中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2012年
2期
150-155
,共6页
郭海彬%殷宝莉%张翠莲%李杭生%夏松%张天%贾楠%杨锦建
郭海彬%慇寶莉%張翠蓮%李杭生%夏鬆%張天%賈楠%楊錦建
곽해빈%은보리%장취련%리항생%하송%장천%가남%양금건
受精,体外%治疗失败%精子计数%顶体蛋白酶%预测
受精,體外%治療失敗%精子計數%頂體蛋白酶%預測
수정,체외%치료실패%정자계수%정체단백매%예측
Fertilization in vitro%Treatment failure%Sperm count%Acrosin%Forecasting
目的 探讨精子质量对短时受精后受精结局的预测价值.方法 选取2009年1月至2010年6月在河南省人民医院生殖医学中心进行早期受精观察的常规体外受精胚胎移植(IVF-ET)的患者,筛除年龄＞ 38岁,且第2次减数分裂中期(MⅡ)卵母细胞数＜3个的患者,共有558个周期.按是否进行补救卵胞浆内单精子显微注射术(Re-ICSI)分为常规体外受精(IVF)组(472周期)和Re-ICSI组(86周期).按既往妊娠史将IVF组和Re-ICSI组分为原发不孕和继发不孕,其中IVF组原发不孕269周期,继发不孕203周期；Re-ICSI组原发不孕64周期,继发不孕22周期.IVF组和ReICSI组患者胚胎种植率、临床妊娠率、早期流产率的比较采用x2检验,活产率的比较采用Fisher精确概率检验.IVF组和Re-ICSI组间不孕年限、前向运动精子数量、精子畸形率、精子顶体酶活性的比较采用Mann-Whitney U检验.结果 IVF组胚胎种植率、临床妊娠率、早期流产率、活产率分别为29.4％、44.9％、13.4％、37.0％,Re-ICSI组分别为25.7％、34.6％、10.7％、29.6％,差异均无统计学意义(x2=0.869、2.963、0.010,P=0.351、0.085、0.922、0.098).IVF组中,原发不孕患者的不孕年限、前向运动精子数量、精子畸形率、顶体酶活性分别为4.00(3.00 ～6.00)年、58.37( 33.64 ～102.27)×106条、81.09％ (79.41％～88.69％)、76.30(48.50 ～92.46) μIU/106条精子,Re-ICSI组分别为5.00 (3.25～8.00)年、36.33 (20.59 ～ 64.43)×106条、85.50％ (81.28％ ～ 89.02％)、47.14(31.61 ～90.24) μIU/106条精子,差异均有统计学意义(Z=-2.617、- 3.505、- 3.553、-3.530,P=0.009、0.000、0.000、0.000).IVF组中,继发不孕患者的不孕年限、前向运动精子数量、精子畸形率、顶体酶活性分别为5.00(3.00～7.00)年、63.00( 34.20 ～ 107.73)×106条、81.29％(79.90％ ～ 86.09％)、78.34( 53.87 ～ 98.00)μIU/106条精子,Re-ICSI组分别为5.00 (3.75 ～7.00)年、28.80(18.57 ～48.56)×106条、88.79％(84.04％ ～95.64％)、54.70(39.73 ～76.77) μIU/106条精子,除不孕年限外,其他各项指标差异均有统计学意义(Z=-0.338、-3.505、-3.553、-3.530,P =0.735、0.000、0.000、0.006).结论 患者的不孕年限、前向运动精子数量、精子畸形率、顶体酶活性对短时受精后是否出现受精失败有预测价值.
