脱颗粒细胞与授精时间间隔对单精子卵胞浆内注射妊娠结局的影响

目的探讨不同的脱颗粒细胞与卵胞浆内单精子显微注射技术(intracytoplasmic sperm injection,ICSI)时间间隔对新鲜周期ICSI妊娠结局的影响。方法回顾性分析邢台不孕不育专科医院/邢台生殖与遗传专科医院生殖中心2017~2018年行新鲜周期ICSI-ET患者的临床资料,共371个周期。根据脱颗粒细胞与ICSI时间间隔分为3组:A组(64个周期):t≤1 h组,B组(133个周期):1 h2 h组。分别比较不同的脱颗粒细胞与ICSI时间间隔对妊娠结局的影响。结果3组基本资料、2 PN受精率、2 PN卵裂率、可用胚胎率比较,差异均无统计学意义(P>0.05)。A组和B组的妊娠率比较,差异无统计学意义(P>0.05),但两组和C组比较,差异均有统计学意义(P<0.05);A组的种植率高于B组和C组,差异均有统计学意义(P<0.05),但B组和C组比较,差异无统计学意义(P>0.05);3组流产率比较,差异无统计学意义(P>0.05)。结论卵母细胞脱颗粒后2 h内行ICSI能够获得较好的妊娠结局,且1 h内操作妊娠结局更好。     

Clinical and neonatal outcomes of intrauterine insemination with frozen donor sperm

This retrospective study evaluated the association between frozen donor sperm used for intrauterine insemination and clinical and neonatal outcomes, including 304 singleton pregnancies resulting from artificial insemination by the husband (AIH) and 173 singleton pregnancies resulting from artificial insemination by a donor (AID). The clinical outcomes for AID showed no increased risk of abortion, ectopic pregnancy or pregnancy complications compared to those for AIH. There were no differences in gender, gestational age or prematurity of live births between the two groups. However, the birthweight of live births from AID was significantly higher than that from AIH. Moreover, the AID group exhibited no increased risk of stillbirths or fetal defects compared to the AIH group. These results indicate that frozen donor sperm did not increase the occurrence of adverse clinical and neonatal outcomes when compared to sperm from the husband.

Abbreviations: AID: artificial insemination by a donor; AIH: artificial insemination by the husband; ART: assisted reproduction technology; FET: frozen embryo transfer; IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; IUI: intrauterine insemination; LBW: low birth weight     

卵胞浆内单精子注射后多原核合子发生的相关研究进展

多原核合子是常规体外受精-胚胎移植过程中的正常现象,卵胞浆内单精子注射(ICSI)避免了多精子受精造成的多原核合子,但仍有可能出现多原核合子.ICSI后多原核合子出现主要是由于第二极体排出异常造成,卵母细胞质量、男方精液情况以及ICSI操作技术本身都是多原核合子形成的影响因素.该文针对ICSI后多原核合子的产生机制、影响因素、妊娠结局及相应处理措施进行综述.     

卵胞浆内单精子显微注射技术的临床应用

目的:探讨男性因素不育症和常规体外受精(IVF)失败者采用卵胞浆内单精子显微注射(ICSI)治疗的临床效果.方法:对51例男性因素不育症和常规体外受精(IVF)失败者共计59个ICSI治疗周期进行了回顾性分析.结果:59个ICSI治疗周期共取卵596个,MⅡ期卵母细胞471个,MⅡ期卵母细胞正常受精率82.21%,卵裂率89.04%,临床妊娠19例,周期临床妊娠率为32.20%.结论:对男性因素不育症和常规体外受精(IVF)失败者ICSI是一种有效的治疗方法.     

