[不明原因不孕症患者的精卵相互作用及体外受精临床结局]

[Sperm-oocyte interaction and in vitro fertilization clinical outcomes in patients with unexplained infertility].

作者信息

Liu Nenghui, Zhang Zhenhui, Li Yanping, Liu Dong'e, Chen Xianhua, Yao Zhongyuan

机构信息

Reproductive Medical Center, Department of Obstetrics and Gynaecology, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 May;36(5):439-47. doi: 10.3969/j.issn.1672-7347.2011.05.012.

DOI:10.3969/j.issn.1672-7347.2011.05.012

PMID:21685701

Abstract

OBJECTIVE

To determine the sperm-zona pellucida (ZP) binding and ZP-induced acrosome reaction in patients with unexplained infertility, and to discuss the relationship between ZP-induced acrosome reaction and fertilization rate.

METHODS

We compared the fertilization rate and good embryo rate in patients with unexplained infertility after fertilization in 2 ways. Based on the causes of infertility, patients were divided into an unexplained infertility group (Group A) and a pure female tubal factor group (Group B). Oocytes which were obtained by super ovulation from 25 patients with unexplained infertility were randomly divided into 2 groups with conventional in vitro fertilization (IVF) (Group A1) and intracytoplasmic sperm injection (ICSI) fertilization (Group A2). The pure female tubal factor group (Group B) had conventional IVF. We conducted sperm-ZP binding and ZP-induced acrosome reaction experiments with 2 groups of men's sperms separately. We compared the number of sperm-egg binding and ZP-induced acrosome reaction rate and discussed the relationship between the ZP-induced acrosome reaction and fertilization rate, and also the fertilization rate, good embryo rate and pregnancy rate in patients with unexplained infertility after fertilization in 2 ways.

RESULTS

The average number of sperm-egg binding (78.29 ± 16.31) and the ZP-induced acrosome reaction rate (55.87 ± 27.69) % in Group A were lower than those of Group B [94.63 ± 6.72, (82.53 ± 17.99)%]. The difference between the average number of sperm-egg binding and the ZP-induced acrosome reaction was significant (P <0.01). The fertilization rate of Group A1 was significantly lower than that of Group B and Group A2 (P <0.01). But there was no significant difference in the good embryo rate among the 3 groups. There was no significant difference between Group A2 and B in fertilization rate and good embryo rate (P <0.05). There was no significant difference in pregnancy rate between Group A and B (P <0.05). Fertilization rate and the rate of acrosome reaction had marked positive correlation with statistical significance (r =0.932, P <0.01).

CONCLUSION

ZP binding and ZP-induced acrosome reaction are very important experiments in sperm function test for patients with unexplained infertility. It can not only effectively avoid no embryo transferring due to complete failure of fertilization but also get a desirable outcome of pregnancy using half-ICSI fertilization in patients with unexplained infertility.

摘要

目的

测定不明原因不孕症患者精子与透明带（ZP）的结合及ZP诱导的顶体反应，并探讨ZP诱导的顶体反应与受精率之间的关系。

方法

我们通过两种方式比较不明原因不孕症患者受精后的受精率和优质胚胎率。根据不孕原因，将患者分为不明原因不孕症组（A组）和单纯女性输卵管因素组（B组）。从25例不明原因不孕症患者中通过超排卵获得的卵母细胞随机分为两组，分别采用常规体外受精（IVF）（A1组）和卵胞浆内单精子注射（ICSI）受精（A2组）。单纯女性输卵管因素组（B组）采用常规IVF。我们分别对两组男性精子进行精子-ZP结合和ZP诱导的顶体反应实验。比较精卵结合数和ZP诱导的顶体反应率，探讨ZP诱导的顶体反应与受精率之间的关系，以及不明原因不孕症患者两种受精方式后的受精率、优质胚胎率和妊娠率。

结果

A组精卵结合平均数（78.29±16.31）和ZP诱导顶体反应率（55.87±27.69）%低于B组[94. *63±6.72，（82.53±17.99）%]。精卵结合平均数与ZP诱导顶体反应之间差异有统计学意义（P<0.01）。A1组受精率显著低于B组和A2组（P<0.01）。但三组优质胚胎率差异无统计学意义。A2组与B组受精率和优质胚胎率差异无统计学意义（P<0.05）。A组与B组妊娠率差异无统计学意义（P<0.05）。受精率与顶体反应率呈显著正相关，具有统计学意义（r =0.932，P<0.01）。