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。

单精子卵细胞显微注射治疗严重男性因素不育17个周期的临床分析

目的 :观察应用单精子卵细胞显微注射治疗严重男性因素不育的临床效果。方法 :应用单精子卵细胞显微注射法。结果 :在 1 7例患者的 1 7个周期中 ,共获 6例妊娠 ,妊娠率达 35.3%。结论 :对由严重男性因素引起不育的患者应用单精子卵细胞显微注射技术要比常规体外受精

卵细胞浆单精子显微注射(ICSI)治疗不育67个周期分析

目的 :分析卵细胞浆内单精子显微注射授精 (ICSI)治疗因少弱精及梗阻性无精症所致之不育症的临床效果。方法 :采用 Gn RH-α+ FSH/ h MG+ h CG促排卵 ,对成熟卵细胞 (M )进行显微注射授精 ,受精卵体外培养 3天后移植回子宫腔。结果 :6 7个周期获成熟卵 (M ) 5 86个 ,受精率 76 .2 8%。临床妊娠率 2 5 .37%。结论 :ICSI是治疗不育的有效方法。

两种精子处理方法的卵细胞胞质内单精子显微注射结局的比较

目的：评价密度梯度离心和改良上游法两种处理活动精子的分离方法在卵细胞胞质内单精子显微注射（ICSI）中的效果，从而指导临床应用。方法：选取2004年10月-2005年4月在本中心完成的42例患者42个周期为研究对象，前瞻性比较了两种精子分离方法的受精率、卵裂率、优质胚胎率、临床妊娠率、精子畸形率、精子回吸收率等。结果：两种方法分离精子所获得的ICSI胚胎移植（ICSI—ET）中，受精率、卵裂率、优胚率、临床妊娠率均无明显差异，但是改良上游法所获得的精子畸形率明显高于密度梯度离心法（P〈0，01）；重度少精子症密度梯度离心法回吸收精子优于改良上游法（P〈0．01）。结论：在辅助生育技术ICSI—ET中，密度梯度离心法分离活动精子临床妊娠结局与改良上游法无明显差异；除对重度少精子症者外，均可以采用改良上游法。

体外受精失败后不同时间行补救性卵细胞浆单精子显微注射的对比分析

目的 通过对常规体外授精(IVF)失败(未观察到第二极体)后不同时间行补救性卵细胞浆单精子显微注射(ICSI)的临床资料比较,探讨补救性ICSI的最佳时间. 方法 回顾性分析常规体外授精(IVF)失败后6 h(早期组)与22 h(传统组)行补救性ICSI的临床资料,比较两组的受精率、卵裂率、优胚率、种植率和妊娠率. 结果 早期组受精率、种植率、临床妊娠率分别为74.6%(56/75)、37.5%(9/24)、53.8%(7/13);传统组受精率为63.0%(29/46)、种植率和临床妊娠率均为0.早期组7例妊娠中4例单胎,3例流产;早期组和传统组受精率比较,差异无统计学意义,妊娠率和种植率比较,差异有统计学意义(P【0.05); 结论 早期补救性ICSI在受精率、种植率和临床妊娠率上可能优于传统补救性ICSI.

基于微型机器人的显微注射系统设计与实验

针对传统显微注射操作中手动操作难度大、成本高等问题,设计了一种基于微型机器人的低成本显微注射系统.首先,介绍三自由度微型机器人、信号控制器和功率放大器的结构和设计原理.其次,分析机器人在平面和垂直方向的运动性能.在驱动信号100 Hz时,平面尺蠖式蠕动速度可达32.5μm/步;在驱动信号高于200 Hz时,步进分辨率小于5μm;垂直方向运动最大范围5 mm,最小分辨率达2μm,满足实际要求.最后,设计了显微针对插、虾卵细胞吸附固定实验和虾卵细胞注射实验,结果表明,本文方案操作简单、重复性强,显微注射成功率达88%.

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.

受精前卵细胞卵周腔显微注射法制备转基因动物

在医学实验动物模型、生物反应器、器官移植、禽畜活体内的基因表达调控、禽畜育种及品种改良等科学研究领域中,转基因动物技术有着广泛的应用前景[1]。目前转基因动物的制备,主要是在动物胚胎发育的不同阶段采用原核显微注射法、逆转录病毒载体法和胚胎干细胞法等技术,但...

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.

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。

利用爪蟾卵母细胞建立人类低密度脂蛋白受体基因表达系统

目的 在爪蟾卵母细胞中建立人类低密度脂蛋白受体基因的表达系统,此系统可被用于降血脂和抗动脉粥样硬化的研究。方法和结果 冰块麻醉爪蟾,切取卵巢,获得V、VI期卵母细胞,经用1g/L胶原酶孵育过夜除去卵母细胞外层的卵巢膜和滤泡膜,培养3天后存活率仍可达95 %以上。用DiI标记的低密度脂蛋白荧光配体测定膜上结合荧光,发现V、VI期卵母细胞膜上未见有内源性低密度脂蛋白受体,如将人低密度脂蛋白受体的表达质粒p3.7低密度脂蛋白导入爪蟾卵母细胞核中,培养后用DiI标记的低密度脂蛋白配体测定可见膜上发出红色荧光,用抗低密度脂蛋白受体的抗体经免疫荧光检测法测定可见膜上有绿色荧光,免疫胶体金标记透射电镜检测可见膜上有内吞的胶体金颗粒。结论 外源性的人类低密度脂蛋白受体基因能在爪蟾V、VI期卵母细胞中表达,此低密度脂蛋白受体基因表达系统可用于中药降血脂抗动脉粥样硬化机理的研究。

