摘要
目的探讨体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)中影响可用胚胎率的主要因素。方法回顾性分析行IVF/ICSI-ET治疗的2 578个周期共24 772枚卵母细胞。按获卵数将其分为A组(1~5)、B组(6~10)、C组(11~15)、D组(16~20)、E组(>20),比较各组的受精率、卵裂率、MⅡ卵率、有效胚胎形成数(率)、妊娠率及胚胎种植率等。采用多因素线性回归分析筛选出影响受精率、卵裂率、卵子成熟率以及可用胚胎数(率)的独立相关因素,同时排除单因素分析中出现的混杂。结果单因素分析各组卵子成熟卵率有差异,但没有看到趋势性变化;IVF受精率在各组间有统计学差异,而ICSI受精率各组间无统计学差异。卵裂率各组间无统计学差异,可用胚胎数以及冷冻胚胎数A^E组依次增加,而可用胚胎率随着获卵数的增加却逐渐降低(44.6%、36.0%、33.5%、29.4%、28.8%,P=0.00)。多因素分析提示取卵数的标准化回归系数的绝对值最大(B=-0.205,P=0.00),t的绝对值也最大(t=-8.299),表明取卵数对可用胚胎率的影响最大,提示取卵数越多,可用胚胎率越低。而卵子数目对卵子成熟率、受精率以及卵裂率没有影响。结论随着取卵数的增多,虽然可用胚胎数是增加的,但可用胚胎的转化率却降低了。今后的促排卵目标不是产生的卵子越多越好,而是采用合适的方案尽量减少对卵巢的过度刺激,获得一定数量的正常卵子并形成优质的可供移植的胚胎。
ObjectiveTo identify the the major impact factor on the transferable embryos formation in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） cycles.MethodsA large retrospective cohort study （n=2 578） was performed. Patients performing IVF/ICSI-ET were reviewed, and were categorized into five groups according to the number of oocytes retrieved （1-5 oocytes in group A, 6-10 oocytes in group B, 11-15 oocytes in group C, 16-20 oocytes in group D, 〉20 oocytes in group E）. Oocyte maturity, fertilization rate as well as embyo cleavage rate and transferable embryos formation rate were compared among the five groups. Multivariate liner regression analysis was performed to assess the association between oocyte number and transferable embryos formation rate after adjusting for confounding factors that were identified in the univariate analysis.
ResultsThere were significant differences in the oocyte maturity rate, fertilization rate after IVF, no difference was found in fertilization rate after ICSI and embyo cleavage rate among the groups. Transferable embryo formation rate gradually decreased with the increasing number of retrieved oocytes （44.6%, 36.0%, 33.5%, 29.4%, 28.8%, P=0.00）. Both univariate and multivariate analysis found that oocyte number was positively associated with number of transferable embryos, but were negatively assiociated with transferable embryos formation rate. Oocyte number was the dominant factor affect on transferable embryos formation （B=-0.205, t=-8.299, P=0.00）.ConclusionThe number of transferable embryos increases with occyte yield, but the proportion of transferable embryos formation declines. Future ovarian stimulation should not focus on obtaining as many oocytes as possible. Strategies should aim at less interference with ovarian physiology, and facilitating selection of the best quality embryo for transfer.
作者
潘家坪
滕晓明
王羽
吴海霞
梁珊珊
胡烨
阮井玲
黄媚媛
陈智勤
Pan Jiaping Teng Xiaoming Wang Yu Wu Haixia Liang Shanshan Wu Ye Ruan Jingling Huang Meiyuan Chen Zhiqin(Shanghai First Maternity and lnfant Hospital, Tong Ji University, Shanghai 200040, Chin)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2017年第3期175-181,共7页
Chinese Journal of Reproduction and Contraception
基金
卫生计生委公益项目(201402004)~~
关键词
获卵数
有效胚胎形成率
控制性超促排卵(COH)
卵子利用率
Occyte number
Transferable embryo formation rate
Oocyte maturity
Fertilization rate
Controlled ovarian hyperstimulation （COH）
