不同受精方式对单原核胚胎发育潜能的影响

不同受精方式对单原核胚胎发育潜能的影响

【第一作者简介】王珊珊(1986-)，女，实习研究员、硕士，主要从事生殖医学研究。

【摘要】目的:探讨常规体外受精（IVF）及卵胞浆内单精子注射（ICSI）后单原核胚胎的发育潜能，为提高卵子利用率探寻可行的方法。方法:回顾性分析3614个IVF周期和1306个ICSI周期的患者资料。按照年龄分为35岁3组，分析不同授精方式下女方年龄对单原核受精卵出现的影响，并进一步研究35岁以下患者中，不同授精方式对单原核胚胎发育潜能的影响。结果:在IVF和ICSI周期中，>35岁组的单原核受精卵形成率显著高于<30岁组(P<0??05)。35岁以下女性患者中，IVF组单原核胚胎的囊胚形成率及优质囊胚形成率显著高于ICSI组（28??97% vs 12??12%，11??90% vs 0），并具有统计学差异(P<0??05)。结论:女方年龄、授精方式可能与异常受精的发生有关。在行辅助生殖技术（ART）时应综合考虑这些因素，为临床提高卵子利用率提供新思路。

【关键词】体外受精；卵胞浆内单精子注射；单原核

Influence of different fertilization modes on the developmental potential of monopronucleus embryosWANG Shanshan, ZENG Huiming, ZHANG Ningyuan, SUN Haixiang

△. Reproductive Medicine Center, Drum-Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China

【Abstract】Objectives: To investigate the developmental potential of monopronucleus embryos in in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) to explore a feasible approach for improving the utilization rate of oocytes. Method: Data of 3614 patients in IVF cycles and 1306 patients in ICSI cycles were retrospectively analyzed respectively, and divided into three groups according to age of patients, 35 years group. The impact of age on monopronucleus zygotes was analyzed in different fertilization modes and the influence of different fertilization modes on the developmental potential of monopronucleus zygotes was further studied in group of patients under 35 years old. Results: The formation rate of monopronucleus zygotes for the group >35 years was substantially higher than that in group <30 years (P<0??05) in IVF and ICSI cycles. Among female patients under 35 years old, the blastocyst rate and high-quality blastocyst rate of embryos from monopronucleus zygotes in the IVF group were substantially higher than the ICSI group (28??97% vs 12??12%, 11??90% vs 0), with statistically significant differences

(P<0??05). Conclusion: The age of female patients and fertilization modes may be related to the occurrence of abnormal fertilization. Multiple factors should be considered during assisted reproductive technology (ART), to provide new ideas for improving the utilization of oocytes.

【Key words】In vitro fertilization; Intracytoplasmic sperm injection; Monopronuclear

【中图分类号】R329.1【文献标志码】A

在体外受精-胚胎移植（IVF-ET）过程中，卵子在常规体外受精（in vitro fertilization, IVF）或卵胞浆内单精子注射（intracytoplasmic sperm injection, ICSI）后16~18h，显微镜下观察到两个原核（2PN），且在卵周隙内可见2个极体，该受精卵则被判断为正常受精，而出现单原核（monopronucleus zygotes,1PN）及多原核（≥3PN）则视为异常受精。有研究报道，多核胚胎不仅使胚胎的着床失败率和自然流产率升高，还可导致葡萄胎的产生和染色体异常儿的出生，不能用于移植\[1\]。对于单原核胚胎，是否有可利用价值，目前尚无定论。因此，临床上通常选择正常受精而发育形成的优质胚胎进行移植。细胞遗传学研究表明，发生卵裂的单原核卵子80%为二倍体，12%为单倍体，另有7%为三倍体\[2\]。除了遗传学因素外，不同授精方式在卵裂的过程中也起着非常