常规IVF不受精周期行补救卵母细胞单精子注射

【目的】探讨常规体外受精胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)不受精时,应用卵母细胞单精子显微注射(intracytoplasmic sperm injection,ICSI)技术进行补救授精的临床意义。【方法】2001年8月～2005年8月,在499个常规IVF-ET周期中有25个周期完全不受精,进行补救ICSI,并与同期实施的179个正常ICSI周期进行比较。【结果】补救ICSI组与正常ICSI组比较,HCG日平均血清雌二醇水平、每个成熟卵泡平均血清雌二醇量、每个周期的获卵数无明显差别,补救ICSI受精率为57.7%,低于正常ICSI组(67.8%),补救ICSI组平均每个周期获得胚胎数(7.8±3.9)比正常ICSI(10.0±4.9)组少,且有统计学意义(P<0.01)。补救ICSI组≥4细胞的胚胎占总胚胎数的54.5%,低于正常ICSI组(87.5%),有统计学意义(P<0.01)。正常ICSI组妊娠率为38.5%,补救ICSI组无一例妊娠。补救ICSI组中有8例在下一周期行ICSI,有2例妊娠并分娩2个健康女婴。【结论】补救ICSI虽可以避免取消IVF周期,但其受精率和妊娠率低,其临床应用价值还有待于进一步探讨。对于常规IVF不受精的患者,再次治疗时可考虑行ICSI助孕。

常规受精和卵母细胞胞浆内单精子注射受精在获卵较少周期的临床结局比较

目的探讨体外受精—胚胎移植(IVF-ET)周期中,获卵数较少的患者受精方式的选择。方法选择在该院进行IVF-ET,女方获卵数≤3的夫妇做为研究对象。根据女方年龄分为≥35岁组和<35岁组,根据精液情况分为正常精液ICSI组和少弱精ICSI组,分别比较各组内的2PN率、卵裂率、临床妊娠率、着床率及活婴产率。结果对于获卵数较少的夫妇,不论女方年龄是否≥35岁,采取常规受精与采取单精子注射受精的2PN率、卵裂率、临床妊娠率、着床率及活婴产率均没有显著性差异。精液正常行ICSI和少弱精行ICSI的2PN率、卵裂率、临床妊娠率、着床率及活婴产率均没有显著性差异。结论 IVF治疗时,获卵数较少的夫妇单精子注射并不能改善妊娠结局,受精方式的选择仍以精液指标为准。

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

【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。

激光鉴别存活精子行卵母细胞胞浆内单精子注射的应用效果

目的探讨利用激光鉴别存活精子在卵母细胞胞浆内单精子注射(ICSI)中的应用效果。方法随机选取生殖中心经睾丸穿刺活检后实施卵母细胞胞浆内单精子注射的患者15例作为观察对象,将其中获得成熟卵母细胞随机分为2组,激光组采用激光法来鉴别存活精子后实施ICSI,对照组操作依照人员经验选择尾部柔软的精子实施ICSI。比较2组卵母细胞的受精率、卵裂率、优质胚胎率。结果患者平均年龄(31.07±3.33)岁,平均不孕年限(4.27±2.12)年,促性腺激素(Gn)平均使用天数(12.33±0.98)d,Gn平均使用量(1 993.27±353.36)IU,HCG日E2水平(2 602.87±625.92)pg/mL;采用不同方法鉴别存活精子实施ICSI后,2组卵母细胞的成熟率分别为84.26%、84.88%,受精率分别为61.33%、61.64%,2组比较差异无统计学意义(P>0.05);激光组的卵裂率为97.83%,对照组的卵裂率为93.48%,2组比较差异无统计学意义(P>0.05);激光组优质胚胎率为60.47%,高于对照组的37.78%(P<0.05)。结论采用激光法可以有效鉴别严重弱精子症患者精子存活的情况,达到与目前技术一致的受精率,同时有助于提高ICSI后卵裂率和优质胚胎率,是严重弱精子症患者ICSI技术的有利辅助方法。

