无原核有双极体的卵母细胞体外发育潜能及移植结局的探讨

摘要

目的:探讨无原核有双极体0PN(2PB)的卵母细胞体外发育潜能及移植结局,评估其在临床应用的价值.方法:回顾性分析在134个观察到0PN(2PB)卵母细胞常规IVF周期中,0PN(2PB)卵母细胞与同周期正常受精(2PN)的卵母细胞一起培养至第3d(D3),根据卵裂球数目、大小、碎片、细胞质均匀度进行胚胎质量评估,8个周期移植完全来源0PN(2PB)卵母细胞发育的胚胎.结果:134个周期中共获卵1107枚,0PN(2PB)卵母细胞240枚,2PN卵母细胞639枚.0PN(2PB)卵母细胞形成率、卵裂率、D2优胚率、D3优胚率分别21.7％、80.8％、46.9％、28.9％;2PN形成率、卵裂率、D2优胚率、D3优胚率分别57.7％、97.0％、55.2％、40.8％.0PN(2PB)在形成率、卵裂率、D3优胚率与2PN比较有显著差异(P＜0.01);D2优胚率与2PN比较有差异(P＜0.05).同一周期中0PN(2PB)卵母细胞与2PN在形成数、卵裂数、D2优胚数、D3优胚数比较,有显著差异(P＜0.01).8个周期移植完全来源0PN(2PB)胚胎,临床妊娠4例,双胎1例,单胎3例,3个健康婴儿出生;2例孕早期流产,着床率38.5％ (5/13),流产率50.0％ (2/4).结论:在2PN胚胎质量差,无移植胚胎或无2PN胚胎时,0PN(2PB)胚胎可作为被选胚胎,在患者充分知情同意下,进行移植.%Objectives:To probe into the in vitro developmental potential of the 0PN (2PB) oocyte and the outcomes of its transfer,in order to assess the value of its clinical application.Methods:The 0PN (2PB) oocytes observed in the 138 conventional IVF cycles were retrospectively analyzed.The 0PN (2PB) oocytes and the normally fertilized 2PN oocytes of the same cycle were cultured for three days.The quality of the embryos was assessed based on the blastomeres,size,fragments and cytoplasmic uniformity.The transferred embryos of the 8 cycles were all the embryos developed from the 0PN (2PB) oocytes.Results:In the 134cycles,1107 eggs,240 0PN (2PB) oocytes and 639 2PN oocytes were obtained.There were significant differences between 240 0PN (2PB) oocytes and the 2PN oocytes in the formation rate (21.7％ of 0PN (2PB) oocytes and 57.7％ of 2PN oocytes),the cleavage rate (80.8％ of 0PN (2PB) oocytes and 97.0％ of 2PN oocytes),D2 high-quality embryo rate (P ＜ 0.05)(46.9％ of 0PN (2PB) oocytes and 55.2％ of 2PN oocytes) and the D3 high-quality embryo rate (P ＜ 0.01)(28.9％ of0PN (2PB) oocytes and 40.8％ of 2PN oocytes).In the same cycle,the 0PN (2PB) oocytes also showed notable differences from the 2PN ones in the numbers of the formation,cleavage,D2 high-quality embryos and D3 high-quality embryos.The transferred embryos in the 8 cycles were all from the 0PN (2PB) ones.Of the 4 cases of clinical pregnancy,one was twin pregnancy and three were single pregnancy.Three healthy babies were delivered.Two cases were of early pregnancy abortion.The implantation rate was 38.5 (5/13) and the abortion rate was 50％ (2/4).Conclusion:When the 2PN embryos are poor in quality and there are no transfer embryos or 2PN embryos,0PN (2PB) embryos can serve as the alternative embryos and be transferred with the agreement of the patients.