Van den Bergh M, Bertrand E, Englert Y
Fertility Unit, Erasmus Hospital, Free University of Brussels, Belgium.
J Assist Reprod Genet. 1995 Apr;12(4):258-62. doi: 10.1007/BF02212928.
Our objective was to evaluate the time course and the predictive value of the extrusion of the second polar body after intracytoplasmic injection (ICSI) related to the fertilization rate, embryo cleavage and quality.
The setting was the in vitro fertilization program of a university hospital.
Twenty-one patients were treated with intracytoplasmic single sperm injection either for fertilization failure in IVF, low fertilization in IVF (< 5%), or severe male factors.
One hundred thirty-five of 205 metaphase 2 oocytes treated with intracytoplasmic single sperm injection were observed 1, 2, and 3 hr after the assisted fertilization procedure. Extrusion of the second polar body was recorded. For each of these oocytes, fertilization was noted 18 hr after ICSI and cleavage and embryo quality were assessed 24 hr later. The 70 remaining oocytes were used to assess a possible negative effect of repeated exposure to light microscopy.
The extrusion of the second polar body 3 hr after injection was an observation with a sensitivity of 0.87, a specificity of 0.58, and a high positive predictive value (0.90) toward oocyte fertilization. Twenty-nine and four-tenths percent of the oocytes extruded a second polar body within the first hour, 56.6% within the first 2 hr, and 78.3% had a second polar body 3 hr after injection. This time course was related neither to the speed of embryo cleavage nor to the embryo quality. Fertilization, cleavage, and embryo quality were not affected by repeated observation as deduced from comparison with the control group and confirmed by a high pregnancy (62% per oocyte retrieval) and implantation rate (22% per replaced embryo).
Oocytes can be checked, in all safety, 3 hr after a single sperm injection for the presence of a second polar to predict oocyte fertilization with a high certainty.
我们的目的是评估卵母细胞胞浆内单精子注射（ICSI）后第二极体排出的时间进程及其与受精率、胚胎分裂和质量的预测价值。
研究在一所大学医院的体外受精项目中进行。
21例患者接受了卵母细胞胞浆内单精子注射治疗，原因包括体外受精（IVF）受精失败、IVF受精率低（<5%）或严重男性因素。
对205个接受卵母细胞胞浆内单精子注射的中期Ⅱ级卵母细胞中的135个，在辅助受精程序后1、2和3小时进行观察。记录第二极体的排出情况。对于这些卵母细胞中的每一个，在ICSI后18小时记录受精情况，并在24小时后评估分裂情况和胚胎质量。其余70个卵母细胞用于评估反复暴露于光学显微镜下可能产生的负面影响。
注射后3小时第二极体的排出对卵母细胞受精具有较高的预测价值，其敏感性为0.87，特异性为0.58，阳性预测值较高（0.90）。29.4%的卵母细胞在第一小时内排出第二极体，56.6%在最初2小时内排出，78.3%在注射后3小时排出第二极体。这个时间进程与胚胎分裂速度和胚胎质量均无关。与对照组比较推断，反复观察对受精、分裂和胚胎质量没有影响，且高妊娠率（每次取卵62%）和着床率（每次移植胚胎22%）证实了这一点。
单次精子注射3小时后，可以安全地检查卵母细胞是否存在第二极体，从而高度准确地预测卵母细胞受精情况。
