卵胞质内单精子显微注射后异常受精的影响因素分析

目的:探讨卵胞质内单精子显微注射(ICSI)后异常受精发生的影响因素。方法:回顾性分析299个ICSI周期,按照是否有异常受精分为异常受精组(n=118)和正常对照组(n=181),异常受精组至少发生1个非2原核(2PN)的受精卵。比较分析异常受精组和对照组临床和实验室资料。结果:异常受精组hCG注射日E2水平(14 097±3 066 pmol/L)高于对照组(1 2461±6 836 pmol/L),差异有统计学意义(P<0.05);异常受精组获卵数及成熟卵数分别为17.8±7.2个、15.3±6.1个,多于对照组的13.6±7.0个、10.2±5.3个,差异均有统计学意义(P<0.01);卵子成熟率(81.7%vs76.4%)、2PN受精率(78.4%vs 86.9%),组间比较差异均有统计学意义(P<0.01);而患者年龄、基础激素水平、促性腺激素(Gn)使用总量、精子来源及质量、着床率、临床妊娠率组间比较,差异均无统计学意义(P>0.05)。结论:卵巢对Gn刺激的高反应性可能与ICSI后异常受精的发生有关。异常受精卵的发生虽对临床结局无明显影响,但减少异常受精发生率,增加卵子利用率,可能会提高累积妊娠率。

Parameters Related to the Formation of Abnormol Fertilized Zygotes after Intracytoplasmic Sperm Injection

Objective: To investigate the related influence factors on abnormal fertilized zygotes after intracytoplasmic sperm injection(ICSI).Methods: A total of 299 ICSI cycles were studied retrospectively.They were divided into abnormal fertilized group(n=118) which at least had one non-2 pronucleus(2PN) or ≥3PN zygote and the control(n=181).Results: The E2level on the day of hCG injection was higher in abnormal fertilized group(14 097±3 066 pmol/L) than that in the control(1 2461 ±6 836 pmol/L),P<0.05.The number of oocytes retrieved(17.8 ±7.2) and mature oocytes(15.3±6.1) were larger in abnormal fertilized group than those in control group(13.6 ± 7.0 vs 10.2 ± 5.3),respectively;P<0.01.While significant differences of the maturity rates of oocytes(81.7%),the rates of 2PN zygote(78.4%) were observed in abnormal fertilized group when compared with those in the control(76.4%,86.9%,respectively)(P<0.01).There were no statistical differences between the two groups in age,basic hormone levels,amount of gonadotropin administration,sperm quality,implantation rate and pregnancy rate.Conclusion: The high responders of ovary may be related to the abnormal fertilization after ICSI.The outcome of pregnancy is not influenced by the abnormal zygotes,but reducing the incidence of abnormal fertilization and increasing oocytes utilization may improve the accumulative pregnancy rate.