Disordered zona pellucida-induced acrosome reaction and failure of in vitro fertilization in patients with unexplained infertility
Disordered zona pellucida-induced acrosome reaction and failure of in vitro fertilization in patients with unexplained infertility
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DOI：
10.1016/s0015-0282(02)04555-7
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发表时间：
2003-01-01
影响因子：
6.7
通讯作者：
Baker, HWG
中科院分区：
文献类型：
--
作者：
Liu, DY;Baker, HWG
目的：探讨不明原因不育症患者中透明带(ZP)诱导的顶体反应(AR)与受精率、妊娠率的关系。设计：前瞻性研究。地点：学术研究和教学三级医院。患者(S)：精液分析正常的不明原因不育患者。干预(S)：无。主要结局衡量(S)：精液分析、ZP诱导的AR、采用体外受精(IVF)或卵胞浆内单精子注射(ICSI)方法检测受精率和妊娠率。结果(S)ZP诱导的AR和受精率与标准IVF(n=65)有统计学意义的相关性。DZPIAR患者(ZP诱导的AR小于或等于16%)的平均受精率为23%，而ZP诱导的AR患者的受精率为16%，后者的平均受精率为61%。DZPIAR预测体外受精率为30%的敏感性为80%，特异性为86%。在260例筛查的患者中，DZPIAR的频率为29%。10名DZPIAR患者的平均受精率为15%，在最初的试管受精周期中没有怀孕，在随后的ICSI周期中受精率为61%(其中3例为活产妊娠)。33例DZPIAR患者接受ICSI治疗，平均受精率为71%，每枚胚胎移植的活产妊娠率为17%。16例患者平均移植3.2个胚胎后发生活产妊娠(包括1对双胞胎)。结论：DZPIAR患者标准IVF受精率低或为零，而ICSI受精率和妊娠率高。精液分析正常的不明原因不育症患者中，高达29%可能患有这种情况，应该通过ICSI而不是标准的试管受精来诊断和治疗。
Objective: To determine the relationship between the zona pellucida (ZP)-induced acrosome reaction (AR) and fertilization rate and pregnancy rate in standard IVF and the frequency of disordered ZP-induced AR (DZPIAR) in patients with unexplained infertility.Design: Prospective study.Setting: Academic research and teaching tertiary hospital.Patient(s): Patients with unexplained, infertility with normal semen analysis.Intervention(s): None.Main Outcome Measure(s): Semen analysis, the ZP-induced AR, and measurements of fertilization rate and pregnancy rate with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).Result(s): A statistically significant correlation was found for the ZP-induced AR and fertilization rate with standard IVF (n = 65). Patients with DZPIAR (ZP-induced AR of less than or equal to16%) had an average fertilization rate of 23%, in contrast to patients with ZP-induced AR of >16%, who had an average fertilization rate of 61%. The sensitivity and specificity of DZPIAR for prediction of IVF rates = 30% were 80% and 86%, respectively. Of 260 patients screened, the frequency of DZPIAR was 29%. Ten patients with DZPIAR had an average fertilization rate of 15% and no pregnancy with initial IVF cycles, and a fertilization rate of 61% (with three, live-birth pregnancies) with subsequent ICSI cycles. Another 33 patients with DZPIAR were treated with ICSI alone, with an average fertilization rate of 71% and a live-birth pregnancy rate of 17% per embryo transfer. Sixteen of the patients had live-birth pregnancies (including one set of twins) after undergoing an average of 3.2 embryo transfers.Conclusion(s): Patients with DZPIAR have a low or zero fertilization rate with standard IVF but high fertilization and pregnancy rates with ICSI. Up to 29% of patients with unexplained infertility with normal semen analysis may have this condition, which should be diagnosed and treated with ICSI rather then standard IVF.