常规体外受精形成三倍体受精卵的相关因素分析

目的：探讨常规体外受精（IVF）中形成三倍体受精卵的临床影响因素。方法：回顾性分析郑州大学第一附属医院生殖医学中心1987个IVF周期，按照3原核（PN）受精频率分为3组：正常组（3PN%=0， n=754）、低频3PN受精组（0＜3PN%＜20%，n=660）、高频3PN受精组（3PN%≥20%，n=573）。比较分析3组的临床资料、实验室资料以及妊娠结局。结果：患者的年龄、基础卵泡刺激素（bFSH）、促性腺激素（Gn）使用时间及总量、人绒毛膜促性腺激素（hCG）日孕激素（P）值、精液优化后精子浓度差异均无统计学意义（P＞0.05）。正常组的获卵数以及成熟卵数低于低频3PN受精组和高频3PN受精组（P＜0.01）。低频3PN受精组和高频3PN受精组hCG日的雌二醇（E2）水平均高于正常组（P＜0.05），而2组hCG日≥14 mm卵泡率低于正常组（P＜0.01）；3组之间的正常受精率差异有统计学意义（P＜0.01）；正常组的临床妊娠率与低频3PN受精组比较差异无统计学意义（P＞0.05），但高于高频3PN受精组（P＜0.01）。另外，低频3PN受精组和高频3PN受精组的精液优化后精子活动比率高于正常组（P＜0.01），其中，a级、b级精子比例低频3PN受精组和高频3PN受精组高于正常组（P＜0.01），c级、d级精子比例低频3PN受精组和高频3PN受精组低于正常组（P＜0.01）；3组患者的着床率、优质胚胎率、早期流产率差异无统计学意义（均P＞0.05）。结论：hCG日较高E2水平与3PN发生有关；较高的≥14 mm卵泡率与避免3PN的发生有关；精子优化后活动比率相对偏低也与避免3PN形成有关。3PN的发生可能影响着床率及临床妊娠率。

Factors Related to Triploid Zygotes in Routine in vitro Fertilization

Objective：To explore those factors related to triploid zygotes in routine in vitro fertilization-embryo transfer （IVF-ET）. Methods：To analyze retrospectively the clinical data of 1 987 IVF cycles. According to the 3PN rate, 1 987 IVF cycles were divided into three groups：normal group （3PN%=0, n=754）, the low frequency group （0〈3PN%〈20%, n=660） and the high frequency group （3PN%≥20 %, n=573）. Results：There were significant differences in the age of patients, the basal level of follicle stimulate hormone （FSH）, days of Gn, the total ampoules of Gn, the progesterone level on the day of hCG administration, and sperm concentration after optimization （P〉0.05）. The numbers of the retrieved oocytes and the maturated oocytes in both low and high frequency of 3PN groups were significantly higher than that in the normal group （P〈0.01）. E2 levels on the day of hCG administration in those groups were also higher than that in the normal group （P〈0.05）, while the ≥14 mm follicles rates on the day of hCG administration were significantly lower than that in the normal group（P〈0.01）. It was sure that there was significant difference in the normal fertilization rate among the three groups（P〈0.01）. The clinical pregnancy rates in the low frequency of 3PN group and the normal group had no statistical differences （ P〉0 . 05 ） , but were higher than the high frequency of 3PN group （ P〈0 . 01 ） . Interestingly, the sperm mobility rates after optimization in both low and high frequency of 3PN groups were significantly higher than that in the normal group, the rates of class a and b movement sperms were higher while the rates of class c and d movement sperms were lower in two groups than those in the normal group （P〈0.01）, There were not significant differences in the rate of good quality embryo, the implantation rate and the abortion rate among three groups （P〉0.05）. Conclusions：The higher level of estrogen on the day of hCG administration are positively associated with the occurrence of 3PN. The higher rate of ≥14 mm follicle by B ultrasound on the day of hCG administration, and the lower rate of living sperm after optimization, is negatively associated with the occurrence of 3PN. The higher rates of 3PN may affect the implantation rate and the clinical pregnancy rate.