不明原因原发性不孕者宫腔内人工授精失败后治疗方案的选择

Treatment Option for Unexplained Primary Infertility Following Failed Intrauterine Insemination

目的 :探讨对不明原因原发性不孕患者行宫腔内人工授精 (IUI)失败后治疗方法的合理选择。 方法 :将6 1例共 6 5个周期的此类患者分为A、B、C、D 4组 ,分别为IUI后体外受精 (IVF)组 37个周期、IUI后卵细胞胞质内单精子注射 (ICSI)组 19个周期、IUI后一半行IVF一半行ICSI组 4个周期、IUI及IVF失败后第 2次改行ICSI组5个周期 ,同时随机选取常规行IVF治疗共 35个周期为E组、常规行ICSI治疗共 2 4个周期为F组作为对照 ,分别比较其正常受精率、完全不受精率、优质胚胎率、妊娠率及种植率。 结果 :A组的正常受精率、完全不受精率 (分别为 5 5 .4 %、2 1.6 % )与E组 (分别为 72 .8%、0 % )相比 ,差异有显著性 (P <0 .0 5 ,P <0 .0 0 5 ) ;与B组 (分别为6 8.4 %、0 % )相比 ,差异有显著性 (P <0 .0 5 ,P <0 .0 1)。D组患者自身对照前 1次IVF及随后的ICSI治疗 ,其正常受精率分别为 12 .2 %、74 .2 % ,差异有显著性 (P <0 .0 0 5 )。 结论 :不明原因原发性不孕患者IUI失败后行IVF有约 2 0 %完全不受精的可能 ,作为充分知情后的选择 ,行ICSI治疗可以获得较高的受精率 ,使患者有供移植的胚胎 ,但ICSI不应为推荐性的选择。

Objective: To determine an optimal insemination technique for unexplained infertility patients undergoing IVF or ICSI following failed intrauterine insemination (IUI). Methods: Sixty-five cycles of 61 patients with failed IUI were divided into four groups: Group A (37 cycles of IVF), Group B (19 cycles of ICSI), Group C (4 cycles of IVF and ICSI: half and half), Group D(5 cycles of ICSI after failed IVF). The conventional IVF cycles were defined as Group E (37 cycles), and the conventional ICSI cycles defined as Group F (24 cycles). The fertilization rate, completely failed fertilization rate, high quality embryo rate, clinical pregnancy rate and the implantation rate were compared among all the groups. Results: There were statistically significant differences in the fertilization rate, completely failed fertilization rate between Groups A and E ( 55.4% vs 72.8%, P< 0.05; 21.6% vs 0%, P< 0.005), and Groups A and B ( 55.4% vs 68.4%, P< 0.05; 21.6% vs 0%, P< 0.01 ). In Group D, there was statistically significant difference in the fertilization rate between IVF cycles and ICSI cycles ( 12.2% vs 74.2%, P< 0.005). Conclusion: The present study demonstrates that there may be 20% of totally failed fertilization in IVF cycles with unexplained primary infertility following failed IUI, and ICSI treatment can increase fertilization rate and avoid complete fertilization failure.