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目的 探讨体外成熟卵母细胞的受精方式及影响其胚胎发育的因素.方法 收集本院2008年7月至12月因男性因素需进行卵母细胞胞浆内单精子注射术(ICSI)助孕的135对夫妇未成熟的卵母细胞(DO)354枚,置入P1培养体系中观察培养20～24、26～30、36～40 h后的成熟情况.去除了退化的成熟卵母细胞,随机分为常规体外受精(IVF)和ICSI组,比较2组的正常受精率、卵裂率、第3天优质胚胎率及各组优质胚胎和非优质胚胎的患者年龄、不孕年限、促排时间及卵母细胞体外成熟时间.结果 卵母细胞体外成熟率为82.5%(292/354),IVF组正常受精率56.5%(70/124)低于ICSI组69.9%(107/153)(P<0.05).两组卵裂率和优质胚胎率差异无统计学意义(P>0.05).2组组内优质胚胎的患者年龄、体外成熟时间均小于非优质胚胎(P<0.05);不孕年限及促排时间差异无统计学意义(P>0.05).结论 ICSI能够提高体外成熟卵母细胞的受精率.体外成熟卵母细胞具有常规受精的能力,第3天胚胎质量与ICSI相似.患者年龄和卵母细胞体外成熟时间是体外成熟卵母细胞发育能力的主要影响因素.

Objective To investigate the fertilization method and related factors of embryonic development competence for in vitro mature (IVM) human oocytes. Methods Between July and December, 2008, 354 immature oocytes were obtained from 135 couples during intracytoplasmic sperm injection (ICSI) procedure as required for assisted reproduction due to male infertility in our hospital. These oocytes were incubated in PI culture system and observed for their maturation at 20-24, 26-30 and 36-40 h. The matured oocytes (degenerative ones were excluded) were randomly divided into routine in vitro fertilization (IVF) group or ICSI group to receive fertilization accordingly. The rates of natural fertilization, cleavage and day-3 good embryos were compared between the two groups. Meanwhile, intra-greup comparisons were performed between patients with good embryos and non- good embryos for their age, duration of infertility, length of stimulated ovulation and time to maturation of the oocytes in vitro. Results The rate of oocytes for maturation in vitro was 82. 5% (292/354). The rate of natural fertilization was lower in IVF group than that in ICSI group [56.5% (70/124) vs 69.9% (107/153), P<0.05], and there were no significant difference in rates of cleavage and good embryos between two groups (P>0.05). Patients with good embryos in both groups were with younger age and less time to IVM than those with non-good embryos (P< 0.05). but did not differ significantly in duration of infertility and length of stimulated ovulation (P>0.05). Conclusions ICSI can improve the fertilization rate of IVM. IVM oocytes are able to be fertilized by routine IVF and the day-3 quality of embryos from routine IVF are similar to those from ICSI. Patients' age and time to maturation of the oocytes in vitro seem to be the major factors of the development competence of IVM oocytes.