辅助生殖助孕中棕色卵子对妊娠结局的影响

Effect of brown ovum on pregnancy outcome in assisted reproduction

目的探讨辅助生殖技术中棕色卵子对妊娠结局的影响。方法回顾性分析2020年8月至2023年4月在昆明市第一人民医院接受辅助生殖助孕治疗的217例患者的临床资料,根据患者卵子透明带颜色将其分为棕色卵子组(n=69)和正常卵子组(n=148),比较两组患者的基础性激素[卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、孕酮(P)、血清抗苗勒管激素(AMH)]水平、促性腺激素(Gn)使用天数、Gn总量以及获卵数、卵子成熟率(MⅡ)、受精率、卵裂率、D3优胚率、囊胚形成率、体外受精(IVF)/卵胞浆内单精子注射(ICSI)的正常受精率;比较两组患者的临床妊娠率、累积妊娠率、活产率及流产率;比较两组患者的颗粒细胞线粒体DNA含量及线粒体膜电位(MMP)水平。结果棕色卵子组患者AMH为(2.21±1.42)ng/mL,明显低于正常卵子组的(3.34±3.26)ng/mL,Gn用量为(3124±758.52)IU,明显高于正常卵子组的(2563±612.40)IU,差异均有统计学意义(P<0.05),但两组患者的平均年龄、体质量指数(BMI)、基础FSH、LH、E2、P水平及Gn的使用天数比较差异均无统计学意义(P>0.05);棕色卵子组患者的获卵数、D3优胚率、囊胚形成率分别为8.9±1.30、(34.2±12.20)%、(34.6±10.90)%,明显低于正常卵子组的11.2±1.01、(45.1±19.80)%、(48.4±11.80)%,差异均有统计学意义(P<0.05),但两组患者的MⅡ、IVF/ICSI的正常受精率、ICSI退化率、卵裂率比较差异均无统计学意义(P>0.05);棕色卵子组患者的临床妊娠率、累积妊娠率、活产率分别为28.99%、39.13%、21.74%,明显低于正常卵子组的53.38%、58.11%、39.86%,差异均有统计学意义(P<0.05);棕色卵子组患者的线粒体膜电位MMP平均灰度值为15.33±1.20,明显低于正常卵子组的22.33±0.33,差异有统计学意义(P<0.05),但两组患者的mtDNA拷贝数比较差异无统计学意义(P>0.05)。结论人类辅助生殖助孕中棕色卵子形成机制与Gn用量相关,其获卵数、D3优胚率、囊胚形成率均显著降低,膜电位也显著较低,线粒体功能异常,颗粒细胞受损,胚胎质量及发育受影响,因此,应避免移植棕色卵子。

Objective To investigate the effect of brown ovum on pregnancy outcome in assisted reproduction.Methods The clinical data of 217 patients who received assisted reproduction in Kunming First People's Hospital from August 2020 to April 2023 were retrospectively analyzed.According to the color of zona pellucida,the patients were divided into brown ovum group(n=69)and normal ovum group(n=148).The basic sex hormone(follicle-stimulating hormone[FSH],luteinizing hormone[LH],estradiol[E2],progesterone[P],serum anti-Mullerian hormone[AMH])levels,the days of gonadotropin(Gn)use,Gn dosage,the number of eggs obtained,the rate of egg maturation(MⅡ),the rate of fertilization,the cleavage rate,high-quality embryos rate of D3,the rate of blastocyst formation,and the normal fertilization rate of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)were compared between the two groups;the clinical pregnancy rate,cumulative pregnancy rate,live birth rate,and abortion rate were compared between the two groups;mitochondrial DNA content and mitochondrial membrane potential(MMP)level of granular cells were also compared.Results AMH in brown ovum group was(2.21±1.42)ng/mL,which was significantly lower than(3.34±3.26)ng/mL in normal ovum group;Gn dosage was(3124±758.52)IU,which was significantly higher than(2563±612.40)IU in normal ovum group;the differences were statistically significant(P<0.05).However,there was no statistically significant differences in the mean age,body mass index(BMI),basic FSH,LH,E2,P level,and the days of Gn use between the two groups(P>0.05).The number of eggs obtained,high-quality embryos rate of D3,and rate of blastocyst formation in the brown ovum group were 8.9±1.30,(34.2±12.20)%,and(34.6±10.90)%,respectively,which were significantly lower than 11.2±1.01,(45.1±19.80)%,and(48.4±11.80)%in the normal ovum group(P<0.05).There was no statistically significant difference in MⅡ,normal fertilization rate of IVF/ICSI,ICSI degeneration rate,and cleavage rate between the two groups(P>0.05).The clinical pregnancy rate,cumulative pregnancy rate,and live birth rate in the brown ovum group were 28.99%,39.13%,and 21.74%,respectively,which were significantly lower than 53.38%,58.11%,and 39.86%in the normal ovum group(P<0.05).The mean gray value of mitochondrial membrane po-tential MMP in the brown ovum group was 15.33±1.20,which was significantly lower than 22.33±0.33 in the normal ovum group(P<0.05).There was no statistically significant difference in mtDNA copy number between the two groups(P>0.05).Conclusion The formation mechanism of brown ovum in assisted reproduction and pregnancy is related to the dosage of Gn.Brown ovum brings reduced number of eggs obtained,reduced high-quality embryos rate of D3,re-duced rate of blastocyst formation,low membrane potential,abnormal mitochondrial function,damaged granular cells,and can affect the embryo quality and development.Therefore,brown ovum transplantation should be avoided.