促性腺激素释放激素激动剂或拮抗剂治疗时,卵母细胞成熟度和植入前发育与卵泡直径的关系

Objective: To analyze the distribution of oocytes nuclear maturational stages and intracytoplasmic sperm injection (ICSI) outcome in relation to follicular size, after controlled ovarian hyperstimulation (COH), using gonadotropin- releasing hormone (GnRH) antagonist or agonist protocols. Design: Prospective comparative study. Setting: Fertility unit in an academic hospital. Patient(s): Normo- ovulatory patients with unexplained, male and/or tubal factor infertility undergoing ICSI treatment. Intervention(s): Oocytes were retrieved from small (7- 12 mm) and large follicles (>12 mm). Main Outcome Measure(s): Oocyte nuclear maturation stage, fertilization and preimplantation embryonic development of the mature ova evaluated. Result(s): Distribution of oocyte maturation stages from small follicles did not differ between the two COH protocols. From large follicles, a statistically significantly higher percentage of immature oocytes was retrieved after antagonist compared with agonist treatment (16 vs 11% , respectively). No statistically significant differences existed regarding ICSI outcome of mature ova within the same follicle diameter range between COH protocols. Inseminated ova from small follicles presented a significantly higher number of embryos with delayed development on day 3 after ICSI. Conclusion(s): A greater heterogeneity of maturity was found in the population of oocyte stages that were present after the antagonist protocol. Matured oocytes retrieved from small follicles generated embryos of lower developmental potential than oocytes derived from larger follicles.

睾丸细针抽吸精子行卵细胞浆内单精子显微注射的临床研究

目的 探讨睾丸细针抽吸精子行卵细胞浆内单精子显微注射 (ICSI)的临床价值。方法 本中心在建立稳定的体外受精 胚胎移植 (IVF ET)基础上 ,采用控制性超排卵方案并使用改良的显微操作系统 ,对 8例 (8个周期 )梗阻性无精子症患者以睾丸细针抽吸精子行ICSI术治疗。结果 其受精率、优秀胚胎率和临床妊娠率分别为 80 %(80 / 10 0 )、6 4.3% (4 5 / 70 )和 6 2 .5 % (5 / 8)。

胚胎早裂联合胚胎发育速度及形态评分在胚胎选择中的应用

目的探讨胚胎早裂联合胚胎发育速度及形态评分对于体外授精/卵母细胞单精子显微注射(IVF/ICSI)周期中胚胎选择的意义。方法IVF/ICSI 610周期,随机分为A、B两组。A组(269周期)单以授精后72 h(D3)胚胎发育速度及形态评分选择胚胎;B组(341周期)在此基础上联合胚胎早裂情况进行胚胎选择。比较两组的临床妊娠率和单胚着床率;比较B组移植胚胎中有早裂胚胎和无早裂胚胎者的妊娠结局。结果B组临床妊娠率和单胚着床率均高于A组(P<0.05);B组移植胚胎中有早裂胚胎者的临床妊娠率和单胚着床率均高于无早裂胚胎者(P<0.01)。结论与单纯的胚胎发育速度及形态评分比较,胚胎早裂联合胚胎发育速度及形态评分进行胚胎评价可显著改善IVF/ICSI的临床结局。

附睾或睾丸精子对梗阻性无精子症ICSI治疗结局影响的系统评价

目的:系统评价梗阻性无精子症患者选择附睾精子或睾丸精子行ICSI治疗对其临床结局的影响。方法:通过计算机检索Pub Med、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2015年12月有关梗阻性无精子症患者采用附睾精子或睾丸精子行ICSI治疗的文献,由2位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用Rev Man5.3软件进行meta分析。结果:共纳入14项试验研究,包括梗阻性无精子症患者1 278例,共计1 552个周期。Meta分析结果显示:梗阻性无精子症患者行ICSI治疗,附睾精子比睾丸精子具有更好的受精率[RR=1.08,95%CI(1.05,1.11),P<0.01];附睾精子和睾丸精子的卵裂率[RR=1.04,95%CI(0.99,1.10),P=0.13]、优质胚胎率[RR=1.01,95%CI(0.93,1.09),P=0.85]、种植率[RR=1.14,95%CI(0.75,1.73),P=0.55]、临床妊娠率[RR=1.14,95%CI(0.98,1.31),P=0.08]以及流产率[RR=0.86,95%CI(0.53,1.39),P=0.54]差异均无统计学意义。结论:梗阻性无精子症患者行ICSI治疗,附睾精子显示出更高的受精率,而在卵裂率、优质胚胎率、种植率、临床妊娠率以及流产率方面,两者临床结局差异不大。

ICSI与常规IVF的临床应用分析

目的:探讨卵母细胞质内单精子显微注射(ICSI)的临床应用价值及其安全性。方法:回顾性分析2008年在我中心接受不孕治疗共1 303周期,其中ICSI组307周期、常规体外受精(IVF)组996周期,比较两组的正常卵裂率、优质胚胎率、可用胚胎率、胚胎种植率、临床妊娠率、流产率、抱婴率及畸形率。结果:两组间的正常卵裂率、优胚率、可用胚胎率,临床妊娠率,流产率、抱婴率及畸形率均差异无统计学意义(P>0.05)。结论:ICSI技术是治疗男性不育的有效方法,其出生后代安全性与常规体外受精—胚胎移植(IVF-ET)相似。