影响卵母细胞胞浆内单精子注射效率的精子相关因素

卵母细胞胞浆内单精子注射(ICSI)技术作为辅助受精的一种手段,自从出现以来,就显示出广泛的应用前景。ICSI将体外受精和胚胎的显微操作技术相结合,大大降低对精子质量的要求,在畜牧业生产实践和哺乳动物生殖生理的基础研究中都有着十分重要的意义。然而,ICSI过程中的每一个环节都可能影响到其效果,最主要和最根本的影响因素是精子和卵子本身的状态。论文就精子有关方面的因素,简要综述了精子顶体与核周鞘、细胞骨架与中心粒、DTT处理和卵母细胞激活因子(SOAF)等对ICSI的影响。

牛卵母细胞浆内单精子注射的研究进展

卵母细胞浆内单精子注射(ICSI)技术是20世纪80年代发展起来的一种人工辅助生殖技术。目前,ICSI技术已经成功的用于生产试管婴儿,治疗人类的男性不育。在牛上,ICSI技术主要用于生产性控胚胎以及受精机理和转基因的研究。作者综述了牛ICSI技术的研究现状和研究进展,重点讨论了牛ICSI技术的各种影响因素,阐述了ICSI技术目前存在的问题,并展望了ICSI技术的应用前景。

卵母细胞胞浆内单精子注射的临床应用研究

目的 观察卵母细胞胞浆内单精子注射 (ICSI)治疗不孕症的临床疗效。 方法 1 998年 1 1月～2 0 0 2年 1 2月对我院生殖中心 93例不孕患者进行ICSI治疗 93个周期。 结果 共获卵 1 0 78个 ,获卵率 90 .0 0 % ;卵裂 80 6个 ,卵裂率 89.3 6% ;受精率 74.77%。临床妊娠 3 3例 ,妊娠率 3 5 .48% ;已成功分娩2 5例。

减少卵子老化对于补救性卵母细胞单精子显微注射结局的影响

Objective: To evaluate the results of a novel protocol that allows to rescue IVF unfertilized oocytes by intracytoplasmic sperm injection (ICSI).Design: Prospective clinical trial.Setting: Private reproductive medical center.Patient(s): Thirty patients undergoing IVF.Intervention(s): Controlled ovarian stimulation (COS), conventional IVF, rescue ICSI, embryo culture, and embryo transfer.Main Outcome Measure(s): Identification of unfertilized IVF oocytes 6 hours after insemination and fertilization, and developmental rates of those oocytes after rescue microinjection, as well implantation and pregnancy rates (PR).Result(s): All oocytes (392) from 30 patients were inseminated with standard IVF 3 hours after ovum pick- up.Polar body (PB) status was checked at decumulation and rechecked 3 hours later.Eighty- two oocytes were fertilized after IVF alone and 184 nonactivated oocytes (failed fertilization) were rescue microinjected and 166 of them fertilized (20 patients).Cleavage stage on day 2 was significantly more advanced and embryo grade was higher after standard IVF fertilization than after rescue ICSI.Eight of the 30 embryos transferred were implanted in the IVF- only patients (27% )- and 8 of 68 embryos in the rescue ICSI patients (12% ).Conclusion(s): Rescue ICSI of unfertilized IVF oocytes 6 hours after insemination (9 hours after egg retrieval) can provide normal fertilization, embryo development, and pregnancy; however, corresponding outcome parameters tend to be impaired in comparison to the standard IVF fertilization results.

