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目的探讨原核期评分系统与受精后第3天胚胎形态、受精后第6天囊胚形成和着床率之间的关系,以评估其在体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)中的应用价值。方法于常规IVF或卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)受精后16～20 h观察受精情况,将正常受精卵母细胞参照Scott提出的Z评分系统分为Z1～Z4四种类型,比较不同原核类型之间的卵裂率,胚胎第3天(D3)优质胚胎率和第6天(D6)囊胚形成率。并通过分析着床结局明确的移植胚胎,比较各种类型受精卵之间的着床率。结果 Z4组受精卵的卵裂率(92.9%)、D3优质胚胎率(14.25%)、D6囊胚形成率(10.48%)均明显低于其他各组(P<0.01)。Z4组的着床率(5.88%)很低,但各组的着床率之间差异无显著性(P>0.05)。Z1、Z2、Z3三组间的卵裂率、D3优质胚胎率、D6囊胚形成率和着床率之间差异均无统计学意义(P>0.05)。结论异常的原核形态(Z4型)可预测胚胎的体内外发育潜能,但核仁的形态特征并不一定能预测胚胎的活力,Z1、Z2和Z3胚胎可能具有相同的发育潜能。
Objective To investigate the relationship between the prokaryotic scoring system and embryonic morphology on the 3rd day after fertilization, blastocyst formation and implantation rate on the 6th day after fertilization to evaluate its relationship with in vitro fertilization-embryo transfer (IVF -ET) in the application value. Methods The fertilization was observed 16-18 h after routine IVF or intracytoplasmic sperm injection (ICSI). The normal fertilized oocytes were divided into four types Z1 ~ Z4 according to Scott’s Z-score system , The cleavage rate between different prokaryotic types, the good embryo rate on day 3 (D3) and the blastocyst formation rate on day 6 (D6) were compared. And through the analysis of implantation outcome clear transplant embryos to compare the rate of implantation of various types of fertilized eggs. Results The cleavage rate (92.9%), D3 high quality embryo rate (14.25%) and D6 blastocyst formation rate (10.48%) in Z4 group were significantly lower than those in other groups (P <0.01). The implantation rate in Z4 group (5.88%) was very low, but there was no significant difference in the implantation rate between groups (P> 0.05). The cleavage rate, D3 high quality embryo rate, D6 blastocyst formation rate and implantation rate of Z1, Z2 and Z3 were not statistically significant (P> 0.05). Conclusion The abnormal prokaryotic morphology (Z4) predicts the in vitro and in vivo developmental potential of embryos. However, morphological features of nucleoli do not necessarily predict embryo viability. Z1, Z2 and Z3 embryos may have the same developmental potential.