【作者】 张振辉；

【导师】 刘能辉；

【作者基本信息】 中南大学 ， 妇产科学， 2010， 硕士

【摘要】 【目的】1.研究不明原因不孕患者的精子功能。2.探讨不明原因不孕患者体外受精方式对临床结局的影响。【方法】选择2009年07月至2010年1月在我院生殖中心行IVF治疗的55例患者,根据不孕不育的原因将患者分为不明原因不孕组(A组)和单纯女方输卵管因素组(B组)。将不明原因不孕组25例患者通过超排卵获取的成熟卵母细胞随机分为两组,分别行常规体外受精(Al组)和ICSI受精(A2组)；单纯女方输卵管因素组(B组)采用常规的体外受精。将两组男方的精子利用废卵分别进行精卵结合实验和透明带诱发精子顶体反应实验。观察A组与B组平均精卵结合数和透明带诱发精子顶体反应情况,分析透明带诱发精子顶体反应率与受精率的关系。比较不明原因不孕组通过两种方式受精后的受精率、优胚率及妊娠率。【结果】1.A组平均精卵结合数(78.29)和透明带诱发精子顶体反应率(55.87%)明显低于B组的平均精卵结合数(94.63)及透明带诱发精子顶体反应率(82.53%),差异具有显著性(P<0.001)。2.A1组的受精率(49.32%)明显低于B组(64.42%)和A2组(71.33%),差异具有统计学意义,而A1组的优胚率(44.44%),与A2组(56.86%)及B组的优胚率(53.81%)相比,差异无统计学意义。A2组的受精率及优胚率与B组比较,差异也无统计学意义。3.A组的妊娠率(36%)与B组(40%)相比,差异无统计学意义。4.A1组的受精率与透明带诱发精子顶体反应率具有显著的相关性,有统计学意义(r=0.932 P<0.01)。【结论】1.对于不明原因不孕患者,精卵结合及透明带诱发精子顶体反应是有重要意义的精子功能检测方法。2.不明原因不孕患者的卵子采用Half-ICSI,可有效避免受精完全失败导致的无胚胎移植情况,获得较理想的妊娠结局。更多还原

【Abstract】 Objective1.Study sperm function of patients with unexplained infertility.2.To explore the impact on clinical outcomes the insemination methods for patients diagnosed with unexplained infertility.MethodsAccording to the causes of infertility,patients were divided into unexplained infertility group (Group A) and the pure female tubal factor group(Group B).The oocytes which were obtained by super ovulation from the 25 unexplained infertility patients were randomly divided into two groups with conventional in vitro fertilization (Group A1) and ICSI fertilization (Group A2);purely female tubal factor group(Group B) with conventional in vitro fertilization.We did sperm-zona pellucida binding and ZP-induced acrosome reaction experiments with the two groups of men’s sperm separately.Comparison of the number of sperm-egg binding and zona pellucida induced acrosome reaction rate, discuss the relationship between the zona pellucida (ZP)-induced acrosome reaction (AR) and fertilization rate. Comparison of fertilization rate good embryo rate and pregnancy rate in patients with unexplained infertility after fertilization in two ways.Results 1.The average number of sperm-egg binding(78.29±16.31)and the zona pellucida induced acrosome reaction rate(55.87±27.69%)in Group A is lower than that of Group B;and the difference between average number of sperm-egg binding (94.63±6.72)and the zona pellucida induced acrosome reaction(82.53±17.99%)was significant (P<0.001).2.The fertilization rate of Group Al was significantly lower than that of Group B and the A2 group separately.But there was no significant statistical difference in the rate of good embryos rate among the groups.3.There was no statistically significant difference between A2 and B group in fertilization rate and good embryo rate.4.There was no significant differences in pregnancy rate between Group A and Group B.5.Fertilization rate and the rate of acrosome reaction had marked positive correlation.Moreover, there was statistically significant (r= 0.932, P<0.01). Conclution 1.sperm-zona pellucida binding and ZP-induced acrosome reaction are very important experiments in sperm function test for unexplained infertility patients.2.It can not only effectively avoid no embryonic transferring situation by the complete failure of fertilization but also get a desirable outcome of pregnancy using Half-ICSI fertilization in patients with unexplained infertility.更多还原