短时二次取精在辅助生殖技术中的应用分析

胡旭; 姚冠颖; 张琍钧; 韩中将; 冯科

doi:10.16766/j.cnki.issn.1674-4152.003380

短时二次取精在辅助生殖技术中的应用分析

doi: 10.16766/j.cnki.issn.1674-4152.003380

1.
南阳市中心医院生殖医学科，河南南阳 473009
2.
河南省人民医院生殖中心，河南郑州 450003

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20210012

详细信息

通讯作者:
胡旭，E-mail：337499850@qq.com

中图分类号: R446.19 R711.6
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- 文章访问数: 292
- HTML全文浏览量: 95
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2023-09-01
- 网络出版日期: 2024-03-27

Analysis of the application of short-interval second ejaculation in assisted reproductive technology

1.
Department of Reproductive Medicine, Nanyang Central Hospital, Nanyang, Henan 473009, China

摘要

摘要: 目的探讨取卵日短时二次取精对精液质量、最终授精方式、受精率及优胚率的影响。方法回顾分析2020年1月—2022年12月于南阳市中心医院生殖医学科拟行常规体外受精的32个取卵周期，男方均完成第1次取精(第1次取精精液优化后前向运动精子总数＜1.0×10⁶个)和短时二次取精(第1次取精后2 h内)，分析2次精液质量及最终授精方式。对以上周期按最终授精方式分为体外受精(IVF，5例)、卵胞浆内单精子注射(ICSI，11例)、IVF+早补救ICSI(16例)3组，分析各组的受精率、卵裂率以及优胚率等。结果短时二次取精的精液体积显著小于第1次[(1.56±0.55)mL vs. (2.56±1.33)mL，t=5.847，P=0.038]，精子浓度、总活力、前向运动及非前向运动精子比率与第1次取精相比差异均无统计学意义(P＞0.05)。统计最终授精方式，IVF、ICSI、IVF+早补救ICSI比例分别为15.6%、34.4%、50.0%。3组女性患者的年龄、BMI、不孕年限、不孕类型及获卵数差异均无统计学意义(P＞0.05)。IVF+早补救ICSI组的正常受精率和优质胚胎率显著低于ICSI组(P=0.009、0.010)，余各组间的正常受精率、卵裂率、优质胚胎率差异均无统计学意义。结论短时二次取精虽能够有效补充前向运动精子总数，但行常规体外受精时早补救ICSI比例明显上升，一次取精精液质量欠佳时改行ICSI授精可能是更好的选择。
- 短时二次取精 /
- 精液质量 /
- 授精方式 /
- 受精率 /
- 优胚率
Abstract: Objective To investigate the effects of short-interval second ejaculation on semen quality, final fertilization methods, fertilization rate and high-quality embryo rate. Methods A retrospective analysis of 32 occyte retrieval cycles of conventional in vitro fertilization at the Reproductive Medicine Department of Nanyang Central Hospital from January 2020 to December 2022. The first ejaculation (The total number of progressive motility sperm was < 1.0×10⁶ after the optimization of the first semen extraction) and the short-interval second ejaculation (within 2 hours after the first ejaculation) were performed in all the males. Semen quality and final fertilization methods were analyzed. The above cycles were divided into three groups according to the fertilization method: in vitro fertilization (IVF, n=5), intracytoplasmic sperm injection (ICSI, n=11), IVF+early rescue ICSI (n=16), and the fertilization rate, cleavage rate and high-quality embryo rate of each group were analyzed. Results The semen volume of short-interval second ejaculation was significantly lower than that of the first ejaculation [(1.56±0.55) mL vs. (2.56±1.33) mL, t=5.847, P=0.038], and the sperm concentration, total motility, and percentage of progressive motility and non-progressive motility sperms were not statistically significant between short-interval second ejaculation and first ejaculation (P>0.05). According to statistics on the final fertilization methods, the proportion of IVF, ICSI, IVF+early rescue ICSI accounted for 15.6%, 34.4% and 50.0%, respectively. There were no significant differences in age, BMI, infertility years, infertility types and number of occytes obtained among the three groups (P>0.05). The normal fertilization rate and high-quality embryo rate of IVF+early rescue ICSI groups were significantly lower than those of ICSI groups (P=0.009, 0.010), and there was no significant difference in normal fertilization rate, cleavage rate and high-quality embryo rate among other groups. Conclusion Although short-interval second ejaculation can effectively replenish the total number of progressive motility sperm, the proportion of early rescue ICSI increases significantly during conventional in vitro fertilization, so ICSI may be a better choice when the quality of semen is poor.
- Short-interval second ejaculation /
- Semen quality /
- Final fertilization methods /
- Fertilization rate /
- High-quality embryo rate

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表 1 3组患者基础信息比较

Table 1. Comparison of basic information among the three groups

组别	例数	年龄(x±s, 岁)		BMI(x±s)		女性不孕年限(x±s, 年)	女性不孕类型(例)		获卵数(x±s, 枚)
组别	例数	男性	女性	男性	女性	女性不孕年限(x±s, 年)	原发不孕	继发不孕	获卵数(x±s, 枚)
IVF组	5	30.40±2.61	29.20±2.78	24.12±2.13	23.64±4.49	4.40±1.14	3	2	14.00±5.95
ICSI组	11	31.45±4.69	29.45±4.52	25.64±3.73	22.66±2.74	4.20±1.27	8	3	10.18±4.23
IVF+早补救ICSI组	16	32.45±3.25	30.75±4.55	24.58±2.21	22.23±2.83	5.37±3.09	13	3	10.56±4.70
统计量		1.073	1.244^a	0.814	0.396^a	0.773^a	0.964^b		1.229^a
P值		0.355	0.303	0.453	0.676	0.528	0.618		0.307
注：^a为F值，^b为χ²值。

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表 2 2次取精精液参数比较

Table 2. Comparison of semen parameters between the two extractions

项目	精液体积(x±s, mL)	精子浓度[M(P₂₅, P₇₅), ×10⁶/mL]	总活力(x±s, %)	前向运动(x±s, %)	非前向运动(x±s, %)
一次取精	2.56±1.33	25.00(19.50, 44.25)	24.75±8.12	15.88±5.86	8.88±3.13
短时二次取精	1.56±0.55	21.50(19.50, 36.50)	22.63±6.18	15.25±4.13	7.38±2.50
统计量	5.847^a	0.225^b	0.344^a	0.061^a	1.118^a
P值	0.038	0.635	0.567	0.809	0.308
注：^a为t值，^b为Z值。

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表 3 最终授精方式及各组优化后前向运动精子总数

Table 3. Final insemination mode and total number of progressively motile sperm after optimization in each group

组别	例数(%)	优化后前向运动精子总数(x±s, ×10⁶个)
IVF组	5(15.6)	3.25±1.32
ICSI组	11(34.4)	0.39±0.19
IVF+早补救ICSI组	16(50.0)	2.26±0.97

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表 4 3组正常受精率、卵裂率和优质胚胎率比较(%)

Table 4. Comparison of normal fertilization rate, cleavage rate and high-quality embryo rate among the three groups (%)

组别	例数	正常受精率	卵裂率	优质胚胎率
IVF组	5	63.63(42/66)	97.62(41/42)	58.53(24/41)
ICSI组	11	72.34(68/94)^a	98.48(65/66)	60.00(39/65)^a
IVF+早补救ICSI组	16	55.30(73/132)	97.26(71/73)	38.03(27/71)
χ²值		6.846	0.246	7.817
P值		0.033	0.620	0.020
注：与IVF+早补救ICSI组比较，检验标准为P < 0.05/3=0.017。

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