Y染色体微缺失对卵胞质内单精子注射胚胎情况和临床结局的影响

目的:探讨Y染色体微缺失对卵胞质内单精子注射(ICSI)胚胎形成情况和临床结局的影响。方法:收集22例Y染色体微缺失患者进行的27个ICSI治疗周期(研究组)的胚胎和临床结局资料,另收集同期88例严重少精子症或无精子症非Y染色体微缺失患者的101个ICSI治疗周期(对照组)的相应资料进行回顾性分析;同时比较不同Y染色体微缺失类型患者进行ICSI的胚胎资料和临床结局。结果:研究组和对照组的受精率分别为84.91%与86.30%,卵裂率分别为95.45%与96.79%,优质胚胎率分别为49.35%与45.03%,新鲜周期移植优质胚胎率分别为80.36%与84.80%,临床妊娠率分别为65.22%与60.40%,胚胎着床率分别为41.07%与33.60%,早期流产率分别为0.00%与4.92%,活产率分别为56.52%与55.45%,男婴比例分别为56.25%与47.83%。各观察指标组间均无统计学差异(P>0.05)。AZFb区部分缺失组2个新鲜胚胎移植周期中有1例获得生化妊娠,但后转阴性;d区部分缺失组及d区和c区部分缺失组各1次新鲜胚胎移植周期且均未获得妊娠;d区部分缺失加c区全部缺失组19个新鲜胚胎移植周期15例获得妊娠且无一例发生流产。结论:Y染色体微缺失对ICSI治疗周期形成的胚胎情况和妊娠结局无显著性影响,但AZFd区部分缺失加c区全部缺失患者配偶临床妊娠机会高于其他类型Y染色体微缺失患者,AZFb区部分缺失病例配偶有妊娠丢失发生。

Effects of the Y Chromosome Microdeletions on the Embryo Development and Clinical Outcome via ICSI

Objective: To determine whether the presence of a Y chromosome microdeletion confers any effect on the embryo development and clinical outcome via intracytoplasmic sperm injection(ICSI).Methods: A retrospective study was performed on 22 patients with Y microdeletions who attempted 27 ICSI cycles(study group) at our center.The patients in study group were matched to 88 controls treated with 101 ICSI cycles at the same time who had either severe oligozoospermia or azoospermia with normal Y chromosomes(control group).The data of the embryo development and clinical outcome between the two groups were compared.Furthermore,the patients were divided into 4 groups according to their results of AZF microdeletion,and then the embryonic and clinical data were compared among them.Results: The fertilization rates of the study group and the control were 84.91% and 86.30%,respectively.The cleavage rates were 95.45% and 96.79%,the high-quality embryo rates were 49.35% and 45.03%,the high-quality embryo rates of fresh embryo transfer were 80.36% and 84.80%,the clinical pregnancy rates were 65.22% and 60.40%,the implantation rates were 41.07% and 33.60%,the abortion rates in earlier stage were 0.00% and 4.92%,the live birth rates were 56.52% and 55.45%,the male neonates rates were 56.25% and 47.83%.All the observational targets of 2 groups showed no significant differences(P>0.05).One in the two fresh embryo transfer cycles of the partial AZFb microdeletion group had a biochemical pregnancy but lost later.Both of the partial AZFd microdeletion group and the partial AZFd and partial AZFc microdeletion group underwent once fresh embryo transfer but were not pregnant.Whereas,15 cases in the 19 fresh embryo transfer cycles of the partial AZFd and whole AZFc microdeletion group got pregnant and no one aborted.Conclusion: Y chromosome microdeletion has no significant effect on the embryo development and clinical outcome of the ICSI treatment cycle.But the spouses of whom has a partial AZFd and whole AZFc microdeletion get a higher clinical pregnancy chance than those has other kinds of Y chromosome microdeletions.Moreover,the partial AZFb microdeletion patient'spouse underwent a pregnancy loss.