在IVF中,精子从各种不同的方向穿透卵母细胞[12],因此,雄原核与雌原核以不同分方式相互靠近,从而形成PN1、PN2、PN3和PN4四种不同的原核构型。但在ICSI中,精子是被已固定的方向注入卵母细胞中的,即在3点的位置,卵子的极体则位于6或12点的位置。由于精子是被注射于卵母细胞的中心或稍偏里处,所以以ICSI方式受精的所有卵母细胞应该表现为同一原核构型。然而,通过我们的观察,事实却并非如此。所有通过IVF或ICSI产生的合子,其原核构型均表现出与以上四种相似的情形,且几率基本相同,这些事实说明,合子原核构型的类型与精子的穿透方向是没有关联的,因此可以将原核构型作为评估胚胎发育潜能的指标。在我们的研究中,平行于极体的PN1和PN4型合子,与PN2、PN3型相比,其受精或ICSI后24~26h胚胎的早期卵裂率显著增高(P<0.05)。移植早期卵裂发育成的优质胚胎与晚期卵裂的优胚相比,其种植率及怀孕率均显著增高(P<0.05),这与国外的报道一致[1314],在原核消失和卵裂之间,对一部分不同构型的合子每隔几小时进行观察,并未发现原核构型的改变。通过对动物合子的观察发现,在卵裂之前,或者是雌原核移向雄原核,或者是雄原核移向雌原核,最终雌雄原核质膜相互融合,形成二倍体的合子核[15]。因此,在此期间,原核或纺锤体一定会发生旋转,为卵裂事件的发生做好准备。以第3天胚胎的形态学结合原核的构型和早期卵裂与否对移植的胚胎进行选择,结果表明,与PN2、PN3构型的合子相比,移植PN1、PN4构型和早期卵裂的胚胎其种植率和怀孕率均显著升高(P<0.05,表2);同时,PN1、PN4来源的胚胎其早期卵裂率,优质胚胎率及囊胚率均显著增加(P<0.05,表1)。
本研究通过对原核构型及胚胎质量和发育潜力的观察,来评估原核构型早期卵裂与胚胎发育、种植率和怀孕率之间的关系。提示临床上移植有限的胚胎时,在胚胎评分同样的情况下,可采用合子原核构型及早期卵裂为指标来指导选择植入胚胎。且该研究方法简单,耗时少,对胚胎无损伤,对于选择优质胚胎进行移植,提高种植成活率和试管婴儿效率有一定的意义。
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