ICSI中不同来源精子对卵母细胞受精、胚胎质量及发育潜能的影响

摘要

Objective To evaluate the impact of spermatozoa from different sources on normal fertilization of oocytes, embryo quality and embryo developmental potential in intracytoplasmic sperm injection (ICSI) cycles. Methods A retrospective analysis was conducted among 197 patients undergoing ICSI cycles in our center. The patients were classified into 3 groups according to the sources of semen, namely ejaculated spermatozoa group (n=102), percutaneous epididymal sperm aspiration (PESA) group (n=68), and testicular sperm aspiration (TESA) group (n=27). The ejaculated spermatozoa group was further classified into oligoasthenoteratozoospermia (n=67) and cryptozoospermia (n=35) subgroups. The normal fertilization, high-quality embryo, implantation and clinical pregnancy rates were compared among the groups; the rate of high-quality blastocyst formation in in-vitro culture of non-top quality embryos was also observed. Results The patients with PESA showed significantly higher normal fertilization rate (75.6%) than those in oligoasthenoteratozoospermia (64.8%), cryptozoospermia (62.1%), and TESA (61.6%) groups (P<0.05). No significant differences were found in the high-quality embryo, implantation, and clinical pregnancy rates among the groups (P>0.05). The rate of high-quality blastocyst formation in the in-vitro culture of non-top quality embryos was also comparable among the groups (P>0.05). Conclusion Although spermatozoa obtained with by PESA is associated with a higher normal fertilization rate, the sources of spermatozoa do not significantly affect the embryonic quality and developmental potential in ICSI cycles.%目的：研究卵胞浆内单精子注射技术（ICSI）中不同来源精子对卵母细胞受精、胚胎质量及发育潜能的影响。方法回顾性分析我中心因单纯男性因素行ICSI助孕治疗的197例患者的临床资料，按不同精子来源分为射精组（n=102）、PESA组（n=68）、TESA组（n=27）3组，其中将射精组又分为严重少弱畸精子症组（n=67）和隐匿精子症组（n=35）。比较4组间受精率、优质胚胎率、新鲜胚胎移植周期的着床率及妊娠率，以及低质胚胎继续培养的优质囊胚形成率。结果少弱畸精子射精组、隐匿精子射精组、PESA组、TESA组的正常受精率分别为64.8%、62.1%、75.6%、61.6%，其中PESA组明显高于其它3组（P<0.05），4组的优质胚胎率、新鲜胚胎移植周期的着床率及妊娠率无明显差异（P>0.05）。4组间低质胚胎继续培养的优质囊胚形成率也无显著差异（P>0.05）。结论PESA来源的精子ICSI中正常受精率较高，但在ICSI中不同来源精子对胚胎质量及发育潜能无显著影响。