CAJ | 학술논문

目的：分析体外受精-胚胎移植（ IVF-ET）治疗中，去除颗粒细胞观察第二极体对胚胎质量及结局的影响。方法回顾性分析苏州市立医院生殖与遗传中心2011年1月至2013年1月IVF-ET治疗周期患者的数据，根据受精后3h是否观察第二极体将504个周期分为两组（组1，第二极体观察组；组2，非第二极体观察组），对数据进行比较。结果两组第2次减数分裂中期Ⅱ（MⅡ）卵率（组1：82．3％，组2：85．9％），2原核（2PN）率（组1：55．6％，组2：60．5％），1PN率（组1：3．2％，组2：5．3％），差异均有统计学意义（χ2值分别为0．000、0．000、0．000，均P＜0．05）；多精受精率、卵裂率、优质胚胎率、临床妊娠率及种植率差异均无统计学意义（均P＞0．05）。组1中32个周期由于受精失败或者低受精，于受精后6h行补救性卵胞浆内单精子注射（res-ICSI）；组2中1个周期完全受精失败，于受精后20h行res-ICSI。结论去除颗粒细胞观察第二极体的卵子受精后不影响多精受精率、卵裂率、优质胚胎率、临床妊娠率及种植率，而第二极体观察时间的提前，可能导致了组1MⅡ率、正常受精率及单原核受精率的降低。第二极体观察能够尽量避免患者由于受精失败取消IVF周期，并降低了ICSI技术的使用率，IVF不受精或低受精病例可以通过res-ICSI补救。
목적：분석체외수정-배태이식（ IVF-ET）치료중，거제과립세포관찰제이겁체대배태질량급결국적영향。방법회고성분석소주시립의원생식여유전중심2011년1월지2013년1월IVF-ET치료주기환자적수거，근거수정후3h시부관찰제이겁체장504개주기분위량조（조1，제이겁체관찰조；조2，비제이겁체관찰조），대수거진행비교。결과량조제2차감수분렬중기Ⅱ（MⅡ）란솔（조1：82．3％，조2：85．9％），2원핵（2PN）솔（조1：55．6％，조2：60．5％），1PN솔（조1：3．2％，조2：5．3％），차이균유통계학의의（χ2치분별위0．000、0．000、0．000，균P＜0．05）；다정수정솔、란렬솔、우질배태솔、림상임신솔급충식솔차이균무통계학의의（균P＞0．05）。조1중32개주기유우수정실패혹자저수정，우수정후6h행보구성란포장내단정자주사（res-ICSI）；조2중1개주기완전수정실패，우수정후20h행res-ICSI。결론거제과립세포관찰제이겁체적란자수정후불영향다정수정솔、란렬솔、우질배태솔、림상임신솔급충식솔，이제이겁체관찰시간적제전，가능도치료조1MⅡ솔、정상수정솔급단원핵수정솔적강저。제이겁체관찰능구진량피면환자유우수정실패취소IVF주기，병강저료ICSI기술적사용솔，IVF불수정혹저수정병례가이통과res-ICSI보구。
Objective To analyze the influence of cumulus cells removal after short co-incubation of gametes on quality and outcomes of embryo in in vitro fertilization-embryo transfer (IVF-ET) treatment.Methods Data of infertility patients receiving IVF-ET treatment in the reproductive center of Suzhou Municipal Hospital Affiliated to Nanjing Medical University from January 2011 to January 2013 were retrospectively analyzed.According to whether second polar body was detected , 504 cycles were divided into two groups:group 1(detected group), group 2 (non-detected group).The data were compared between two groups .Results The MⅡoocytes rate (group 1:82.3%, group 2:85.9%), normal fertilization rate (group 1:55.6%, group 2:60.5%), and 1PN rate (group 1:3.2%, group 2:5.3%) between two groups were significantly different (allχ2 value was 0.000, all P<0.05).There were no significant differences in polyspermy rate, cleavage rate, good quality embryo rate, clinical pregnancy rate and implantation rate (all P>0.05).There were 32 cycles receiving early res-ICSI 6h after insemination due to fertilization failure and low fertilization rate in group 1, and 1 cycle received late res-ICSI 20h after insemination in group 2.Conclusion Mechanical removal of cumulus cells to detect the second polar body does not affect polyspermy rate, cleavage rate, good quality embryo rate , clinical pregnancy rate and implantation rate .The lower MⅡ oocytes rate, normal fertilization rate and 1PN rate may be caused by the early detection time .With second polar body detection , cancellof IVF can be avoided because of fertilization failure .It also decreases ICSI rate obviously in IVF treatment .Fertilization failure and low fertilization cases can be rescued by res-ICSI.