授精后5h补救性卵胞浆内单精子显微注射的临床应用价值

山东大学学报(医学版) ›› 2011, Vol. 49 ›› Issue (10): 139-142.

授精后5h补救性卵胞浆内单精子显微注射的临床应用价值

杨慧军1, 李媛1, 吴克良1, 李梅1, 车詈2, 马水英1, 仲万霞1, 陈子江1

1.山东大学附属省立医院生殖医学中心；国家辅助生殖与优生工程技术研究中心；
生殖内分泌教育部重点实验室；山东省生殖医学重点实验室, 济南 250021;
2. Case Western Reserve University, Cleveland, Ohio 44106, USA

收稿日期:2011-05-27 出版日期:2011-10-10 发布日期:2011-10-10
通讯作者: 陈子江(1959- )，教授，博士生导师，主要从事人类生殖医学领域的研究。 Email: chenzijaing@hotmail.com
作者简介:杨慧军(1978- )，女，博士研究生，主要从事辅助生殖医学研究。
基金资助:
国家重点基础研究发展计划(973项目)资助课题(2007CB948103);国家重点基础研究发展计划(973项目)资助课题（2011CB944502）

Value of rescue intra-cytoplasmic sperm injection 5 hours post-insemination in in vitro fertilization

YANG Hui-jun1, LI Yuan1, WU Ke-liang1, LI Mei1, CHE Li2, MA Shui-ying1, ZHONG Wan-xia1, CHEN Zi-jiang1

1. Center for Reproductive Medicine, Provincial Hospital Affiliated to Shandong University National Research Center for
Assisted Reproductive Technology and Reproductive Genetics, China The Key laboratory for Reproductive Endocrinology of
Ministry of Education Shandong Provincial Key Laboratory of Reproductive Medicine 324 Jingwu Road, Jinan, 250021, China;
2. Case Western Reserve University, Cleveland, Ohio 44106, USA

Received:2011-05-27 Online:2011-10-10 Published:2011-10-10

摘要/Abstract

摘要：

目的探讨授精后5h对可能受精失败的卵子行补救性卵胞浆内单精子显微注射(ICSI)的可行性。方法授精后3、4、5h分别观察卵子是否排出第二极体。若已经排出第二极体，则认为卵子已经被激活，是受精的征象。如果患者在授精后5h观察少于65%的卵子排出第二极体，则剩余的只有第一极体的卵子接受补救性ICSI。1050例接受体外受精-胚胎移植(IVFET)的患者，按照有无补救性ICSI 将患者分为2组：Ⅰ组：部分接受补救性ICSI，本组又按照有无补救性ICSI将卵子分为两部分：补救性ICSI部分及IVF部分；Ⅱ组：未接受补救性ICSI。201例接受ICSI治疗的患者作为对照组。结果 ①Ⅰ组患者卵子在授精后3、4、5h第二极体排出率均低于Ⅱ组(P<0.05)，Ⅰ组患者原发不孕的比例、不明原因性不孕的比例高于Ⅱ组(P<0.05)；②Ⅰ组、Ⅱ组、对照组，受精率、多精受精率、临床妊娠率、种植率均无显著性差异(P>0.05)，但Ⅰ组补救性ICSI部分卵子优胚率低于Ⅱ组和对照组(P<0.05)。结论 IVF中精卵共培养3h是可行的；授精后5h第二极体的排出可作为卵子激活的征象；授精后5h行补救性ICSI可获得可观的临床结局，且不会增加多精受精率；低受精率可能更易出现在原因不明性不孕及原发不孕患者。

关键词: 短时授精；极体；补救性卵胞浆内单精子显微注射

Abstract:

Objective To assess the value of rescue intracytoplasmic sperm injection(ICSI) 5 hours post-insemination (hpi) with short co-incubation in in vitro fertilization-embryo transfer(IVF-ET). Methods Extrusion of the second polar body was observed 3, 4, and 5 hpi, and that oocytes extruded the second polar body were regarded as fertilization. If less than 65% of oocytes from 1 patient were observed to extrude the second polar body 5 hpi, the remaining oocytes with only the first polar body underwent rescue ICSI. 1050 patients who received IVF were divided into group Ⅰ: partly receiving rescue ICS I, and group Ⅱ: without rescue ICSI. Oocytes in group Ⅰwere divided into rescue ICSIoocytes and only IVF oocytes. 201 patients in the control group received ICSI. Results ① The rates of oocytes which extruded the second polar body 3, 4, and 5 hpi in groupⅠ were all lower than those in group Ⅱ(P<0.05), and the rates of primary infertility and unexplained infertility in groupⅠ were higher than those in groupⅡ(P<0.05). ② No difference existed in fertilization rate, poly-spermic rate, clinical pregnancy rate, and implantation rate among rescue ICSI oocytes in groupⅠ,the control group, and groupⅡ(P>0.05). The rate of high quality embryo oriented from rescue ICSI oocytes in groupⅠ was lower than that in group Ⅱ and the control group(P<0.05). Conclusions Gamete co-incubation for 3h is feasible in IVF. Extrusion of the second polar body 5 hpi is regarded as fertilization. Early rescue ICSI 5 hpi results in satisfactory clinical outcomes, while the poly-spermic rate is not increased. Primary infertility and unexplained infertility are liable to have a low fertilization rate.

Key words: Short incubation; Polar body; Rescue intracytoplasmic sperm injection

中图分类号:

R711.6

杨慧军1, 李媛1, 吴克良1, 李梅1, 车詈2, 马水英1, 仲万霞1, 陈子江1. 授精后5h补救性卵胞浆内单精子显微注射的临床应用价值[J]. 山东大学学报(医学版), 2011, 49(10): 139-142.

YANG Hui-jun1, LI Yuan1, WU Ke-liang1, LI Mei1, CHE Li2, MA Shui-ying1, ZHONG Wan-xia1, CHEN Zi-jiang1. Value of rescue intra-cytoplasmic sperm injection 5 hours post-insemination in in vitro fertilization[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(10): 139-142.

参考文献

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed

[1]	哈灵侠1,2, 石玉华1, 赵君利2, 陈子江1. 宁夏地区多囊卵巢综合征患者不同雄激素状态脂代谢特点的比较性分析[J]. 山东大学学报(医学版), 2013, 51(9): 88-91.
[2]	王玮1,滑天2,曹金凤1,崔娜1,杨爱敏1,姜蕾1,郝桂敏1. 来曲唑在多囊卵巢综合征促排卵中的应用[J]. 山东大学学报(医学版), 2013, 51(06): 25-28.
[3]	郑荣华，石玉华，盛燕，高芹，高选，陈子江. 多囊卵巢综合征患者白细胞计数的变化特点[J]. 山东大学学报(医学版), 2012, 50(7): 78-80.