影响供精人工授精临床结局多因素分析

目的:探讨多种因素对AID治疗结局的影响。方法:回顾2008年11月~2010年5月在生殖中心实施AID助孕治疗的418名妇女639个治疗周期的病例,综合分析不孕妇女的年龄、输卵管情况、治疗周期、促排卵用药及授精次数等因素对AID治疗妊娠结局的影响。结果:AID周期妊娠率为34.90%(223/639),例数妊娠率为53.34%(223/418)。临床妊娠率与女方年龄、是否合并输卵管因素、授精与排卵时间等有一定关系。排卵前后短时内单次授精的平均妊娠率反而高于排卵前后双次授精。639个AID周期中,随治疗周期的增加累计妊娠率随之增高,但周期妊娠率下降,第1~3周期临床妊娠率依次为37.08%、31.98%、21.95%。AID促排卵周期妊娠率与自然周期无差异(34.02%、35.63%)。结论:不孕妇女的年龄、输卵管情况及授精时机的掌握是影响供精人工授精成功率的重要因素。对超过3周期仍不孕者,可考虑改行供精体外授精-胚胎移植进行助孕。     

供精精液冻存时间对人工受精结局及子代出生缺陷的影响

目的:探讨精液冻存时间对供精人工受精(AID)结局及子代出生缺陷的影响。方法:回顾性分析2007年4月~2013年4月在本生殖中心实施AID助孕治疗的6038例妇女共14 290个AID周期的临床资料,分析供精精液冻存0.5~1年、1~3年、3~5年、5~7年、7~10年对AID妊娠率、流产率、子代出生缺陷率的影响。结果:供精精液不同冻存时间的妊娠率、流产率未见统计学差异(P0.05);子代出生缺陷发生率为1.33%,不同冻存时间子代出生缺陷率未见统计学差异(P0.05)。结论:供精精液冻存0.5~10年,并不影响AID的临床妊娠率、流产率和子代出生缺陷率,用于人工受精安全有效,能获得类似自然妊娠的效果。     

Relationship between processed total motile sperm count of husband or donor semen and pregnancy outcome following intrauterine insemination

We retrospectively analyzed 6,360 artificial insemination cycles of husband's semen through intrauterine insemination (AIH-IUI) or artificial insemination with donor semen through intrauterine insemination (AID-IUI) in patients with infertility between August, 1998 and August, 2010. The relationship between processed total motile sperm count (PTMS) and pregnancy outcome was determined. The study was divided into 6 groups according to PTMS. Group 1:?≤?2.0 million, Group 2: 2.1-4.0 million, Group 3: 4.1-6.0 million, Group 4: 6.1-8.0 million, Group 5: 8.1-10.0 million, and Group 6: >10.0 million. There was no statistically significant difference in age, duration of infertility, unilateral tubal patency, induced ovulation, and single IUI or double IUI between the 6 groups in both AIH-IUI and AID-IUI. The total clinical pregnancy rate of AIH-IUI was 10.81 % and AID-IUI was 27.52 %. Among the 6 groups, the clinical pregnancy rate was the lowest in Group 1 (P?<?0.05) in both AIH-IUI and AID-IUI. With the increased PTMS, the clinical pregnancy rate of IUI was improved. However, a statistical difference between groups was only observed for Group 1. When PTMS is?≤?2?×?10⁶ the clinical pregnancy rate of IUI is significantly decreased. In this case in vitro fertilization (IVF) should be adopted.     

IVF-ET与ICSI选择2个胚胎移植助孕结局分析

目的:探讨选择2个胚胎移植对IVF-ET与ICSI助孕结局的影响。方法:回顾2008年12月～2010年9月在福建省妇幼保健院接受体外受精-胚胎移植(IVF-ET)的494个新鲜周期病例,对3天体外培养胚胎进行全面评级后,各年龄组均选择2个胚胎移植,按含0、1、2个优质胚胎分成3组,比较其对助孕结局的影响。结果:494周期中,2个均为优质胚胎移植的391个周期,占79.14%;含1个优质胚胎移植的74个周期,占15.00%;2个均非优质胚胎移植的29个周期,占5.87%。总的周期妊娠率为40.16%,种植率为25.81%,多胎率为27.27%,其中4例为3胎,50例为双胎。选择2个优质胚胎移植组妊娠率为46.04%,种植率为30.05%,多胎率为29.44%。结论:通过提高优质胚胎选择的准确性,选择2个最优质胚胎移植有助于提高胚胎着床能力和临床妊娠率,获得良好的妊娠结局,但多胎妊娠的发生率并不降低。     