在体外受精和卵母细胞单精子显微注射结局中由精子染色质散布试验测得的精子脱氧核糖核酸碎片水平的价值

Objective: To determine the prognostic value of sperm DNA fragmentation levels, as measured by the sperm chromatin dispersion (SCD) test, in predicting IVF and ICSI outcome. Design: Double- blind prospective study. Setting: University- affiliated private IVF setting. Patient(s): A total of 85 couples undergoing infertility treatment with IVF/ICSI. Intervention( s): Analysis of DNA fragmentation by the SCD test in 170 aliquots obtained from the ejaculate and from the processed semen used for assisted reproductive technologies (ART). Main Outcome Measure(s): Percentage of spermatozoa with fragmented DNA was statistically correlated with embryo quality and reproductive success. Result(s): Fertilization rate was inversely correlated with DNA fragmentation (r =- 0.245 P=.045). Higher DNA fragmentation rate gave an increased proportion of zygotes showing asynchrony between the nucleolar precursor bodies of zygote pronuclei (73.8% vs. 28.8% P < .001). In addition, the slower embryo development and worst morphology on day 6 was correlated with higher sperm DNA fragmentation (47.7% vs. 29.4% P=.044). We also observed a negative correlation between DNA fragmentation and the implantation rate (r =- 0.250 P=.042). However, SCD test values were not statistically different in cycles that resulted in a pregnancy compared with those that did not (33.2 vs. 28.2 and 32.4 vs. 34.7). Conclusion(s): This is the first report that describes a correlation between sperm DNA integrity, asmeasured by the SCD test, and fertilization rate, embryo quality, and implantation rate in IVF/ICSI. The degree of DNA fragmentation was inversely correlatedwith fertilization rate, synchrony of the nucleolar precursor bodies’ pattern in pronuclei, embryo ability to achieve blastocyst stage, and embryo morphological quality. Because SCD test values were correlated with embryo quality and blastocyst rate, the lack of correlation between sperm DNA fragmentation and pregnancy outcome in IVF might be due to embryo selection before transfer. The ability of the SCD test to predict the blastocyst rate after IVF/ICSI warrants further study.

行卵母细胞单精子显微注射且年龄≥40岁的患者使用促性腺激素释放激素类似物进行控制性超促排卵治疗短期或长期方案的比较

To determine whether the short or long protocol for controlled ovarian hyperstimulation works better in older patients undergoing IVF. Design: Controlled, randomized study. Setting: A single private IVF center. Patient(s): Two hundred twenty infertile women aged ≥ 40 years undergoing IVF.Intervention(s): At their first IVF cycle, the women were randomized into two stud groups according to a computer-generated number sequence: 110 patients were treated with a long protocol, and the other 110 were treated with a short protocol for controlled ovarian hyperstimulation. Main Outcome Measure(s): Days of stimulation, E2 level at the day of hCG administration, amount of FSH administered, number of oocytes collected, number of embryos obtained, pregnancy rate, implantation rate. Result(s): Patients treated with a long protocol showed a significantly higher number of oocytes retrieved, a higher number of embryos obtained, and a higher pregnancy rate, both for cycle and transfer, compared with the short-protocol patients. The other parameters evaluated did not show any statistically significant differences. Conclusion(s): Our study showed that the long protocol performed better than the short protocol in older women. Our findings demonstrated that flare-up in older women might be detrimental.

卵母细胞内单精子注射是所有体外受孕病例应选择的治疗方式吗?

卵母细胞内单精子注射(ICSI)以其高受精率和妊娠率已经逐渐替代了常规体外受精(IVF)和其他类型的显微操作,而作为对严重男性不育的首选治疗方法。自从将单个精子注射入卵母细胞而成功获得妊娠的第一例报道以来,这项技术已在世界各地被广泛应用。

辅助孵化对卵母细胞单精子显微注射结局的影响:一项前瞻性随机临床试验及妊娠追踪观察

Objective: To evaluate the overall effect of assisted hatching (AH) on the implantation, pregnancy, and live birth rates in women undergoing intracytoplasmic sperm injection (ICSI)- cycles; and to determine the effect of AH on the cytogenetic outcome (chromosomal constitution) of pregnancy.Design: Prospective, randomized study.Setting: Academic research environment.Patient(s): A total of 172 couples were enrolled in the study.Intervention(s): Assisted hatching was carried out on day- 3 ICSI embryos.Main Outcome Measure(s): Implantation, clinical pregnancy, and live birth rates; cytogenetic analysis of abortuses and umbilical cord blood samples from newborns.Result(s): Biochemical, clinical, and ongoing pregnancy rates were not significantly different between the AH and control groups.The implantation rate was higher in the AH group than in the control group (16% vs.8% ), especially in women aged ≥ 35 years.Postnatal umbilical cord blood samples were collected and cytogenetically analyzed from 39 live births (20 from the AH group, 19 from the control group).Two abnormal karyotypes were found (one AH, one control).There were seven spontaneous losses during the study interval.Six of the abortuses underwent cytogenetic study (five AH, one control), and four were found to have an abnormal karyotype (three AH, one control). Conclusion: We found that AH improves implantation rates of ICSI cycles and seems to be most effective in women aged ≥ 35 years.A larger sample size is needed to determine whether AH improves the take- home- baby rate.Assisted hatching did not affect the rate of chromosomal abnormalities in live births in this study.

