MⅡ卵子数与人绒毛膜促性腺激素注射日14mm以上卵泡数比率对卵胞浆内单精子显微注射结局的影响

Influence of the rate of MⅡ oocyte and dominant follicles on HCG-day on the outcomes during intracytoplasmic sperm injection and embryo transfer procedure

目的探讨卵胞浆内单精子显微注射(ICSI)-移植周期中MⅡ卵子数与人绒毛膜促性腺激素(HCG)注射日14 mm以上卵泡数的比率与胚胎发育及妊娠结局的关系,并探讨其影响因素。方法回顾性分析2013年3月至2014年7月在上海交通大学医学院附属瑞金医院生殖中心接受ICSI治疗的男性因素不孕患者460例,根据MⅡ卵子数与HCG注射日14 mm以上卵泡数的比率分为四组,A组为≤50%,B组50%~80%,C组80%~120%,D组为120%~140%,分析这四组的获卵率、成熟度、受精率、胚胎发育情况及妊娠结局。结果 A组虽然获卵率(85.93%)与B、C两组(86.86%、95.65%)比较无统计学差异,但成熟度(56.62%)、受精率(74.1%)、优胚率(10.89%)、累积妊娠率(37.5%)低于B、C两组(B组分别为86.5%,83.01%,26.84%,48.78%,C组分别为90%,80.34%,30.86%,50.04%)(均P<0.05),D组的受精率(67.17%)也低于B、C两组(83.01%,80.34%)(P<0.05),D组的优胚率、累积妊娠率(23.84%,47.82%)虽然低于B、C两组(B组分别为26.84%,48.78%,C组分别为30.86%,50.04%),但无明显统计学差异。结论 MⅡ卵子数与HCG注射日14 mm以上卵泡数的比率对ICSI的妊娠结局有一定的预测作用。因此,HCG注射日成熟卵泡的充分获得是ICSI-胚胎移植周期中获得足够可用胚及保障妊娠和健康婴儿的必要条件。

Objective To study the relationship between the rate of MⅡ oocyte and dominant follicles on HCG and embryo development and pregnancy outcomes during intracytoplasmic sperm injection and embryo transfer procedure. Methods A total of 460 intracytoplasmic sperm injection(ICSI) cycles were conducted. The cycles were classified into 4 groups according to the rate: less than 50% as group A, 50% to 80% as group B, 80% to 120% as group C, 120% to 140% as group D. Embryo development and pregnancy outcomes were compared among the four groups. Results There were significantly lower in group A than B, C groups in maturation rate of oocytes, fertilization rate, high quality embryo rate and cumulative pregnancy rate(A group 56.62%, 4.1%, 10.89%, 7.5% vs. B group 86.5%, 83.01%, 26.84%, 48.78%, C group 90%, 80.34%, 30.86%, 50.04%)(P<0.05). The cases from group D obtained lower fertilization rate(67.17%) than group B(83.01%) and group C(83.01%)(P<0.05). Conclusion Mature oocyte retrieved rate may determine the outcomes of ICSI, not the number of retrieved oocyte.