不同促排卵方案对供精人工授精妊娠结局的影响

目的:探讨不同促排卵方案对供精人工授精(AID)妊娠结局的影响。方法:回顾性分析2015年8月-2016年12月因男方因素于本中心接受供精人工授精手术(AID)治疗的患者320例,共422个治疗周期。按照治疗方案的不同分为5组,分别为自然周期(NC)组、氯米芬(CC)组、来曲唑(LE)组、重组人卵泡刺激素(rh-FSH)组和尿卵泡刺激素(u-FSH)组,对各组的妊娠结局进行比较分析。结果:(1)NC组、CC组、LE组、rh-FSH组和u-FSH组的临床妊娠率分别为26.3%、16.5%、25.9%、22.6%和20%,CC组的临床妊娠率低于其他几组(P<0.05),NC组、LE组、rh-FSH组和u-FSH组临床妊娠率差异无统计学意义(P均>0.05);(2)hCG日子宫内膜厚度各组之间差异没有统计学意义(P>0.05),hCG日A型内膜比率CC组(25%)低于其他各组(P<0.05),而NC组、LE组、rh-FSH组和u-FSH组的A型内膜比率差异没有统计学意义(P均>0.05);(3)hCG日成熟卵泡个数CC组最多,与NC组和LE组比较差异有统计学意义(P<0.05),卵泡直径CC组最大,与NC组和u-FSH组比较差异有统计学意义(P<0.05)。结论:促排卵并不一定增加AID临床妊娠率,CC组临床妊娠率较低,可能与其抗雌激素作用影响内膜有关,LE组单卵泡发育效果好,临床妊娠率比CC组高,可以进一步进行临床大样本研究。     

Comparative study on risk for birth defects among infants after in vitro fertilization and intracytoplasmic sperm injection

This large retrospective study was conducted to compare the risk for birth defects among infants conceived by in vitro fertilization (IVF) with that among infants conceived by intracytoplasmic sperm injection (ICSI) and to explore the effect of frozen embryo transfer (FET) on the risk for birth defects among infants born by IVF and ICSI. All patients who received assisted reproductive technology (ART) treatment and who underwent childbirth during the period January 2005–August 2017 were included in this study. There were 18,221 births after ART included in the analysis; of these births, 12,649 were conceived by IVF, and 5,572 were conceived by ICSI. In the study, the prevalence of any birth defect in singleton infants was 1.15% with the use of IVF and 1.38% with the use of ICSI, and that in twin infants increased to 2.74% by IVF and 2.58% by ICSI. However, no significant difference between IVF and ICSI was found among all infants, singleton births or twin births. Additionally, in assessing ART infants born after FET, we did not detect a difference in the risk for birth defects between infants born by IVF and those born by ICSI. These results indicate that among the entire cohort of children conceived from ART and among the children conceived from FET, the risk for birth defects after ICSI is similar to that after IVF.Abbreviations: IVF: in vitro fertilization; ICSI: intracytoplasmic sperm injection; FET: frozen embryo transfer; ART: assisted reproductive technology; ET: embryo transfer; BMI: body mass index; OHSS: ovarian hyperstimulation syndrome; CMOH: Chinese Ministry of Health; ICD-10: International Classification of Diseases, 10^th edition; PTB: preterm birth; OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval     

Clinical outcome of cycles with oocyte degeneration after intracytoplasmic sperm injection

There are variant rates of oocyte degeneration after intracytoplasmic sperm injection (ICSI) among different patients. Oocyte degeneration after ICSI may reflect the cohort of oocyte quality and subsequent embryo development capacity and clinical outcome. This retrospective study analyzed 255 cycles with at least one degenerated oocyte after ICSI (degeneration group) and 243 cycles with no degenerated oocytes after ICSI (control group). Basic characteristics like female age, body mass index, duration of infertility, hormone (FSH, LH, E₂) levels on day 3 of menses, and primary infertility patient rate were similar between the two groups (p > 0.05). Total dose of gonadotropin and length of stimulation were also similar between the two groups (p > 0.05), but the degeneration group exhibited a more exuberant response to ovarian stimulation as reflected by more oocytes retrieved (p < 0.05). The number of 2PN embryos available and high quality embryos were similar between the two groups (p > 0.05), but the high quality embryo rate, early cleavage embryo rate, and available embryo rate were all statistically lower than the control group (p < 0.05). Embryo developmental kinetics seemed to be disturbed and embryo fragmentation rate increased in the degeneration group (p < 0.05). However, there was no statistical difference in the distribution of graded embryos transferred, and there were no statistical differences in the pregnancy rate, implantation rate, and abortion rate between the two groups (p > 0.05). We deduce that the presence of oocyte degeneration after ICSI may be associated with decreased embryo quality with embryo development kinetics disturbed. However, the clinical outcomes may not be affected if the premise that sufficient high quality degeneration group embryos are available for transfer.     

