部分卵母细胞浆内单精子注射的临床结局及影响受精率的相关因素分析

The clinical outcome of half intracytoplasmic sperm injection and the analysis of related factors affecting the fertilization rate of in vitro fertilization

目的探讨在受精失败高危因素患者中采用部分卵胞浆内单精子注射(half-ICSI)对临床结局的影响及对体外受精(IVF)受精率的相关因素分析。方法回顾性分析2017年1月至2018年12月在本院因原发不孕、不孕年限≥5年、不明原因不孕、3次人工授精失败(同时满足两条即可)half-ICSI授精方案的363例患者的临床资料。比较同一患者两种受精方式之间(IVF和ICSI)的受精率、卵裂率、囊胚形成率及妊娠结局。同时采用多因素线性回归分析模型,分析影响IVF受精率的相关因素。结果363例患者IVF组与ICSI组的受精率为(79.87%,2384/2985;88.37%,2265/2563)、早期流产率为(12.60%,16/127;25%,20/80),两组比较,差异有统计学意义(P<0.05)。IVF组与ICSI组平均2PN受精数为[(5.54±1.55)个;(5.75±1.28)个]、2PN卵裂数[(5.41±1.45)个;(5.63±1.31)个]、卵裂率(89.26%,2128/2384;91.13%,2064/2265)、囊胚形成率(40.03%,643/1606;38.55%,628/1629),两组比较,差异均无统计学意义(P>0.05);IVF组与ICSI组平均移植胚胎数[(1.81±0.37)个;(1.82±0.45)个]、胚胎种植率(38.33%,161/420;42.24%,109/258)、临床妊娠率(54.74%,127/232;56.74%,80/141)、双胎妊娠率(26.78%,34/127;23.75%,19/80)、活产率(47.41%,110/232;41.13%,58/141)比较,差异均无统计学意义(P>0.05)。多因素线性回归分析显示,获卵数及促性腺激素(gonadotropin,Gn)总量与IVF受精率呈负相关(回归系数:-0.158,-0.060;P<0.05)。结论对具有受精失败高危因素的患者,行half-ICSI助孕可以提高部分患者的受精率,其中IVF受精率跟获卵数以及Gn用量成负相关,但对大多数患者而言并没有明显的受益。

Objective To investigate the effect of half intracytoplasmic sperm microinjection(half-ICSI)on clinical outcomes in patients with high-risk factors for fertilization failure and to analyze the related factors of in vitro fertilization(IVF)fertilization rate.Methods A retrospective analysis of 363 patients who underwent half-ICSI fertilization in our hospital from January 2017 to December 2018 due to primary infertility,infertility years≥5,infertility of unknown cause,artificial insemination failed for 3 cycles(two criteria should be met simultaneously).The fertilization rate,cleavage rate,blastocyst formation rate,and pregnancy outcome were compared between two fertilization methods(IVF and ICSI)in the same patient.At the same time,a multi-factor regression analysis model was used to analyze the relevant factors affecting the IVF fertilization rate.Results The fertilization rate of the 363 patients in the IVF group and the ICSI group(79.87%,2384/2985;88.37%,2265/2563),and the early abortion rate was(12.60%,16/127;25%,20/80).There was statistically significant difference between the two groups(P<0.05).The average number of 2PN fertilizations in the IVF and ICSI groups was(5.54±1.55;5.75±1.28),the number of 2PN cleavages(5.41±1.45;5.63±1.31),and the rate of cleavage(89.26%,2128/2384;91.13%,2064/2265),blastocyst formation rate(40.03%,643/1606;38.55%,628/1629);There was no statistically significant difference between the two groups(P>0.05).The average number of embryos transferred in IVF and ICSI groups(1.81±0.37;1.82±0.45),embryo implantation rate(38.33%,161/420;42.24%,109/258),clinical pregnancy rate(54.74%,127/232;56.74%,80/141),twin pregnancy rate(26.78%,34/127;23.75%,19/80),live birth rate(47.41%,110/232;41.13%,58/141),There was no statistically significant difference between the two groups(P>0.05).Multivariate regression analysis showed that the number of retrieved oocytes obtained and the total amount of gonadotropin was negatively correlated with the IVF fertilization rate(regression coefficients were-0.1578,-0.060;P<0.05).Conclusion For patients with high-risk factors for fertilization failure,half-ICSI assisted pregnancy can increase the fertilization rate of some patients.The fertilization rate is inversely related to the number of retrieved oocytes and the amount of Gn.However,for most patients,there was no obvious benefit,and the early abortion rate of the embryos in the ICSI fertilization group was significantly increased.