卵胞浆内单精子显微注射后三原核合子发生相关因素及妊娠结局分析

摘要

Objective To investigate clinical or laboratory factors influence development of triploid (3PN) zygotes after intracytoplasmic sperm injection(ICSI) and pregnancy results. Methods A retrospective study of 287 ICSI cycles was carried out from the center of Reproductive Medicine of the second hospital of Hebei Medical University from January 2007 to December 2008. Cycles were divided into two groups; group A, cycles with one or more 3PN zygotes after ICSI, and group B, cycles with no 3PN zygotes. Age, amount of gonadotropin administered, peak estradiol levels, number of oocytes retrieved and injected, time between retrieval and injection, percentage of oocyte abnormal, sperm quality, percentage of diploid zygotes, and implantation rates, pregnancy rates,abortion rates and something else were compared between two groups. Results Compared with patients in group B, those in group A received significantly fewer ampoules of gonadotropins(28. 45 ±8. 68 vs 33. 66 ± 14. 02) , had higher estradiol levels( 10203. 04 ±3402. 97pmol/L vs 8649. 27 ± 3870. 19pmol/L) , and had more oocytes( 17. 09 ± 8. 58 vs 11. 34 ±6. 52) , and oocytes injected( 13. 61 ± 7. 49 vs 9. 26 ±5. 41) and lower percentages of diploid zygotes[ (66. 85 ± 18. 69)% vs (77. 39 ± 19. 31)% ]. However, implantation rates, pregnancy rates, abortion rates did not differ between two groups. Conclusion The abnomal quality or internal stucture of oocytes dued to high responders to ovarian may be a possible cause of 3PN zygotes after ICSI. But it is not associated with low pregnancy outcome and should not be completently explained by high responders to ovarian.%目的 探讨卵胞浆内单精子显微注射(ICSI)后的三原核(3PN)合子发生的相关因素及对妊娠结局的影响.方法 对2007年1月至2008年12月在河北医科大学第二医院生殖医学中心行ICSI的287个周期进行回顾性分析.将周期分为2组,A组:至少有1个以上的3PN发生.B组:无3PN的发生.比较两组的年龄、促性腺激素(Gn)用量、雌二醇峰值、获卵数、单精子注射卵数、取卵至ICSI时间、不正常卵子率、精子质量、双原核合子率、种植率、妊娠率、流产率等.结果 A组和B组Gn用量、雌二醇峰值、获卵数、单精子注射卵子数和双原核合子率分别为[(28.45±8.68)支对(33.66±14.02)支,75U/支]、[(10203.04±3402.97)pmol/L]对[(8649.27±3870.19)pmo1/L]、[(17.09±8.58)枚对(11.34±6.52)枚]、[(13.61±7.49)枚对(9.26±5.41)枚]、[(66.85±18.69)%对(77.39±19.31)%],差异有统计学意义(P＜0.05).两组种植率、妊娠率、流产率差异无统计学意义.结论 卵巢对Gn刺激的高反应所造成的部分卵子质量或内部结构的异常可能是ICSI后发生3PN合子的原因.但3PN发生对妊娠结局无明显影响,不能用高反应完全解释.