短时受精在体外受精-胚胎移植治疗周期中的应用价值

目的:比较IVF-ET治疗中精卵孵育不同时间对胚胎质量及治疗结局的影响。方法:189个IVF-ET周期按精卵共孵育时间不同分为短时受精组(A组,精卵共孵育2h)和传统受精组(B组,精卵孵育过夜)。两组中又根据男方精液质量是否正常分为精液正常组和精液异常组(中重度精液异常),分别比较4组的受精率、多精受精率、卵裂率、优质胚胎率、妊娠率、胚胎种植率和流产率。结果:①4组的受精率、多精受精率、卵裂率和流产率差异无统计学意义(P>0.05)。②短时受精组的优质胚胎率、临床妊娠率和胚胎种植率显著高于传统受精组(P分别<0.05、<0.01)。③短时受精中精液正常组(A1组)与精液异常组(A2组)的优质胚胎率、临床妊娠率及胚胎种植率均高于传统受精中的精液异常组(B2组,P分别<0.01或<0.05),而与传统受精中的精液正常组(B1组)比较差异均无统计学意义(P>0.05)。结论:①短时受精不影响受精率、卵裂率和流产率,可提高优质胚胎率、临床妊娠率及胚胎种植率;②短时受精不减少多精受精率;③短时受精对精液质量异常(中重度精液异常)周期治疗结果明显改善。     

Short coincubation of gametes in in vitro fertilization improves implantation and pregnancy rates: a prospective, randomized, controlled study

OBJECTIVE: To examine the benefits of short coincubation of gametes compared to prolonged incubation in in vitro fertilization (IVF). DESIGN: Prospective randomized controlled study. SETTING: Hospital-based fertility center. PATIENT(S): One hundred thirty patients (group 1) and 129 patients (group 2). INTERVENTION(S): Oocytes from group 1 were exposed to spermatozoa for 2 hours, and oocytes from group 2 were exposed to spermatozoa for 20 hours. MAIN OUTCOME MEASURE(S): Fertilization and cleavage rates, embryo quality, and pregnancy and implantation rates were evaluated. Estradiol (E(2)) and progesterone (P(4)) levels were measured in the wells of culture dishes after 2-hour exposure of oocytes/zygotes to spermatozoa in group 1 and after 20-hour exposure in both the groups. RESULT(S): There was no difference between the two groups in the fertilization rate and the number of embryos obtained. However, the proportion of grade 1 embryos was significantly higher among group 1 compared to group 2 patients. Clinical pregnancy and implantation rates were significantly higher among group 1 compared to group 2. The significantly higher levels of E(2) and P(4) in the 20-hour cultures compared with the 2-hour cultures may have been detrimental to embryo quality, pregnancy, and implantation rates. CONCLUSION(S): Coincubation of gametes for 2 hours with standard or high insemination concentrations of spermatozoa significantly improved embryo quality and the pregnancy and implantation rates compared with overnight incubation of gametes.