供精人工授精临床结局影响因素分析

目的：探讨供精人工授精（AID）临床结局的影响因素。方法：回顾性分析2012年1月—2017年4月1 810对夫妇共4 067个AID周期的临床资料,分析女方年龄、女方不孕因素、治疗方案、授精时机及治疗周期数与临床结局的相关性。结果：①临床妊娠率、活产率随年龄增长均有下降趋势（均P＜0.05）。②女方合并排卵障碍、盆腔子宫内膜异位症术后及盆腔炎性疾病后遗症者AID临床结局与单纯男方因素者相比,差异均无统计学意义（均P＞0.05）。③自然周期、氯米芬、来曲唑及单纯促性腺激素（Gn）促排卵周期的临床妊娠率、宫内妊娠流产率和活产率差异均无统计学意义（均P＞0.05）;氯米芬和来曲唑促排卵周期的多胎妊娠率显著高于自然周期（均P＜0.001）。④无论自然周期还是促排卵周期,排卵前与排卵后授精的临床结局比较,差异均无统计学意义（均P＞0.05）。⑤前4个治疗周期随着治疗周期数的增加,累计妊娠率与累计活产率显著升高（均P＜0.05),第5个治疗周期开始累计妊娠率与累计活产率均无明显增长（均P＞0.05）。结论：女性年龄是影响AID临床结局的重要因素;未发现其他女性不孕因素及授精时机显著影响AID临床结局。实施3个或4个AID周期仍未孕者或女性年龄超过40岁建议行供精体外受精助孕。     

影响宫腔内人工授精治疗结果的因素探讨

目的:探讨影响宫腔内人工授精(IUI)治疗结果的因素,以提高IUI治疗的临床效果。方法:对415个IUI治疗周期的240例患者的年龄、不孕年限、不孕原因、精液处理方法和处理后精子情况、IUI治疗周期数、一个周期内2次IUI以及促排卵方案与治疗结果的关系进行分析。结果:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用与治疗结果有关;精液处理方法、一个周期内2次IUI和不同的促排卵方案对治疗结果没有影响。结论:患者的年龄、处理后精子情况、IUI周期数和促排卵药物的使用是影响IUI治疗结果的重要因素;一个周期内2次IUI和增加IUI的治疗周期数无法提高IUI治疗的临床妊娠率。     

畸精症行卵胞浆内单精子注射治疗后的妊娠结局和新生儿结局

目的 观察畸精症患者行卵胞浆内单精子注射治疗(ICSI)后的妊娠结局和新生儿结局. 方法 回顾性的分析2011年10月-2013年7月因单纯女方输卵管因素或男方畸精症来本院就诊的874个周期,根据第5版《世界卫生组织人类精液检查与处理实验室手册》推荐的精子形态学分类标准,分为畸精组(n=395)和正常精液组(n=479),比较两组的妊娠结局和新生儿结局. 结果 两组受精率、正常受精率、卵裂率、优胚率、植入率、临床妊娠率、流产率、分娩率比较,差异无统计学意义;两组出生婴儿数的构成比不同,畸精组出生单、双、三胎构成比分别为68.1％、30.3％、1.6％,而正常组分别为58.6％、41.0％、0.4％,差异有统计学意义.两组的新生儿结局,包括孕周、出生体重、性别构成比、出生缺陷率、早产率、低体重率、极低体重率、巨大儿发生率比较,差异均无统计学意义. 结论 ICSI治疗并未对畸精症患者的妊娠结局和新生儿结局造成额外风险.     

