卵泡真实大小与受精及胚胎质量的相关性研究.pdf

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，彭红梅解放军总医院妇产科，北京100853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=4/3R3换算为卵泡直径。每个卵泡按换算后直径分为7 组：13mm、1315mm、1517mm、1719mm、1921mm、2123mm、23mm。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(36.274.34)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)。13mm 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(P0.05)。不同体积卵泡的优胚率不同，1315mm 卵泡优胚率最高(87.5%)，1321mm 卵泡较更大卵泡优胚率更高(P=0.017)，其中 1517mm 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，1517mm 卵泡具有更高的优胚率，胚胎潜能和质量更佳。关键词：辅助生殖技术；卵泡大小；胚胎质量；体外受精-胚胎移植中图分类号：R715文献标志码：A文章编号：2095-5227(2023)06-0613-06DOI：10.3969/j.issn.2095-5227.2023.06.007引用本文：黄楚菁，高原，马慜悦，等.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.Association between accurate size of follicles and fertilization and embryo qualityHUANGChujing,GAOYuan,MAMinyue,LUChongzhao,ZHANGMing,YANGWenhao,ZHANGHuiting,ZHANGYingxin,BIANZiwei,XUPingping,GUOJunli,YANGYizhuo,WANGHui,PENGHongmeiDepartmentofObstetricsandGynecology,ChinesePLAGeneralHospital,Beijing100853,ChinaCorrespondingauthor:PENGHongmei.Email:Abstract:BackgroundEmbryoqualityisadeterminantfactoraffectingreproductiveandbirthoutcomes.Oocytematurationisusuallyassessedindirectlyusingthediametersoffolliclesmeasuredbyultrasound.However,ultrasoundmeasurementisdifficultandhaslowaccuracyintheconditionofmultiplefolliclesdevelopment.Moreaccuratedataareneededtosupportthewidelyusedempiricalvalueandtriggertimeinclinicalpractice.ObjectiveToexploretherelationshipbetweenfolliclesizeandfertilizationandembryoqualityusingmoreaccurateindexesbydirectlymeasuringfollicularfluidvolumeandaveragediameter.MethodsFromSeptember2022toJanuary2023,atotalof42infertilecoupleswhoreceivedassistedreproductivetechnologyattheReproductiveCenteroftheFirstMedicalCenterofChinesePLAGeneralHospitalparticipatedinthestudy.Eachfolliclewasindividuallypunctured and removed under ultrasound,and the follicular fluid volume was measured.Follicle diameter was calculated bymeasuringthevolumeformulaV=4/3R3.Thefolliclesweredividedinto7groupsaccordingtotheconverteddiameter:13mm,13-15mm,15-17mm,17-19mm,19-21mm,21-23mm,23mm.Theoocytes,zygotesandembryoscorrespondingtoeachfolliclewereoperatedseparately,andthedevelopmentoftheembryoswasobserved.ResultsThemeanageof42assistedreproductivewomenwas36.274.34yearsold.Atotalof277oocyteswerecollected,122zygoteswereformed,and122embryoswereobtained(including97high-qualityembryos).Follicles0.05).Therewerestatisticaldifferencesintherateofexcellentembryosamongfolliclesofdifferentsizes(P24 mm）follicle yield a competent oocyte/embryo?J.GynecolObstetInvest，2020，85（5）：416-419.7TamuraI，Kawamoto-JozakiM，FujimuraT，etal.Relationshipbetween follicular size and developmental capacity of 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