發(fā)布時間：2018-02-08 17:10

  本文關(guān)鍵詞： 精子頭部空泡 IMSI 受精率 time-lapse　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:在輔助生殖技術(shù)(assisted reproductive technology,ART)中,對怎樣提高臨床妊娠率、減少移植胚胎數(shù)目的研究主要針對女性因素,但精子在胚胎發(fā)育中的作用同樣重要。怎樣挑選更優(yōu)質(zhì)的精子以及怎樣挑選更具有發(fā)育潛能的胚胎用以移植成為了關(guān)注的焦點。隨著胞質(zhì)內(nèi)形態(tài)學(xué)選擇性精子注射(intracytoplasmic morphologically selected sperm injection,IMSI)技術(shù)的應(yīng)用,研究者在精子核區(qū)經(jīng)常能觀察到至少1個空泡,并發(fā)現(xiàn)精子頭部的這些空泡與IMSI的預(yù)后不良有關(guān)。本研究的目的是應(yīng)用time-lapse探究精子頭部空泡的數(shù)量和大小在IMSI中對胚胎發(fā)育的影響。資料和方法:選自2015年1月至12月期間于大連市婦女兒童醫(yī)療中心生殖門診就診的患者,按納入標(biāo)準(zhǔn)收集選取了 21對不孕夫婦的共243枚MII卵母細(xì)胞進(jìn)行IMSI注射。同時根據(jù)精子頭部空泡情況將胚胎分為四組,A組(n=48)注射精子不含空泡,B組(n=79)注射精子含有1-2個小空泡(d1umm),C組(n=75)注射精子含有2個以上小空泡(d1um),D組(n=41)注射精子含有1個以上大空泡(d≥1um)。分析入組患者的一般情況,如男女方年齡、不孕年限、不孕因素、Gn總量及天數(shù)、精液常規(guī)參數(shù);對四組分別進(jìn)行實驗室一般情況的分析比較,如平均獲卵數(shù)、受精率、卵裂率、D3優(yōu)胚率;應(yīng)用time-lapse對四組胚胎發(fā)育動力學(xué)參數(shù)進(jìn)行統(tǒng)計分析。應(yīng)用SPSS 17.0系統(tǒng)軟件進(jìn)行數(shù)據(jù)分析,計量資料數(shù)據(jù)應(yīng)用方差檢驗,計數(shù)資料應(yīng)用卡方檢驗,以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:對ABCD四組進(jìn)行統(tǒng)計學(xué)分析:①入組患者一般情況:女方平均年齡(33.8±2.1)周歲,男方平均年齡(35.6±4.2)周歲;患者平均不孕年限(2.0± 1.4)年;其中原發(fā)不孕患者14例,繼發(fā)不孕7例;僅男性因素8例,男性因素合并卵管因素 11 例;平均Gn總量(2645.4±216.3)IU;平均Gn天數(shù)(11.5士 1.2)天。21例精液樣本的總體參數(shù):精液體積(3.4±0.6)ml,精子密度(6.1±1.2)10/ml,精子活力(26.9±2.6)%;②四組實驗室一般情況,如2PN受精率、卵裂率無統(tǒng)計學(xué)差異(P0.05),但D組的D3優(yōu)胚率顯著低于A組(66.66%vs 23.53%,P0.001);③A、B、C、D四組的雌雄原核出現(xiàn)時間、消失時間、分裂成2細(xì)胞、3細(xì)胞時間均無統(tǒng)計學(xué)差異;④A組到達(dá)4細(xì)胞的時間(t4,h)顯著早于D組(40.14±4.33 vs 51.16±11.16,P=0.012);A組到達(dá)5細(xì)胞階段的時間(t5,h)顯著早于D組(46.61±3.43 vs 59.74±10.34,P=0.009);A組到達(dá)8細(xì)胞階段的時間(t8,h)顯著早于D組(55.37±3.56 vs 70.12±13.41,P=0.037);⑤A組2細(xì)胞階段(CC2,h)顯著短于D組(9,91±2.23 vs 16.33士6.78,P=0.043);A組從3細(xì)胞到4細(xì)胞的同步性(S2,h)顯著優(yōu)于D組(0.33 ±0.06 vs 1.99±0.06,P=0.024);四組胚胎從3細(xì)胞到5細(xì)胞(CC3)的時間沒有統(tǒng)計學(xué)差異;從5細(xì)胞到8細(xì)胞(S3)的時間沒有統(tǒng)計學(xué)差異。結(jié)論:精子頭部空泡對胚胎早期發(fā)育的影響不能被排除,注射沒有空泡精子到達(dá)4細(xì)胞的時間顯著短于注射大空泡精子,含有大空泡的精子染色體或DNA的損傷可能已經(jīng)超出了胚胎能夠修復(fù)的能力;在IMSI注射前應(yīng)用高倍放大系統(tǒng)對精子頭部空泡的大小和數(shù)量進(jìn)行篩選對早期胚胎的動力學(xué)發(fā)育有重要影響。
[Abstract]:Objective: in assisted reproductive technology (assisted reproductive technology, ART), on how to improve the clinical pregnancy rate, reduce the number of embryos for research purposes the main factors of female, but the role of sperm during embryonic development are equally important. How to choose a better quality of sperm and how to choose more with the developmental potential of embryos for transplantation into the focus of attention. With intracytoplasmic sperm injection (intracytoplasmic morphologically selective morphology of selected sperm injection, IMSI) technology, the researchers often observed at least 1 void in sperm nuclei, and found that these vacuoles and IMSI sperm head of bad prognosis. The purpose of this study is to influence the number and size of the application of time-lapse on sperm head cavity on embryonic development in IMSI. Materials and methods: from January 2015 to December in Dalian city. Women and children's Medical Center reproductive clinic patients, according to the inclusion criteria collect from 21 infertile couples were a total of 243 MII oocytes were injected with IMSI. At the same time according to the situation of the embryo sperm head were divided into four groups, group A (n=48) injection of sperm containing vacuoles, group B (n=79) containing sperm injection 1-2 small vacuoles (d1umm), C group (n=75) injection of sperm containing more than 2 small vacuoles (d1um), D group (n=41) injection of sperm containing more than 1 large vacuoles (d = 1um). Analysis of general groups, such as women age, duration of infertility, infertility factors. The total Gn and the number of days, semen parameters; comparative analysis of four groups of laboratory conditions, such as the average number of oocytes, fertilization rate, cleavage rate, good embryo rate D3; time-lapse application development on the kinetic parameters of the four groups of embryos were analyzed. The application of SPSS 17 software was used for data analysis, measurement data 鏂欐暟鎹簲鐢ㄦ柟宸楠，

本文編號：1495942