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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

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. 卵泡真实大小与受精及胚胎质量的相关性研究[J]. 解放军医学院学报, 2023, 44(6): 613-617, 630. doi: 10.3969/j.issn.2095-5227.2023.06.007
引用本文: 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. 卵泡真实大小与受精及胚胎质量的相关性研究[J]. 解放军医学院学报, 2023, 44(6): 613-617, 630. doi: 10.3969/j.issn.2095-5227.2023.06.007
HUANG Chujing, GAO Yuan, MA Minyue, LU Chongzhao, ZHANG Ming, YANG Wenhao, ZHANG Huiting, ZHANG Yingxin, BIAN Ziwei, XU Pingping, GUO Junli, YANG Yizhuo, WANG Hui, PENG Hongmei. Association between accurate size of follicles and fertilization and embryo quality[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 613-617, 630. doi: 10.3969/j.issn.2095-5227.2023.06.007
Citation: HUANG Chujing, GAO Yuan, MA Minyue, LU Chongzhao, ZHANG Ming, YANG Wenhao, ZHANG Huiting, ZHANG Yingxin, BIAN Ziwei, XU Pingping, GUO Junli, YANG Yizhuo, WANG Hui, PENG Hongmei. Association between accurate size of follicles and fertilization and embryo quality[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2023, 44(6): 613-617, 630. doi: 10.3969/j.issn.2095-5227.2023.06.007

卵泡真实大小与受精及胚胎质量的相关性研究

doi: 10.3969/j.issn.2095-5227.2023.06.007
基金项目: 军委联勤保障部计生专项(19JSZ17)
详细信息
    作者简介:

    黄楚菁,女,在读硕士。研究方向:生殖内分泌。Email: 844857458@qq.com

    通讯作者:

    彭红梅,女,博士,主任医师,教授,解放军总医院第七医学中心妇产医学部派驻一中心妇产科主任,博士生导师。Email: phmeizys@hotmail.com

  • 中图分类号: R715

Association between accurate size of follicles and fertilization and embryo quality

More Information
  • 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。

     

  • 表  1  患者一般情况

    Table  1.   Characteristics of patients

     指标结果
    年龄/岁36.27 ± 4.34
    BMI/(kg·m-2)22.67 ± 3.84
    AMH/[ng·mL-1Md(IQR)]1.57(0.52,3.12)
    AFC/[个,Md(IQR)]7.00(3.00,9.00)
    E2/[pmol·L-1Md(IQR)]2308.00(1196.85,5120.55)
    下载: 导出CSV

    表  2  不同大小卵泡获卵及胚胎发育情况

    Table  2.   Embryological outcome according to follicular size

     变量总例数<13 mm13 ~ 15 mm15 ~ 17 mm17 ~ 19 mm19 ~ 21 mm21 ~ 23 mm≥23 mm
    获卵数/枚17512255730251610
    受精数/(枚,%)12210(83.3)16(64.0)43(75.4)18(60.0)16(64.0)12(75.0)7(70.0)
    优胚数/(枚,%) 977(70.0)14(87.5)37(86.0)15(83.3)13(81.3)9(75.0)2(28.6)
    养囊胚胎/枚 96 71131161410 7
    冷冻胚胎/枚 15 0 4 8 1 2 0 0
    移植胚胎/枚 8 1 1 2 0 2 2 0
    丢弃胚胎/枚 3 2 0 0 1 0 0 0
    囊胚/(枚,%) 473(42.9)6(54.5)16(51.6)10(62.5)7(50.0)3(30.0)2(28.6)
    优质囊胚/(枚,%) 312(66.7)3(50.0)11(68.8)8(80.0)2(28.6)3(100)2(100)
    下载: 导出CSV

    表  3  不同大小卵泡(合并分组)优胚数(率)比较

    Table  3.   High-quality embryo rate for oocytes with different sizes

    直径分组受精总数/枚优胚数/(枚,%)χ2P
    <13 mm107(70.0)7.6910.021
    13 ~ 21 mm9379(84.9)
    ≥21 mm1911(57.9)a
    aP<0.05,vs 13 ~ 21 mm。
    下载: 导出CSV

    表  4  不同大小卵泡形成的胚胎评级情况

    Table  4.   Embryo ratings for embryo obtained from follicles with different sizes

    直径分组受精数/枚胚胎评级/Md(IQR)HP
    <13 mm102(1,4)12.7030.048
    13 ~ 15 mm162(1,2)
    15 ~ 17 mm432(1,2)
    17 ~ 19 mm182(1.75,2)
    19 ~ 21 mm161.5(1,2)
    21 ~ 23 mm121(1,3.5)
    ≥23 mm 73(2,3)a
    aP<0.05,vs 15 ~ 17 mm。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-02-27
  • 网络出版日期:  2023-05-23
  • 刊出日期:  2023-06-28

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