Artificial oocyte activation with calcium ionophore for frozen sperm cycles

Fertilization problems are the major problems that may be faced in 30–55% of the patients during an intracytoplasmic sperm injection (ICSI) cycle. A successful oocyte activation depends on factors related to both sperm and oocyte, and one of the important factors that mediates the process is Ca²⁺ concentration within the oocyte. Artificial oocyte activation (AOA) is a method used for fertilization problems that commonly involve the usage of Ca²⁺ ionophores and is usually used in problems such as total fertilization failure (TFF) and globozoospermia. The aim of the present study was to investigate possible effects of AOA for different groups of patients with fertilization failure. Four groups of patients (previous TFF, low oocyte number, severe sperm quality, and frozen sperm (FS) group) that underwent ICSI with AOA were included in the study. All groups had similar control groups with same indications except TFF, where AOA was not performed. Fertilization rates were significantly higher in the TFF group than those observed in other AOA groups. Fertilization rates and quality of embryos observed in the remaining AOA groups were higher than those of the controls, which were statistically insignificant. Prgenancy rates were higher in all AOA groups compared to the controls, although the differences were significant in FS group only. Quality of embryos and pregnancy rates were lower in the TFF group compared to the remaining AOA groups indicating possible concomitant problems. Fertilization rates, quality of embryos and pregnancy rates seemed to be increased in all indication groups suggesting that not only TFF patients but also a wide variety of patients with different indications may benefit from AOA.

Abbreviations: ICSI: Intracytoplasmic sperm injection; ARTs: Assisted reproductive techniques; Ca: Calcium; AOA: Artificial oocyte activation; TFF: Total fertilization failures; OAT: Oligoasthenoteratozoospemia; IVF: In vitro fertilization; SOAT: Severe OAT; LON: Low ooctye number; FS: Frozen sperm; hCG: human chorionic gonadotrophin; PVP: polyvinylpyrrolidone; HSA: human serum albumin     

精子核蛋白组型转换对首次宫腔内人工授精临床结局的影响

目的 研究精子核蛋白组型转换对首次宫腔内人工授精(intrauterine insemination, IUI)临床结局的影响。方法 对2017年3月至2021年2月于广东省中医院生殖医学科完成的168个首次IUI周期临床资料及术前3个月内的精子核蛋白组型转换数据进行回顾性分析,根据精子核蛋白组型转换异常率(AB阳性率)分为：AB阳性率<30%组(132例)和AB阳性率≥30%组(36例),比较两组IUI临床妊娠率、自然流产率,分析精子核蛋白组型转换预测IUI临床妊娠的价值。根据妊娠结局,将所有患者分为妊娠组(34例)与未妊娠组(134例),将临床妊娠患者分为自然流产组(8例)与未流产组(26例),比较其精子核蛋白组型转换异常率。结果 AB阳性率<30%组与AB阳性率≥30%组的首次IUI临床妊娠率、自然流产率比较,差异均无统计学意义(P>0.05)。妊娠组与未妊娠组、自然流产组与未流产组精子核蛋白组型转换异常率比较,差异均无统计学意义(P>0.05)。ROC曲线显示,精子核蛋白组型转换异常率不能预测IUI临床妊娠(AUC=0.554,95%CI:0.449-0...     

影响供精人工授精成功率因素的临床研究

目的:探讨影响供精人工授精(AID)成功率的各种临床因素及治疗对策。方法:121对夫妇行336个AID周期,其中6例行AID联合促排卵治疗3个周期以上未孕,遂改为供精IVF。结果:336个AID周期中共34例妊娠,周期妊娠率为10.1%。自然周期192例,周期妊娠率为7.2%。自然周期行宫颈管内人工授精(ICI)102周期,周期妊娠率为6.8%(7/102);宫腔内人工授精(IUI)82周期,周期妊娠率为7.3%(6/82);输卵管内精液灌注(FSP)8例,周期妊娠率为12.5%(1/8)。促排卵周期中,CC周期76例,HMG周期68例,妊娠率分别为7.8%和20.5%,两组相比较,HMG周期的妊娠率显著高于CC周期(P<0.05);CC周期和自然周期相比较无显著差异(P>0.05)。在CC和HMG促排卵周期中,均以FSP的妊娠率(16.6%和33.3%)最高(P<0.005),而ICl的周期妊娠率(3.1%和12.5%)显著低于IUI(10.5%和20.5%)和FSP(P<0.01)。6对夫妇行8个周期的供精IVF,周期妊娠率为50%(4/8)。结论:手术方式和促排卵方案的选择与AID的成功率密切相关,改变手术方式和促排卵方案可提高AID的成功率。     

