原因不明性不孕患者同胞卵母细胞行IVF和ICSI结果比较

Comparison of conventional IVF and ICSI on sibling oocytes in unexplained infertility patients

目的：探讨原因不明性不孕患者行常规IVF、ICSI对受精、受精后胚胎的影响。方法：回顾性分析2005年6月～2007年12月间非男性因素不孕的夫妇采用同胞卵和同一份精液行常规IVF和ICSI的受精情况、受精后胚胎的发育潜能。结果：50例原因不明性不孕患者中11例常规IVF受精完全失败，IVF完全受精失败率为22％，ICSI组无完全受精失败。IVF、ICSI均受精组ICSI受精率（82％）高于常规IVF（79％），差异无显著性意义（P〉0．05）。均受精组和仅ICSI受精组患者的年龄、不孕年限、基础FSH、BMI以及精液标本分析均无显著性差异。比较移植不同受精方式的胚胎着床率、妊娠率差异均无显著性意义。结论：对于原因不明性不孕的夫妇选择施行IVF—ICSI split既可避免受精失败所致的周期取消，保证一定的成功率，又可为下一次施行IVF时决定受精方式提供依据，值得推广。尚需要大样本研究原因不明性不孕患者年龄、不孕年限和受精完全失败的关系，为选择ICSI提供依据。

Objective： To explore an optimal insemination technique for unexplained infertility patients undergoing conventional in vitro fertilization （IVF） or intraeytoplasmie sperm injection （ICSI） . Methods： Sibling oocytes were inseminated either by ICSI or conventional IVF from fifty unexplained infertility women. Results： A total of 780 cumulus - oocyte complexes （COC） were collected in 50 cycles. There was no significant difference in the fertilization rate between ICSI （82%） and IVF （79%） in unnecessary ICSI group. No fertilization failure occurred in the group of oocytes inseminated by ICSI, whereas the COC in 11 patients （22%） inseminated by conventional IVF had complete fertilization failure. The best embryos were selected for embryo transfer independently of the insemination procedure and it had no difference in implantation rate and pregnancy rate of the embryos obtained with either technique after the non - randomized transfers. The age, duration of infertility, basal FSH and BMI of the patients in necessary and unnecessary ICSI group had no significant difference. Conclusion： ICSI is not superior to IVF as an insemination technique in unexplained infertility cases. The policy of splitting the sibling ooeytes can effectively minimize complete fertilization failure while maintaining high chances of achieving a pregnancy. At the same time, the optimal fertilization method for subsequent treatment cycles can be determined. More researches arc needed to find the clinical clue of complete fertilization failure for the unexplained infertility patients.