睾丸精子卵母细胞浆内注射治疗梗阻性无精子症所致不育的临床体会

目的:探讨睾丸精子单精子卵母细胞浆内注射(ICSI)治疗梗阻性无精子症所致的男性不育的疗效,以完善辅助生殖技术。方法:选男性不育症夫妇905例分成两组:ICSI组和TESE+ICSI组。ICSI组自行排精后精液内可以找到正常形态活精子的少精症患者行ICSI治疗共863例,TESE+ICSI组经附睾抽吸取精失败而睾丸切开后可找到形态正常活精子的梗阻性无精子症患者用睾丸内精子行ICSI治疗共42例,两组患者的女方均给予超促排卵用药后获取卵母细胞。结果:ICSI组863周期,获得卵子9650个,其中成熟卵母细胞7879个,ICSI7879个,移植808个周期,妊娠256例,妊娠率为31·68%。TESE+ICSI组42周期,获得卵子567个,其中成熟卵母细胞479个,ICSI479个,移植42个周期,妊娠20例,妊娠率为47·60%。对两组的受精率、优质胚胎获得率、临床妊娠率进行比较及统计学分析,TESE+ICSI组的受精率稍低于ICSI组(P<0·05),而两组的优质胚胎获得率及临床妊娠率无显著差异(P>0·05)。结论:睾丸切开取精子进行ICSI治疗同样能够得到较高的受精率、优质胚胎获得率和临床妊娠率。

单精子卵细胞显微注射治疗男性不育的护理

简述单精子卵细胞显微注射治疗男性不育的操作步骤,并从治疗前的心理护理、使用药物的注意事项、术前准备、取卵术后护理、胚胎移植术后的护理等方面报告17例单精子卵细胞显微注射治疗男性不育的配合及护理报告。

乙肝病毒携带者睾丸穿刺取精卵母细胞浆内注射结局

目的 探讨乙肝病毒（HBV）携带者卵母细胞浆内单精子注射（ICSI）后的妊娠效果. 方法 根据患者血清乙肝表面抗原（HBsAg）是否阳性将206个ICSI周期分为3组,女性乙肝病毒携带者组（HBsAg＋、HBeAg＋、HBcAb＋,乙肝大三阳;HBsAg＋、HBeAb＋、HBcAb＋,乙肝小三阳）,男性乙肝病毒携带者组（乙肝大三阳,乙肝小三阳）和对照组,乙肝病毒携带者组和对照组分别比较平均获卵数、受精率、卵裂率、优质胚胎率和临床妊娠率.结果 女性HBV携带组受精率、卵裂率、优质胚胎率和临床妊娠率（84.2％、90.0％、80.7％、25.7％）与对照组（90.3％、97.2％、83.2％、34.2％）比较,差异有统计学意义;男性HBV大三阳组,小三阳组的受精率（88.4％、84.7％）、卵裂率（96.1％、92.0％）、优质胚胎率（89.5％、72.3％）、临床妊娠率（24.0％、26.2％）分别与对照组比较,差异有统计学意义. 结论 乙肝病毒携带者行ICSI后的临床妊娠较正常对照组下降。

小鼠卵母细胞慢速冷冻的初步研究——附人妊娠分娩1例报道

目的:探讨不同浓度蔗糖联合丙二醇(PROH)冷冻保护剂对小鼠卵母细胞冻融的影响。方法:①观察不同蔗糖浓度(0.1mol/L、0.2mol/L、0.3mol/L)联合应用1.5mol/L的PROH对小鼠卵母细胞复苏率的影响。②对1例采卵日未能取得精子的不孕症患者,应用0.3mol/L蔗糖联合1.5mol/LPROH将其卵母细胞用慢速冷冻方法冷冻保存,随后解冻并移植。结果:①随着蔗糖浓度的提高,卵母细胞复苏率也随之升高,0.3mol/L蔗糖组复苏率达74%。②1例患者卵母细胞复苏后行卵胞浆内ICSI-ET,获临床妊娠,妊娠中期羊水染色体核型分析正常,妊娠35周因妊高征剖宫产1健康男婴。结论:对卵母细胞慢速冷冻中,适当提高蔗糖浓度可获得较满意的复苏率、受精率及卵裂率,胚胎移植后能够出生健康新生儿。