【摘要】 目的探讨常规体外受精(IVF)后的未见原核(0PN)合子发生的相关因素及0PN来源胚胎的利用价值。方法对2013年1月至2016年12月在河北医科大学第二医院生殖医学科行常规IVF 10 834个周期进行回顾性分析。(1)将周期分为两组,A1组:存在1个或以上0PN;A2组:无0PN。比较A1、A2两组的临床、实验室指标及新鲜移植周期的妊娠率、流产率、活产率、胎儿畸形率。(2)以每周期0PN的发生率为应变量,回归分析0PN周期产生的相关因素。(3)将新鲜移植周期按移植胚胎来源分为3组,B1组:均为0PN胚胎,B2组:0PN+双原核(2PN)胚胎,B3组:均为2PN胚胎。比较B1、B2、B3 3组的临床、实验室及妊娠结局。结果 (1)A1组与A2组比较,年龄低[(30.3±4.5)岁vs.(30.6±4.7)岁]、刺激周期数少[(1.1±0.6)个vs.(1.2±0.6)个]、基础卵泡刺激素(FSH)低[(8.4±2.2)U/L vs.(8.8±1.6)U/L]、周期获卵数多[(11.2±5.7)枚vs.(10.1±5.7)枚],hCG注射日血清雌二醇(E2)高[(11 482.0±1219.5)pmol/L vs.(10 556.4±1330.4)pmol/L],差异有统计学意义(P<0.05)。(2)患者年龄(r=0.858,P<0.001)、刺激周期数(r=0.892,P<0.05)、基础FSH(r=0.768,P<0.001)、获卵数(r=2.602,P<0.001)及hCG注射日血清E2(r=2.714,P<0.001)与0PN的发生率显著相关。(3)B1组、B2组、B3组种植率分别为16.0%、27.5%、32.0%,妊娠率分别为19.8%、41.6%、47.4%,流产率分别为23.5%、23.5%、15.4%,活产率分别为14.0%、31.8%、39.8%,3组比较差异均有统计学意义,且B3组种植率、妊娠率和活产率明显高于B1、B2组,流产率明显低于B1、B2组(P<0.05)。结论常规IVF后0PN合子形成可能与卵巢储备功能较好有关,而0PN来源卵裂期胚胎在无2PN可利用胚胎的情况下具有一定的移植价值,但是应该充分告知并知情同意。更多还原

【Abstract】 Objective To investigate the factors related to the non-pronuclear（OPN） zygotes after conventional in vitro fertilization（IVF） and the utilization value of OPN-derived embryos.Methods The study analysis of 10 834 fresh cycles of conventional IVF from January 2013 to December 2016 in the Reproductive Medicine Department of the Second Hospital of Hebei Medical University.（1） Cycles were divided into 2 groups;group A1:1 or more OPN existed;Group A2:no OPN.The clinical and laboratory indicators of the A1 and A2 groups,along with the pregnancy rate,abortion rate,live birth rate and fetal malformation rate of the fresh transplant cycle,were compared.（2） Taking the incidence rate of OPN in each cycle as the dependent variable,regression analysis was conducted to analyze the factors related to the generation of OPN cycle.（3） The fresh transplant cycles were divided into three groups according to the source of the transplanted embryos;group B1:all were OPN embryos,group B2:OPN+2 PN embryos,and group B3:all were 2 PN embryos.The clinical,laboratory and pregnancy outcomes of group B1,B2 and B3 were compared.Results（1） Compared with group A2,group A1 had a lower age[（30.3±4.5）year vs.（30.6±4.7）year],a lower number of stimulation cycles（1.1±0.6 vs.1.2±0.6）,a lower basal FSH level [（8.4±2.2） U/L vs.（8.8±1.6） U/L],a higher number of eggs retrieved [（11.2±5.7）vs.（10.1±5.7）]and a higher level of serum E₂ on hCG injection day [（11482.0±1219.5）pmol/L vs.（10556.4±1330.4） pmol/L],all were with statistically significant differences（P<0.05）.（2）The patient’s age（r=0.858,P<0.001）,number of stimulation cycles（r=0.892,P <0.05）,basal FSH（r=0.768,P <0.001）,number of retrieved eggs（r=2.602,P <0.001） and serum E₂ level on hCG injection day（r=2.714,P<0.001） were significantly correlated with the incidence of OPN.（3）The implantation rates of B1,B2 and B3 groups were 16.0%,27.5% and 32.0% respectively,the pregnancy rates were 19.8%,41.6% and47.4%,the abortion rates were 23.5%,23.5% and 15.4%,and the live birth rates were 14.0%,31.8% and 39.8%respectively,and the differences among the three groups were statistically significant.The implantation rate,pregnancy rate,and live birth rate in group B3 were significantly higher than those in group B1 and B2,but the abortion rate was significantly lower（P <0.05）.Conclusion The formation of OPN embryos after conventional IVF may be related to better ovarian reserve function;however,when there is no 2 PN embryo available,OPN embryo may have certain value,but patients should be fully informed.更多还原