目的 探討精子質量對短時受精後受精結跼的預測價值.方法 選取2009年1月至2010年6月在河南省人民醫院生殖醫學中心進行早期受精觀察的常規體外受精胚胎移植(IVF-ET)的患者,篩除年齡＞ 38歲,且第2次減數分裂中期(MⅡ)卵母細胞數＜3箇的患者,共有558箇週期.按是否進行補救卵胞漿內單精子顯微註射術(Re-ICSI)分為常規體外受精(IVF)組(472週期)和Re-ICSI組(86週期).按既往妊娠史將IVF組和Re-ICSI組分為原髮不孕和繼髮不孕,其中IVF組原髮不孕269週期,繼髮不孕203週期；Re-ICSI組原髮不孕64週期,繼髮不孕22週期.IVF組和ReICSI組患者胚胎種植率、臨床妊娠率、早期流產率的比較採用x2檢驗,活產率的比較採用Fisher精確概率檢驗.IVF組和Re-ICSI組間不孕年限、前嚮運動精子數量、精子畸形率、精子頂體酶活性的比較採用Mann-Whitney U檢驗.結果 IVF組胚胎種植率、臨床妊娠率、早期流產率、活產率分彆為29.4％、44.9％、13.4％、37.0％,Re-ICSI組分彆為25.7％、34.6％、10.7％、29.6％,差異均無統計學意義(x2=0.869、2.963、0.010,P=0.351、0.085、0.922、0.098).IVF組中,原髮不孕患者的不孕年限、前嚮運動精子數量、精子畸形率、頂體酶活性分彆為4.00(3.00 ～6.00)年、58.37( 33.64 ～102.27)×106條、81.09％ (79.41％～88.69％)、76.30(48.50 ～92.46) μIU/106條精子,Re-ICSI組分彆為5.00 (3.25～8.00)年、36.33 (20.59 ～ 64.43)×106條、85.50％ (81.28％ ～ 89.02％)、47.14(31.61 ～90.24) μIU/106條精子,差異均有統計學意義(Z=-2.617、- 3.505、- 3.553、-3.530,P=0.009、0.000、0.000、0.000).IVF組中,繼髮不孕患者的不孕年限、前嚮運動精子數量、精子畸形率、頂體酶活性分彆為5.00(3.00～7.00)年、63.00( 34.20 ～ 107.73)×106條、81.29％(79.90％ ～ 86.09％)、78.34( 53.87 ～ 98.00)μIU/106條精子,Re-ICSI組分彆為5.00 (3.75 ～7.00)年、28.80(18.57 ～48.56)×106條、88.79％(84.04％ ～95.64％)、54.70(39.73 ～76.77) μIU/106條精子,除不孕年限外,其他各項指標差異均有統計學意義(Z=-0.338、-3.505、-3.553、-3.530,P =0.735、0.000、0.000、0.006).結論 患者的不孕年限、前嚮運動精子數量、精子畸形率、頂體酶活性對短時受精後是否齣現受精失敗有預測價值.
목적 탐토정자질량대단시수정후수정결국적예측개치.방법 선취2009년1월지2010년6월재하남성인민의원생식의학중심진행조기수정관찰적상규체외수정배태이식(IVF-ET)적환자,사제년령＞ 38세,차제2차감수분렬중기(MⅡ)란모세포수＜3개적환자,공유558개주기.안시부진행보구란포장내단정자현미주사술(Re-ICSI)분위상규체외수정(IVF)조(472주기)화Re-ICSI조(86주기).안기왕임신사장IVF조화Re-ICSI조분위원발불잉화계발불잉,기중IVF조원발불잉269주기,계발불잉203주기；Re-ICSI조원발불잉64주기,계발불잉22주기.IVF조화ReICSI조환자배태충식솔、림상임신솔、조기유산솔적비교채용x2검험,활산솔적비교채용Fisher정학개솔검험.IVF조화Re-ICSI조간불잉년한、전향운동정자수량、정자기형솔、정자정체매활성적비교채용Mann-Whitney U검험.결과 IVF조배태충식솔、림상임신솔、조기유산솔、활산솔분별위29.4％、44.9％、13.4％、37.0％,Re-ICSI조분별위25.7％、34.6％、10.7％、29.6％,차이균무통계학의의(x2=0.869、2.963、0.010,P=0.351、0.085、0.922、0.098).IVF조중,원발불잉환자적불잉년한、전향운동정자수량、정자기형솔、정체매활성분별위4.00(3.00 ～6.00)년、58.37( 33.64 ～102.27)×106조、81.09％ (79.41％～88.69％)、76.30(48.50 ～92.46) μIU/106조정자,Re-ICSI조분별위5.00 (3.25～8.00)년、36.33 (20.59 ～ 64.43)×106조、85.50％ (81.28％ ～ 89.02％)、47.14(31.61 ～90.24) μIU/106조정자,차이균유통계학의의(Z=-2.617、- 3.505、- 3.553、-3.530,P=0.009、0.000、0.000、0.000).IVF조중,계발불잉환자적불잉년한、전향운동정자수량、정자기형솔、정체매활성분별위5.00(3.00～7.00)년、63.00( 34.20 ～ 107.73)×106조、81.29％(79.90％ ～ 86.09％)、78.34( 53.87 ～ 98.00)μIU/106조정자,Re-ICSI조분별위5.00 (3.75 ～7.00)년、28.80(18.57 ～48.56)×106조、88.79％(84.04％ ～95.64％)、54.70(39.73 ～76.77) μIU/106조정자,제불잉년한외,기타각항지표차이균유통계학의의(Z=-0.338、-3.505、-3.553、-3.530,P =0.735、0.000、0.000、0.006).결론 환자적불잉년한、전향운동정자수량、정자기형솔、정체매활성대단시수정후시부출현수정실패유예측개치.
