| 徐 源,孙 健,陈 威,刘 源,吴 煜,张箴波.源自睾丸精子冻融胚胎卵裂球完整性及恢复卵裂对生育结局的影响[J].,2020,(9):1663-1668 |
| 源自睾丸精子冻融胚胎卵裂球完整性及恢复卵裂对生育结局的影响 |
| Effect of Blastomere Integrity and Resumption of Cleavage on the Reproductive Outcome of Freeze-thawed Embryo Generated from Testicular Spermatozoa |
| 投稿时间：2019-09-28 修订日期：2019-10-23 |
| DOI：10.13241/j.cnki.pmb.2020.09.012 |
| 中文关键词: 冻融胚胎移植 睾丸精子 卵裂球完整性 恢复卵裂 生育结局 |
| 英文关键词: Frozen-thawed embryo transfer (FET) Testicular spermatozoa Blastomere integrity Resumption of cleavage Reproductive outcome |
| 基金项目:上海市优秀学术带头人计划项目(19XD1423100) |
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| 中文摘要: |
| 摘要 目的：探讨源自睾丸活检或睾丸显微取精形成的胚胎冷冻复苏后卵裂球完整性及是否恢复卵裂与生育结局的关系。方法：回顾性分析658个冻融胚胎移植(FET)周期，根据精子来源将其分为手淫精子组(ICSI组)445周期，睾丸活检或睾丸显微取精组(TESA组)213周期。ICSI组根据复苏2枚胚胎后完整个数(0、1、2枚)分为3组(A、B、C组)，TESA组也据此分为D、E、F组。ICSI组根据2枚胚胎复苏后恢复卵裂个数(0、1、2枚)分为3组(G、H、I组)，TESA也据此分为J、K、L组。综合比较各组之间的生育结局。结果：①ICSI组与TESA组复苏后胚胎完整率、复苏18-20 h后胚胎卵裂率、种植率、临床妊娠率、活产率、分娩孕周及出生体重比较差异无统计学意义(P>0.05)。但ICSI组早期流产率显著高于TESA组。②ICSI中B组与C组上述妊娠结局指标比较差异无统计学意义(P>0.05)，但种植率、临床妊娠率、活产率均显著高于A组(P<0.05)。TESA三个亚组比较无统计学差异(P>0.05)。ICSI与TESA组间比较差异无统计学意义(P>0.05)。③ICSI中I组种植率、临床妊娠率、继续妊娠率均显著高于H组(P<0.05)，且I组与H组均显著高于G组(P<0.05)。I组活产率显著高于G组和H组(P<0.05)。TESA中L组种植率、临床妊娠率、继续妊娠率、活产率均显著高于J组(P<0.05)。ICSI与TESA组间比较差异无统计学意义(P>0.05)。结论：尽管睾丸活检或睾丸显微取精的精子质量较差，但一旦形成有效胚胎，FET结局与手淫精子来源的胚胎并无差异。至少移植一枚完整胚胎较移植两枚均破损胚胎具有更好的生育结局。至少移植一枚恢复卵裂的胚胎较两枚均不卵裂胚胎具有更好的生育结局。解冻后无完整胚胎且过夜培养后又均未恢复卵裂的胚胎应慎重考虑该周期是否取消移植。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between the blastomere integrity and reproductive outcome, the resumption of cleavage and reproductive outcome respectively, from the freeze-thawed embryo derived from testicular biopsy or testicular microsperm extraction. Methods: A retrospective analysis was performed of data from 658 patients who received frozen-thawed embryos transfer (FET). According to sperm source, these embryos were divided into 445 cycles of ejaculated sperm group (ICSI group) and 213 cycles of testicular biopsy or microdissection testicular sperm extraction (TESA group). When two embryos thawed, ICSI group was divided into three groups (A, B, C group) based on the number of integral embryos (0, 1, 2). Similarly, TESA group was also divided into D, E and F groups. ICSI group was divided into three groups (G, H, I group) according to the number of resumption of cleavages (0, 1, 2) after two embryo frozen-thawed. Similarly, TESA was also divided into J, K and L groups. The reproductive outcome were compared between the groups, respectively. Results: ①The integrity rate, cleavage rate of embryos cultured in vitro within 18-20 h after thawing, implantation rate, clinical pregnancy rate, live birth rate, gestational age and birth weight were not significant difference between ICSI and TESA group (P>0.05). However, the early miscarriage rate in ICSI group was significantly higher than TESA group. ②There was no statistical difference in reproductive outcome mentioned above between group B and group C (P>0.05). However, the implantation rate, clinical pregnancy rate and live birth rate were significantly higher than group A (P<0.05). The reproductive outcome showed no statistical difference between three subgroups of TESA (P>0.05). There was no significant difference between ICSI and TESA groups (P>0.05). ③The implantation rate, clinical pregnancy rate and ongoing pregnancy rate of group I were significantly higher than group H (P<0.05), and both groups were significantly higher than group G (P<0.05). The live birth rate was significantly higher in group I compared with group G and H (P<0.05). The implantation rate, clinical pregnancy rate, ongoing pregnancy rate and live birth rate of L group were significantly higher than group J (P<0.05). There was no significant difference between ICSI and TESA groups (P>0.05). Conclusion: Although the sperm quality of testicular biopsy or microdissection testicular sperm extraction was poor, the FET outcomes were not different from those embryos derived from ejaculated sperm once effective embryos were formed. Transferring at least one integral embryo had better reproductive outcomes than transferring two blastomere damaged embryos. Similarly, better reproductive outcomes was observed in transferring at least one cleavage embryo than two non-cleavage embryos. If there was neither integral embryo after thawing nor cleavage after overnight culture, it should be carefully considered whether to cancel the FET. |
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