卵泡真实大小与受精及胚胎质量的相关性研究

黄楚菁; 高原; 马慜悦; 陆翀曌; 张明; 杨文豪; 张慧婷; 张樱馨; 卞子薇; 徐萍萍; 郭俊丽; 杨怡卓; 王辉; 彭红梅

doi:10.3969/j.issn.2095-5227.2023.06.007

摘要:

背景胚胎质量是影响生育结局的决定性因素。目前，临床上依靠超声下卵泡测量径线间接评估卵母细胞发育成熟度，但在多卵泡发育情况下超声测量难度大、精准度低。临床上广泛使用的经验值、扳机时机均需要准确的数据支持。

目的本文通过直接测定卵泡液体积、计算卵泡径线以获得卵泡真实大小，用更精确的指标探究其与受精及胚胎质量的关系。

方法选取2022年9月 - 2023年1月于解放军总医院第一医学中心生殖中心行辅助生殖助孕的42例女性，在超声下对单个卵泡进行穿刺取卵，测量所获卵泡液体积，根据体积公式V=4/3πR³换算为卵泡直径。每个卵泡按换算后直径分为7组：＜13 mm、13 ~ 15 mm、15 ~ 17 mm、17 ~ 19 mm、19 ~ 21 mm、21 ~ 23 mm、≥23 mm。每个卵泡对应的卵母细胞、受精卵及胚胎均单独处置，并观察胚胎的发育情况。

结果 42例辅助生殖女性平均年龄为(36.27 ± 4.34)岁。共获卵277枚，形成受精卵122枚，形成胚胎122枚(其中优质胚胎97枚)。＜13 mm卵泡中卵母细胞受精率最高(83.3%)，但不同体积卵泡组间的受精率差异无统计学意义(P＞0.05)。不同体积卵泡的优胚率不同，13 ~ 15 mm卵泡优胚率最高(87.5%)， 13 ~ 21 mm卵泡较更大卵泡优胚率更高(P=0.017)，其中15 ~ 17 mm卵泡的胚胎评级最好(P=0.034)。

结论卵泡大小与胚胎潜能和胚胎质量显著相关。较小的卵泡不易于产生优质胚胎，但卵泡过大也会降低胚胎质量，15 ~ 17 mm卵泡具有更高的优胚率，胚胎潜能和质量更佳。

Abstract:

Background Embryo quality is a determinant factor affecting reproductive and birth outcomes. Oocyte maturation is usually assessed indirectly using the diameters of follicles measured by ultrasound. However, ultrasound measurement is difficult and has low accuracy in the condition of multiple follicles development. More accurate data are needed to support the widely used empirical value and trigger time in clinical practice.

Objective To explore the relationship between follicle size and fertilization and embryo quality using more accurate indexes by directly measuring follicular fluid volume and average diameter.

Methods From September 2022 to January 2023, a total of 42 infertile couples who received assisted reproductive technology at the Reproductive Center of the First Medical Center of Chinese PLA General Hospital participated in the study. Each follicle was individually punctured and removed under ultrasound, and the follicular fluid volume was measured. Follicle diameter was calculated by measuring the volume formula V=4/3πR³. The follicles were divided into 7 groups according to the converted diameter: <13mm, 13-15 mm, 15-17 mm, 17-19 mm, 19-21 mm, 21-23 mm, ≥23 mm. The oocytes, zygotes and embryos corresponding to each follicle were operated separately, and the development of the embryos was observed.

Results The mean age of 42 assisted reproductive women was 36.27 ± 4.34 years old. A total of 277 oocytes were collected, 122 zygotes were formed, and 122 embryos were obtained (including 97 high-quality embryos). Follicles < 13 mm had the highest fertility rate of oocyte (83.3%). However, there was no significant difference between follicle size and fertility rate (P>0.05). There were statistical differences in the rate of excellent embryos among follicles of different sizes (P<0.05). Excellent embryo rate of follicles with the diameter of 13-15mm was the highest (87.5%). The excellent embryo rate of follicles with the diameter of 13-21 mm was significantly higher than other larger follicles (P=0.017), and follicles with the diameter of 17-19 mm were the best (P=0.033).

Conclusion Follicle size is significantly correlated to the quality of zygote and embryo. Smaller follicles are difficult to form high-quality embryos, but oversized follicles will also reduce embryo quality. The embryos obtained from follicles with the diameter of 17-19 mm have higher quality and better viability.

卵泡真实大小与受精及胚胎质量的相关性研究

Association between accurate size of follicles and fertilization and embryo quality