体外受精失败后补行卵胞浆内单精子注射的临床价值探讨

Application Value of Rescue ICSI of Unfertilized Oocytes after IVF

目的:探讨卵胞浆内单精子注射(ICSI)在体外受精完全失败或受精率低于25%的常规IVF周期中的临床价值。方法:回顾分析2001.01-2004.12在我院生殖医学中心接受常规IVF治疗的35例非男性因素不育患者,取卵后体外受精培养16-18h,发现卵母细胞完全未受精或受精率低于25%,立即行ICSI再授精。结果:在24个常规IVF低于25%的周期中,共有197个未受精卵,其中159个MⅡ期卵,显微注射159个,受精123个,最终形成胚胎96个,受精率为77.4%,卵裂率为78.1%,在22个新鲜移植周期(每周期的移植胚胎由来源于常规体外受精卵和补救ICSI后受精卵的胚胎组成),共有4例临床妊娠;在8个冷冻移植周期中(每周期的移植胚胎完全来源于补救ICSI后的受精卵),有1例临床妊娠。在11个常规IVF完全失败周期中,共有89个未受精卵,其中78个MⅡ期卵,显微注射78个,受精63个,卵裂51个,受精率为80.7%,卵裂率为80.9%,在10个新鲜移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中共有2例临床妊娠;在2个冷冻移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中有1例单胎妊娠,妊娠早期流产。胚胎来源于常规体外受精卵和补救ICSI后受精卵的移植周期临床妊娠率为18%;胚胎完全来源于补行ICSI后受精卵的移植周期临床妊娠率为20%。结论:ICSI可作为常规IVF失败后的有效补救措施。

Objective： To evaluate the application value of rescue ICSI of unfertilized oocytes after IVF. Methods： The data of 35 cycles of IVF-ET, which were accomplished in our ART center from January 2001 to December 2004, from 35 patients with some infertile factors other than male infertile factor, were analyzed retrospectively. Rescue ICSI of unfertilized oocytes was performed at 16-18 h after routine IVF, if the fertilization rate was less than 25%. Results： There were 197 unfertilized oocytes in 24 IVF cycles in which the fertilization rates were less than 25%. ICSI was performed for 159 MII, oocytes, 123 oocytes were fertilized and the fertilization rate was 77.4%, 96 cleaving embryos were observed and the cleavage rate was 78.1%. Four women got pregnant from 22 cycles in which transferred embryos were come from routine IVF and rescue of ICSI and the pregnancy rate was 18.0%. One woman got pregnant from 8 frozen-thawed embryos transfer cycles in which all transferred embryos were come from rescue ICSI. There were 89 unfertilized oocytes in 11 cycles in which the fertilization rates were zero. ICSI was performed for 78 MII oocytes, 63 oocytes were fertilized and the fertilization rate was 80.7%, 51 cleaving embryos were observed and the cleavage rate was 80.9%. Two women got pregnant from 10 cycles. One woman got pregnant from 2 frozen-thawed embryos transfer cycles, but unfortunately she miscarried the baby. The pregnancy rate was 20%, when all transferred embryos came from rescue ICSI. Conclusion： ICSI is an effective rescue for the oocytes which remain unfertilized 16-18 h after routine IVF.