国际生殖健康/计划生育杂志

国际生殖健康/计划生育杂志 ›› 2023, Vol. 42 ›› Issue (4): 272-276.doi: 10.12280/gjszjk.20230026

• 论著 • 上一篇    下一篇

卵细胞质内单精子注射后多原核发生率对胚胎发育和妊娠结局的影响

倪丹玉, 杨烨, 谢奇君, 姜薇, 凌秀凤()   

  1. 210004 南京医科大学附属妇产医院（南京市妇幼保健院）生殖医学中心
  • 收稿日期:2023-01-29 出版日期:2023-07-15 发布日期:2023-07-26
  • 通讯作者: 凌秀凤 E-mail:lingxiufeng_njfy@163.com
  • 基金资助:
    国家自然科学基金(81871210)

The Effect of Poly-Pronucleus Incidence on Embryo Development and Pregnancy Outcome after ICSI

NI Dan-yu, YANG Ye, XIE Qi-jun, JIANG Wei, LING Xiu-feng()   

  1. Center of Reproductive Medicine, Women′s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
  • Received:2023-01-29 Published:2023-07-15 Online:2023-07-26
  • Contact: LING Xiu-feng E-mail:lingxiufeng_njfy@163.com

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摘要：

目的:探讨多原核（pronucleus，PN）发生率对卵细胞质内单精子注射（intracytoplasmic sperm injection，ICSI）胚胎发育和妊娠结局的影响。方法:回顾性分析南京医科大学附属妇产医院生殖医学中心2016年1月—2021年12月行ICSI助孕治疗患者的临床资料。根据多PN发生率分为3组：对照组（多PN发生率=0%，n=333）、低频多PN组（0%<多PN发生率<20%，n=80）和高频多PN组（多PN发生率≥20%，n=31）。分别比较各组间胚胎发育潜能及妊娠结局情况。结果:与对照组相比，低频多PN组的获卵总数、D3可利用胚胎数增多，正常受精率降低（均P<0.017）。与对照组和低频多PN组相比，高频多PN组正常受精率、D3可利用胚胎数显著降低（均P<0.017）；虽然生化妊娠率低、流产率高，但是差异无统计学意义（P>0.017）。多因素二元Logistic回归分析结果显示，与对照组相比，高频多PN组生化妊娠率（aOR=0.402，95%CI：0.186~0.870，aP=0.021）和活产率（aOR=0.247，95%CI：0.068~0.901，aP=0.034）显著降低。结论:在ICSI周期中，多PN发生率可能反映卵母细胞质量，多PN发生率≥20%预示着胚胎发育情况较差，生化妊娠率、活产率显著降低。

关键词: 精子注射，细胞质内, 原核细胞, 胚胎发育, 妊娠结局

Abstract:

Objective: To explore the impact of poly-pronucleus (PN) incidence on the embryonic development and pregnancy outcome after intracytoplasmic sperm injection (ICSI). Methods: This is a retrospective cohort study, analyzing the clinical data of patients after ICSI between January 2016 and December 2021. The objects of study were divided into three groups according to the proportion of poly-PN: the control group (the proportion of poly-PN=0%, n=333), the low-frequency poly-PN group (0%<the proportion of poly-PN<20%, n=80) and the high-frequency poly-PN group (the proportion of poly-PN≥20%, n=31). The embryonic development and pregnancy outcomes were compared among the groups, respectively. Results: The numbers of oocytes retrieved and available embryos on day 3 (D3) were higher in the low-frequency poly-PN group than those in the control group, but the rates of normal fertilization and high-scoring blastocyst formation were lower than those in the control group (all P<0.017). Compared with the control group and the low-frequency poly-PN group, the high-frequency poly-PN group had lower rate of normal fertilization rate, lower number of available embryos on D3 (all P<0.017), and low rate of biochemical pregnancy and high miscarriage rate (but P>0.017). Multifactorial Logistic analysis showed that patients in the high-frequency poly-PN group had significantly lower biochemical pregnancy rate and live birth rate when compared with the control group (aOR=0.402, 95%CI: 0.186-0.870, aP=0.021; aOR=0.247, 95%CI: 0.068-0.901, aP=0.034). Conclusions: In the ICSI cycles, the incidence of poly-PN may reflect oocyte quality, and the incidence of poly-PN≥20% may predict the poor embryo development, lower biochemical pregnancy rate and lower live birth rate.

Key words: Sperm injections, intracytoplasmic, Prokaryotic cells, Embryonic development, Pregnancy outcome