile sperm through micro-tes⁃ticular sperm extraction(Micro-TESE).【Methods】Retrospective analysis was performed on 167 non-obstructive azoosper⁃mia male patients with motile sperm obtained by micro-TESE between 2018 and 2020,and 230 ICSI cycles for the ma⁃tured oocytes obtained from partner by routine superovulation.The differences in laboratory and clinical outcomes of AOA treatment with or without calcomycin after ICSI were compared.【Results】There were no significant differences in the aver⁃age age of women(29.96±4.61 vs.30.59±4.50,P=0.297),the average number of embryos transferred(1.51±0.50 vs.1.56±0.50,P=0.154)and proportion of the number of transferred blastocysts(24.37%vs.25.00%,P=0.915)between the activated group(G1)and the non-actived group(G2).The total fertilization rate and 2PN fertilization rate and preg⁃nancy rate of first ET in G1 group were higher than those in G2 group(72.77%vs.67.59%,P=0.005;64.33%vs.60.22%,P=0.036;67.09%vs.50.00%,P=0.039),the differences were statistically significant.The incidence of no available em⁃bryo cycle(10.85%vs.9.90%,P=0.815),D3 available embryo rate(41.29%vs.40.74%,P=0.817),implantation rate(34.87%vs.32.05%,P=0.533)and clinical pregnant rate(43.87%vs.41.00%,P=0.651)in G1 group were all higher than those in G2 group,and the differences were not statistically significant.However,the optimal embryo rate(13.44%vs.15.44%,P=0.265)and the sustained pregnant rate(36.13%vs.40.00%,P=0.533)in G1 group were lower than those in G2 group,and the differences were not significant between the two groups.【Conclusion】Assisted oocyte activation can significantly improve the 2PN fertilization rate of ICSI in patients with motile sperm obtained by micro-TESE,and obtain a relatively large number of available Day 3 embryos,but no significant beneficial effect on embryo development quality and sustainable development ability.AOA treatment after ICSI using mobile Micro-Tese sperm should only be used in cases of teratospermiaandsuspected lowfertilization.