国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2015, Vol. 34 ›› Issue (4): 278-282.

• 论著 • 上一篇    下一篇

体外受精/胞浆内单精子注射中异常受精的影响因素分析

刘佰玲，孙莹璞，代玮，卜志勤   

  1. 450052 郑州大学第一附属医院生殖医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-07-15 发布日期:2015-07-15

Analysis of the Factors Affecting Abnormal Fertilization after in Vitro Fertilization and Intracytoplasmic Sperm Injection

LIU Bai-ling，SUN Ying-pu，DAI Wei，BU Zhi-qin   

  1. Reproductive Medical Center，The First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-07-15 Online:2015-07-15

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摘要： 目的：探讨体外受精（IVF）和胞浆内单精子注射（ICSI）后单原核和多原核受精卵生成的影响因素，为降低异常受精率探寻可行的方法。方法：选取2013年9月—2014年2月本中心2 229个周期[1 425个IVF周期和804个ICSI周期]，共计25 160个卵细胞的临床资料，探讨其IVF和ICSI后异常受精的影响因素。结果：①IVF中单原核受精卵生成率与不孕类型、促性腺激素（Gn）剂量及使用时间无关，但IVF周期中女方年龄＞38岁组单原核受精卵生成率显著高于31～38岁组；②常规IVF周期中多原核受精卵生成率显著高于ICSI组；IVF周期中，当获卵数＞15个、取卵日血清雌二醇（E2）水平＞2 000 pg/mL及人绒毛膜促性腺激素（hCG）日E2水平与取卵日E2差值＞4 000 pg/mL者≥3个原核（3PN）形成率显著升高；ICSI周期中，随着女方年龄的增高，特别是女性大于31岁后多原核受精卵生成率显著增高；③采用多重线性回归分析，ICSI受精组中异常原核受精卵数与女方基础（月经周期第2～3天）的E2及黄体生成激素（LH）值、获卵总数呈线性相关，IVF组中异常原核受精卵数与基础（月经周期第2～3天）FSH及获卵总数呈线性关系，IVF组和ICSI组异常原核受精卵数与hCG注射日孕酮（P）/E2×1 000呈反向线性关系。结论：IVF/ICSI中异常受精生成的机制和影响因素不尽相同，临床工作中要针对不同不孕人群选择合适的受精方式，并在促排卵过程根据患者内分泌及卵泡数的变化情况及时更改用药剂量，有助于降低异常受精率。

关键词: 受精, 体外, 胚胎移植, 精子注射, 细胞质内, 单原核, 多原核

Abstract: Objective: To investigate the factors affecting monopronuclear and polypronuclear zygotes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), so as to explore a feasible method to reduce the abnormal fertilization rate. Methods：A total of 2 229 treatment cycles, including 1 425 IVF cycles and 804 ICSI cycles, data from from 25 160 oocytes in our center from September 2013 to February 2014, were included in this retrospective study. Results：① There were not significant relationship between the incidence of monopronuclear zygotes and those factors, including the type of infertility, the Gn dosage and stimulation days, in IVF cycles. However, the incidence of monopronuclear zygotes in those women aged over 38 years was significantly increased, when compared with women aged 31 to 38 years. ② The incidence of polypronuclear zygotes in IVF group was significantly higher than that in ICSI group. In IVF cycles, the incidence of polypronuclear zygotes was significantly increased when the number of retrieved oocytes was more than 15, the serum estradiol level on the day of retrieved oocytes was more than 2 000 pg/mL, or when the difference of serum estradiol levels on the day of retrieved oocytes and the hCG day was more than 4 000 pg/mL. In ICSI cycles, the incidence of polypronuclear zygotes was significantly increased with the woman′s age, especially for those women aged more than 31 years. ③ Using the multiple linear regression analysis, the number of abnormal fertilized oocytes in ICSI group, was linearly related to the basic levels of E2 and LH （2-3 days during the menstrual cycle） and the total number of eggs, while this value in IVF group was linearly related to the basic level of FSH and the total number of eggs. However, the number of abnormal fertilized oocytes in both IVF and ICSI groups were negatively related with the P/E2×1 000 on the hCG day. Conclusions：The mechanism of abnormal fertilization and its factors are different in IVF treatment and ICSI treatment. It is helpful for reducing the incidence of monopronuclear zygotes and polypronuclear zygotes to use the appropriate fertilization for different infertile women, and to use individual stimulation protocol and adjustable dose of Gn according to their basic endocrine and the number of ovarian follicles.

Key words: Fertilization in vitro, Embryo transfer, Sperm injections, intracytoplasmic, Monopronuclear, Polypronuclear