体外受精胚胎移植技术治疗不明原因不孕的疗效分析

Analysis on the treatment result for the couples with infertility by in vitro fertilization and embryo transfer

目的评估体外受精胚胎移植技术(IVF-ET)治疗女性不明原因不孕的效果。方法分析自2000／11- 20002／10,在我中心因不明原因性不孕症首次实施体外受精胚胎移植(1VF-ET)的患者38例,其中有31位患者共有82周期的夫精人工受精(AIH)失败史;其中22例行常规体外受精(IVF),12例行单精子卵胞浆内注射(ICSI)受精, 4例患者的卵母细胞采用一半行IVF,一半行ICSI受精,即IVF+ICSI法。同期因输卵管不通,继发性不孕行IVF-ET治疗的患者59例患者为对照组;对照组均采取常规IVF受精。结果不明原因的不孕患者行常规IVF的卵细胞完全不受精周期出现率为26．92％,明显高于单纯输卵管不通的患者(p=0．001),但周期取卵率、受精后的卵裂率、胚胎种植率、及每移植周期的临床妊娠率无显著差异(P=0．547);结论VF-ET技术可作为不明原因性不孕患者的治疗手段。部分患者在常规体外受精时存在卵细胞受精障碍,单精子卵胞浆内注射对受精障碍的患者是有效的。

Objective To evaluate whether IVF-ET is an effective treatment for unexplained subfertility. Methods 38unexplained infertility couples treated by IVF-ET for first time, among them, 31coupled ever failed AIH for 82 cycles. Sibling oocytes were fertilied by standard IVF on 22 coupls, by ICSI in 12 couples, and 1/2 oocytes by standard IVF, and 1/2 by ICSI in 4 couples. 59 follipian block couples were as control group for IVF-ET, their oocytos inseminated by standard IVF. ResuHs Fertilization failure was more significant difference in wholly silibing cocytes in two group （P=0.001）, the completely insemination failure rate by standard IVF was 26.92% in unexplained fertility group. Except the completely insemination failed couples, other＇ s oocytes fertilization rate , cleavage, and clinical pregnancy rate were same in two groups. In unexplained infertility couples, there were 6 couples pregnancy in 31 who failed by AIH. Conclusions Couples with unexplained infertility undergoing IVF-Et have some pregnancy rate with the foilipian block couples, but the completely insemination failure rate is high by standard IVF. ICSI can solve the problem, but we should note genetic disorder in their offping.