【摘要】 目的探讨卵胞浆内单精子显微注射(ICSI)后早期观察卵母细胞联合人工辅助激活(AOA)技术对ICSI受精率的影响。方法选择接受ICSI的患者60例共61个ICSI周期作为研究组,观察卵母细胞第二极体释放情况,对未排出第二极体的卵母细胞用离子霉素孵育5~10 min行辅助激活,激活时间分别为3 h、5 h、18 h。以同期常规ICSI 23例23个周期为对照组。观察受精失败率及离子霉素激活时机对卵母细胞的受精率及形成胚胎的发育能力的影响。结果研究组中前次ICSI受精失败再次ICSI受精失败发生率为36.0%(9/25),严重圆头畸形精子症当次ICSI受精失败或低下(受精率<30%)发生率为38.9%(7/18),死精2例ICSI均未受精,15例手术取精ICSI受精失败发生率为26.7%(4/15)。MII卵580个,通过机械法激活受精率为55.2%(320/580);对未排出第二极体中的176个卵子行离子霉素激活,AOA受精率为68.2%(120/176),其中3 h与5 h激活的受精率、优胚率和囊胚形成率比较差异无统计学意义(P均>0.05),18 h激活效率最低,与3 h、5 h比较差异有统计学意义(P均<0.05)。移植AOA胚胎共14例,获得临床妊娠6例,临床妊娠率为42.9%。结论通过ICSI后早期观察卵母细胞联合AOA技术可以提高ICSI受精率,是改善ICSI受精失败的有效措施,具有较好的临床应用价值。更多还原

【Abstract】 Objective It is to investigate the effect of early observation combined with assisted oocyte activation( AOA) on fertilization rate of intracytoplasmic sperm injection( ICSI). Methods A total of 61 ICSI cycles of 60 patients undergoing ICSI were selected as study group. The release of the second polar body of the oocytes was observed,the oocytes that did not discharge the second polar body were incubated with ionomycin for 5-10 minutes for AOA. The activation times were 3 hours,5 hours,18 hours. A total of 23 ICSI cycles of 23 patients undergoing routine ICSI at the same time were selected as study group. The failure rate of fertilization and the effects of different activating timing of ionomycin on the fertilization rate of oocyte and the embryo developmental ability were observed. Results The incidence of failed ICSI fertilization again after once of failed ICSI fertilization in the study group was 36. 0%( 9/25),and the incidence of failed or low ICSI fertilization( less than 30%) of severe round malformation sperm was 38. 9%( 7/18),2 cases of dead sperm were not fertilized after ICSI. The incidence of failed ICSI fertilization in 15 cases accepted testicular sperm aspiration was26. 7%( 4/15). There were 580 MII oocytes,the fertilization rate was 55. 2%( 320/580) by mechanical method,and the fertilization rate of AOA was 68. 2%( 120/176) in 176 oocytes that did not discharge the second polar body after ionomycin activation( P < 0. 05). There was no significant difference in fertilization rate,excellent embryo rate and blastocyst formation rate between the ones activated for 3 hours and 5 hours( P > 0. 05),and the activation efficiency of 18 hours was the lowest( P < 0. 05),compared with 3 hours and 5 hours the differences were significant( P > 0. 05). Transplantation of AOA embryos in 14 cases,access to clinical pregnancy in 6 cases,the clinical pregnancy rate was 42. 9%. Conclusion ICSI fertilization can be improved by early observation combined with AOA after ICSI. It is an effective measure to improve ICSI fertilization failure and has good clinical value.更多还原