补救的卵胞浆内单精子注射方法的评估

A study on late intracytoplasmic sperm injection after total conventional in-vitro fertilization failure

目的探讨对常规体外受精(IVF)后完全受精失败(TFF)的卵母细胞进行补救的卵胞浆内单精子注射(L-ICSI)方法的效果。方法自2002年1月至2007年2月对86对夫妇常规IVF后TFF的卵母细胞行L-ICSI,对取卵数目达到12个的原发不育,尤其是对原因不明和子宫内膜异位症不育的14对夫妇采用半数卵母细胞ICSI(Half-ICSI),并进行评估。结果L-ICSI与取卵日ICSI的受精率和分裂胚胎率差异非常显著(P<0.01),而且可移植胚胎数目减少,临床妊娠率极低,仅获得1.2%(1/86)的临床妊娠与分娩。31对L-ICSI的夫妇在本中心行第二次助孕治疗选择取卵日ICSI,获得41.9%(13/31)的妊娠率。Half-ICSI与L-ICSI比较,受精率、分裂胚胎率相似,但临床妊娠率(50%比1.2%)差异非常显著(P<0.01)。Half-ICSI受精率67.6%,临床妊娠率50%(5/10),与取卵日ICSI比较,差异无显著性(P>0.05)。结论L-ICSI作为补救措施作用甚小,建议对合适的人群采用Half-ICSI以避免TFF,提高临床妊娠率。

Objective： The aim of this study was to evaluate the application of late intracytoplasmic sperm injection（L-ICSI） using total fertilization failured（TFF） oocytes by conventional in vitro fertilization（IVF）.Methods： Between January 2002 and February 2007,TFF oocytes by conventional IVF in 86 couples were performed intracytoplasmic sperm injection.In the second trial,14 couples with unexplained infertility or endometriosis were treated by Half-ICSI in 2006.Results： The fertilization rate of L-ICSI oocytes（57.2%） was lower than that of ICSI oocytes right after retrieval（73.6%）（P〈0.01）,the number of transferable embryos decreased,the clinical pregnancy and delivery rate were very low（only 1/86）.For 31 couples who showed unexplained TFF on the first conventional IVF attempt and failed to conceive after L-ICSI,a second attempt was carried out,in which ICSI was used as the only insemination technique on the day of oocyte retrieval.13 viable pregnancies were achieved,yielding a 41.9% pregnancy rate per cycle.Fertilization rate and cleavage rate were similar in L-ICSI and in Half-ICSI,whereas clinical pregnancy rate was significantly higher in Half-ICSI than that in L-ICSI（50.0% vs 1.2%,respectively）.Fertilization rate and clinical pregnancy rate in Half-ICSI were not significantly different from those in fresh cycle ICSI（67.6% vs 71.2% and 50.0% vs 38.2%,respectively）.Conclusions： Our results suggest that L-ICSI can hardly be a successful rescue for the conventional IVF failure.We recommend the use of Half-ICSI to treat suitable indicated infertile couples to avoid TFF and to improve clinical pregnancy rate.