多次人工授精失败后体外受精-胚胎移植疗效临床分析

目的:探讨体外受精-胚胎移植技术(IVF-ET)治疗多次宫腔内人工授精(IUI)失败患者的临床效果。方法;对2005年4月~2009年12月在湖北省妇幼保健院因接受2次以上IUI助孕失败后行IVF/ICSI助孕患者的相关资料进行回顾性分析。结果:①136例多次IUI失败后行IVF/ICSI助孕治疗,取卵周期共156周期,新鲜胚胎移植周期共146周期,临床妊娠72例,临床妊娠率49.32%。②转行IVF/ICSI助孕患者中,行IVF-ET者134例,其中18例受精失败,占13.43%;行ICSI者2例,无1例受精失败。③18例常规体外受精失败患者中,原发不孕12例,占66.67%;不孕年限≥5年者9例,占50.00%,补救ICSI治疗后未见妊娠。结论:IVF-ET是多次IUI助孕失败患者的有效治疗手段;部分患者在常规体外受精时存在受精障碍,ICSI治疗对常规受精障碍的患者是有效的;对于反复IUI助孕失败者结合不孕原因和年限等病史可考虑行短时受精联合早期补救性ICSI治疗,降低完全受精失败的风险。     

染色体多态性与单精子卵泡浆内注射辅助生殖妊娠结局的关系

目的:探讨染色体多态性与单精子卵泡浆内注射(ICSI-ET)辅助生殖的妊娠结局的关系。方法:对拟行IC-SI助孕患者进行常规外周血淋巴细胞培养,采用G显带技术,通过染色体的核型分析,比较染色体多态性组与染色体核型正常组患者的临床妊娠率、早期流产率和种植率。结果:染色体多态性组与正常组相比,胚胎种植率(29.4%vs 26.8%)、临床妊娠率(46.3%vs 50.8%)和早期流产率(10.5%vs 8.2%)均无统计学差异(P>0.05)。结论:染色体多态性对于ICSI-ET助孕患者的种植率、临床妊娠率、早期流产率无明显影响。     

ICSI子代与自然妊娠儿童学龄前期体格及智力发育比较分析

目的 了解卵胞浆内单精子注射(ICSI)技术对子代学龄前期体格及智力发育的影响.方法 使用1∶1病例对照研究方法,回顾性随访收集嘉兴市妇幼保健院生殖医学中心行ICSI技术怀孕成功,并在2009年1月至2010年12月间分娩的儿童病例信息,用电话召回,将愿意参加研究的家庭作为ICSI组.在同期本院出生自然怀孕儿童作为对照组.随访家庭一般情况,出生信息,学龄前期体格发育情况,同时进行韦氏学龄前智力测试.结果 ICSI组及对照组各收集到30例.两组均为男16人,女14人,其中ICSI组双胎3对,对照组无.母亲生育年龄,母亲文化程度,父亲生育年龄,父亲文化程度,均未见显著性差异(均P＞0.05).两组分娩方式,出生体重均值,4～6岁身高与体重均与对照组无显著性差异(均P＞0.05).仅出生孕周均值ICSI组低于对照组(37.27±2.392 vs38.80±1.349),x2 =3.058,P=0.003.韦氏学龄前智力测试结果比较,仅言语商中的图片概括得分ICSI组显著低于对照组(11.00±3.283 vs 13.92±3.283),x2=2.893,P=0.006.其余各项得分和总智商两组间均无显著性差异(均P＞0.05).结论 随访至学龄前期,ICSI子代的体格发育和智力发育情况在正常范围,与自然妊娠儿童发育情况接近.