背景:对POSEIDON患者未成熟卵母细胞进行ICSI以获得更好的早期胚胎发育结果的最佳时机仍然未知。这项研究的目的是为POSEIDON患者的体外成熟GV和MI卵母细胞提供最合适的ICSI时间。
方法:对163例POSEIDON患者的两百三十九个未成熟卵母细胞进行了不同时间的前瞻性ICSI:P-ICSI(ICSI是在第一次极体挤压后4-6小时对体外成熟卵母细胞进行的,N=81),R-ICSI(在第一次极体挤压后不到4小时,对体外成熟的卵母细胞进行ICSI,N=80),和E-ICSI(在取卵后的第二天对体外成熟的卵母细胞进行ICSI,N=78)。收集受精和胚胎发育结果并进行统计学分析。第一极体(PB1)挤压后不同时间培养的体外成熟卵母细胞细胞质的线粒体分布被染色。
结果:与E-ICSI组相比,P-ICSI第3天的胚胎在序贯培养后更多成为囊胚,但无统计学意义(OR=3.71,95%CI:0.94-14.63,P=0.061)。与E-ICSI组相比,P-ICSI组和R-ICSI组的更多胚胎在临床上使用,差异有统计学意义(P-ICSI胚胎OR=5.67,95%CI:2.24~14.35,P=0.000;R-ICSI胚胎OR=3.23,95%CI:1.23~8.45,P=0.017).与E-ICSI组相比,来自P-ICSI和R-ICSI的移植胚胎具有较高的植入率,尽管没有统计学意义(P-ICSI胚胎为35.3%;R-ICSI胚胎为9.1%,E-ICSI胚胎为0%,P=0.050)。在三组中,从P-ICSI组分娩的大多数健康婴儿(P-ICSI为5、1和0,R-ICSI和E-ICSI)。PB1挤压后,体外成熟卵母细胞的细胞质中的线粒体少于4h和4-6h培养,呈现半外周和扩散的分布模式,分别。
结论:我们的结果表明,P-ICSI(ICSI在第一次极体挤压后4-6小时对体外成熟的卵母细胞进行)提供了最有效的利用未成熟卵母细胞的方法。来自P-ICSI的体外成熟卵母细胞细胞质的线粒体分布与R-ICSI不同。
BACKGROUND: The optimal timing of performing ICSI on immature oocytes for POSEIDON patients is still unknown to get better early embryonic development outcomes. The purpose of this study was to implore the most appropriate time to carry out ICSI on in vitro maturation GV and MI oocytes for POSEIDON patients.
METHODS: Two hundred thirty-nine immature oocytes from 163 POSEIDON patients were prospectively performed ICSI at different timings: P-ICSI (ICSI was performed on in vitro matured oocytes 4-6 h after the first polar body extrusion, N = 81), R-ICSI (ICSI was performed on in vitro matured oocytes less than 4 h after the first polar body extrusion, N = 80), and E-ICSI (ICSI was performed on in vitro matured oocytes the next day after oocytes retrieval, N = 78). Fertilization and embryonic development outcomes were collected and statistically analyzed. Mitochondria distribution of cytoplasm of in vitro matured oocytes with different time cultures after the first polar body (PB1) extrusion was stained.
RESULTS: Compared to the E-ICSI group, more day 3 embryos from P-ICSI became blastocysts after sequential culture though without statistical significance (OR = 3.71, 95% CI: 0.94-14.63, P = 0.061). Compared to the E-ICSI group, more embryos from both P-ICSI and R-ICSI groups were clinically used with statistical significance (OR = 5.67, 95% CI: 2.24-14.35, P = 0.000 for P-ICSI embryos; OR = 3.23, 95% CI: 1.23-8.45, P = 0.017 for R-ICSI embryos). Compared to the E-ICSI group, transferred embryos from P-ICSI and R-ICSI had a higher implantation rate though without statistical significance (35.3% for P-ICSI embryos; 9.1% or R-ICSI embryos and 0% for E-ICSI embryos, P = 0.050). Among the three group, there were most healthy babies delivered from the P-ICSI group (5, 1 and 0 for P-ICSI, R-ICSI and E-ICSI respectively). The mitochondria in the cytoplasm of in vitro matured oocytes with a less than 4 h and 4-6 h culture after PB1 extrusion presented semiperipheral and diffused distribution patterns, respectively.
CONCLUSIONS: Our results revealed P-ICSI (ICSI was performed on in vitro matured oocytes 4-6 h after the first polar body extrusion) provided the most efficient method to utilize the immaturation oocytes basing on embryos utilization and live birth outcome for low prognosis patients under the POSEIDON classification. The mitochondria distribution of the in vitro matured oocytes\' cytoplasm from P-ICSI varied that from R-ICSI.