Objective To evaluate the predictive value of the sperm quality to fertilization outcomes after short-time insemination.Methods A total of 558 cycles of short-time insemination in the Reproductive Medical Center of Henan Provincial People's Hospital during January 2009 to June 2010 excluding patients aged ＞ 38 years and M Ⅱ oocyte number ＜ 3 were analyzed retrospectively.According to whether undergo rescue intracytoplasmic sperm injection( Re-ICSI),all cycles were divided into in vitro fertilization (IVF)group (472 cycles) and rescue intracytoplasmic sperm injection (Re-ICSI) group (86 cycles).Both IVFgroup and Re-ICSI group were subdivided into primary infertility and secondary infertility according to previous history of pregnancy.269 primary infertility cycles and 203 secondary infertility cycles were characterized in IVF group; and 64 primary infertility cycles and 22 secondary infertility cycles were characterized in Re-ICSI group.x2 test was applied for comparison of embryo plant rate,clinical pregnancy rate,early miscarriage rate between IVF and Re-ICSI groups,while Fisher test was used for comparison of live birth rate.and Mann-Whitney U test was utilized for comparison of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity between IVF and Re-ICSI groups.Results The embryo plant rate,clinical pregnancy rate,early miscarriage rate,live birth rate of IVF group were:29.4％,44.9％,13.4％,37.0％ respectively; the above indicators in Re-ICSI group were:25.7％,34.6％,10.7％,29.6％ respectively,the differences of the indicators between the two groups had no statistical sigmficance (x2 =0.869,2.963,0.010,P =0.351,0.085,0.922,0.098).Median of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity of primary infertility cycles in IVF group were:4.00(3.00 -6.00) years,58.37(33.64 - 102.27) × 106,81.09％ (79.41％ -88.69％ ),76.30 (48.50 - 92.46 ) μIU/106 sperm respectively ; in Re-ICSI group were:5.00 ( 3.25 -8.00) years,36.33 (20.59 -64.43 ) × 106,85.5％ (81.28％ - 89.02％ ),47.14( 31.61 -90.24) μIU/106 sperm respectively,the differences of them between the two groups had statistical significance (Z =-2.617, -3.505, -3.553, -3.530,P =0.009,0.000,0.000,0.000).Median of duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity of secondary infertility cycles in IVF group were:5.00 (3.00 -7.00) years,63.00 (34.20 - 107.73 ) × 106,81.29％ (79.90 -86.09) ％,78.34 ( 53.87 - 98.00) μIU/106 sperm respectively,in Re-ICSI group were:5.00 ( 3.75 -7.00) years,28.80 ( 18.57 - 48.56 ) × 106,88.79％ ( 84.04 - 95.64 ) ％,54.70 ( 39.73 - 76.77 ) μIU/106 sperm respectively,the differences of them between the two groups showed statistical significance except duration of infertility (Z =- 0.338,- 3.505,- 3.553,- 3.530,P =0.735,0.000,0.000,0.006).Conclusion The duration of infertility,forward moving sperm counts,abnormal sperm rate,sperm acrosin activity have predictive value of fertilization outcomes after short-time insemination.
