人卵母细胞胞浆中央颗粒化对胚胎发育潜能的影响及其分级和成因探讨

目的探讨人类辅助生殖技术中卵母细胞胞浆中央颗粒化(CLGC)对胚胎发育潜能的影响及其分级评估、形成的可能原因。方法回顾性分析荆州市中心医院生殖中心2012年6月至2014年3月卵胞浆内单精子注射(ICSI)治疗的患者,选取全部卵母细胞CLGC的30例患者作为研究组,随机选择同期卵母细胞胞浆形态无异常的200例患者作为胞浆形态正常组,比较二组间年龄、基础FSH、平均促性腺激素(Gn)使用天数、平均Gn总量,以及受精率、卵裂率、优质胚胎率、可利用胚胎率及妊娠结局的差异。并对卵母细胞CLGC的程度进行分级评估,比较轻、重度CLGC患者受精率、优质胚胎率、可利用胚胎率的差异。结果研究组与对照组之间的年龄、基础FSH无统计学差异(P0.05),而平均Gn使用天数、平均Gn总量、受精率、卵裂率、优质胚胎率、可利用胚胎率及临床妊娠率、流产率差异均有统计学意义(P0.05);轻度CLGC组受精率、卵裂率、优质胚胎率、可利用胚胎率均显著高于重度CLGC组(P0.05)。结论人卵母细胞随CLGC的程度加重其胚胎的发育潜能逐渐降低。CLGC作为一种常见的卵母细胞胞浆形态异常对胚胎发育潜能的评估有重要的参考意义。合理的临床降调节方案、合适剂量的Gn使用可能是减少所获卵母细胞CLGC的途径之一。

Investigating effect of centrally located granular cytoplasm of oocytes on embryos developmental potential and its classification standard and formation cause

Objective： To explore the effect of centrally located granular cytoplasm （CLGC）of oocytes on developmental capacity of embryos in assisted reproductive technology （ART）, and the classification standard and the possible cause of the formation of CLGC Methods： The patients treated with intracytoplasmic sperm injection （ICSI）were included in the Reproductive Center of Jingzhou Hospital from June 2012 to March 2014. Thirty patients whose oocytes were totally with centrally located granular cytoplasm were selected as the study group, and 200 patients whose oocytes with normal cytoplasm were randomly selected as the control group. The age, basic FSH, average days of gonadotropin （Gn）usage, average doses of Gn, fertilization rate, cleavage rate, excellent embryo rate, available embryo rate and clinical pregnancy rate were compared between the two groups. The classification standard of oocytes with CLGC was evaluated. The differences of fertilization rate,excellent embryo rate and pregnancy outcome were compared between two groups after classification. Results： There are no significant differences in age and basic FSH levels（P〉0.05）, but the average days of Gn usage, average doses of Gn, fertilization rate, cleavage rate, excellent embryo rate, availableembryo rate,clinical pregnancy rate and abortion rate were all significant different between two groups（P 〈0.05）. The fertilization rate,cleavage rate, excellent embryo rate, available embryo rate in slight CLGC group were significantly higher than those in severe CLGC group（P〈0.05）. Conclusions： The embryonic developmental potential drops along with the severe degree of centrally located granular cytoplasm of oocytes. Oocyte with centrally located granular cytoplasm is a common phenomenon in abnormal oocyte morphology. It can be as an important parameter to evaluate embryo developmental potential. Reasonable down regulation proposal and lower dose of Gn usage could reduce oocytes with centrally located granular cytoplasm.