单纯男性因素不育患者行形态选择性卵胞浆内单精子注射对胚胎发育及临床结局的影响

发布时间：2018-05-11 03:02

本文选题：活精子细胞器形态学检测 + 卵母细胞浆内单精子注射　；参考：《南方医科大学学报》2015年10期

【摘要】：目的使用放大系统对不育男性患者的精子进行形态选择性卵母细胞浆内单精子注射术(IMSI),观察IMSI技术能否改善因男性精液问题而不孕不育夫妇的助孕结局。方法回顾分析本中心2013年1月~2014年11月共82例梗阻性无精子症患者,将行TESA(经皮睾丸穿刺抽吸精子术)获得的睾丸精子通过放大系统(×6600)挑选后行卵母细胞注射(IMSI组),2013年1月~2014年11月共91例梗阻性无精子症患者经TESA取精术后行常规卵母细胞浆内单精子注射(ICSI组);2014年1月~11月共44例畸精子症患者行形态选择性包浆内单精子注射治疗(IMSI组),2014年1月~11月共71例畸精子症患者行常规ICSI治疗(ICSI组)。统计分析ICSI组和IMSI组患者的实验室结局和临床结局。结果梗阻性无精子症患者中正常受精率IMSI组显著高于ICSI组(84.3%vs 77.0%)(P0.05);ICSI组的卵裂率95.5%,优胚率28.2%,囊胚形成率54.8%,种植率26.4%,临床妊娠率47.3%,流产率14%,梗阻性无精子症IMSI组患者的卵裂率96.7%,优胚率29.2%,囊胚形成率54.3%,种植率32.3%,临床妊娠率50.0%,流产率7.3%,两组无显著性差异(P0.05)。畸精子症患者的正常受精率IMSI组显著高于ICSI组(68%vs 75.5%)(P0.05),囊胚形成率IMSI组显著高于ICSI组(54.6%vs 67.9%)(P0.05),ICSI组的卵裂率96.2%,优胚率27.6%,种植率28.2%,临床妊娠率43.7%,流产率9.7%;IMSI组患者的卵裂率95.2%,优胚率27.1%,种植率30.7%,临床妊娠率43.2%,流产率10.5%,两组无显著性差异(P0.05)。结论梗阻性无精子症患者的睾丸精子经放大系统选择后行ICSI,正常受精率较传统ICSI有显著性提高;畸精子症患者射出的精液标本经放大系统挑选后行ICSI,正常受精率、囊胚形成率较传统ICSI有显著性提高。
[Abstract]:Objective to investigate whether IMSI technique can improve the outcome of assisted pregnancy in infertile couples due to male semen problems by using an amplification system to perform morphoselective intracytoplasmic sperm injection (IMSI) in infertile men. Methods 82 patients with obstructive azoospermia from January 2013 to November 2014 were retrospectively analyzed. Testicular spermatozoa obtained by percutaneous testicular aspiration was selected by amplification system (脳 6600) and then oocytes were injected with oocytes. From January 2013 to November 2014, 91 patients with obstructive azoospermia were treated with conventional sperm extraction via TESA. From January to November 2014, 44 patients with teratospermia were treated with morphological selective intracytoplasmic sperm injection, and 71 patients with teratospermia were treated with conventional ICSI from January to November 2014. The laboratory and clinical outcomes of patients with ICSI and IMSI were statistically analyzed. Results the normal fertilization rate in patients with obstructive azoospermia in IMSI group was significantly higher than that in ICSI group (84.3 vs 77.0). The cleavage rate was 95.5%, the excellent embryo rate was 28.2, the blastocyst formation rate was 54.8%, the implantation rate was 26.4%, the clinical pregnancy rate was 47.3%, the abortion rate was 14.3%, and the egg size of the IMSI group with obstructive azoospermia was 144.3%. The cleavage rate was 96. 7%, the excellent embryo rate was 29. 2%, the blastocyst rate was 54. 3%, the implantation rate was 32. 3%, the clinical pregnancy rate was 50. 0%, and the abortion rate was 7. 3. There was no significant difference between the two groups (P 0. 05). The normal fertilization rate in IMSI group was significantly higher than that in ICSI group (P 0.05), the blastocyst formation rate in IMSI group was significantly higher than that in ICSI group (54.6% vs 67.9%), the cleavage rate was 96.26.20%, the embryo rate was 27.6%, the implantation rate was 28.2%, the clinical pregnancy rate was 43.7%, the abortion rate was 9.7m and the cleavage rate of IMSI group was 95.25.00%. The embryo rate was 27.1%, the planting rate was 30.7%, the clinical pregnancy rate was 43.2%, the abortion rate was 10.5%, there was no significant difference between the two groups (P 0.05). Conclusion the normal fertilization rate of testicular spermatozoa of patients with obstructive azoospermia was significantly higher than that of traditional ICSI, and the normal fertilization rate of sperm samples from patients with teratospermia was determined by amplification system. Blastocyst formation rate was significantly higher than that of traditional ICSI.
【作者单位】：南方医科大学南方医院妇产科生殖医学中心;四川省成都市锦江区妇幼保健院生殖医学中心;南方医科大学遗传教研室;
【基金】：四川省科学厅基础医学研究项目(2012JY0066) 广东省科技计划项目(2013B0022000017) 南方医科大学南方医院院长基金(2013C026)
【分类号】：R714.8

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