同源卵母细胞在输卵管性不孕患者行IVF和ICSI的结果比较

Fertilization of IVF versus ICSI using sibling oocytes from patients with tubal infertility

目的比较分析同源卵母细胞分别实施常规体外受精(IVF)和卵胞浆内单精子显微注射(ICSI)的结果。方法回顾性分析2006年8月至2008年8月因输卵管因素不孕的夫妇的48个治疗周期,将同胞卵和同一份精液行常规IVF和ICSI后的结果进行比较分析。结果48例患者中常规IVF完全受精失败8例,ICSI均受精,完全受精失败率为16.7%;IVF、ICSI均受精组中ICSI受精率(78.6%)高于常规IVF(66.4%),差异有统计学意义(P<0.01)。移植常规IVF受精胚胎17例,临床妊娠7例,临床妊娠率41.2%;移植ICSI受精胚胎15例,临床妊娠6例,临床妊娠率40.0%;混合移植IVF+ICSI受精胚胎16例,临床妊娠6例,临床妊娠率37.5%,差异无统计学意义(P>0.05)。结论对于输卵管性不孕且可疑或高危IVF受精障碍人群在首次IVF助孕治疗时,可选择将部分卵行ICSI,减少取消移植的风险。

Objective To compare and analyze the fertilization result and the clinical outcome of sibling oocytes after conventional in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） in patients with tubal obstruction. Methods From August 2006 to August 2008, 48 sibling oocytes from 42 woman with primary infertility and 6 with secondary infertility were inseminated with the corresponding same semen sample by ICSI and conventional IVF respectively in our hospital. The result of fertilization and the clinical outcome were retrospectively studied. Results The rate of complete fertilization failure was 16.7% （8/48） in IVF group while 0 in ICSI group. For the 40 patients whose oocytes were inseminated by ICSI and IVF, there were 470 oocytes harvested, half used for ICSI and half for IVF. The fertilization rate in the ICSI group was 78.6% （173/220）, significantly higher than that in IVF group （156/235, 66.4% ）. In IVF group, 17 best embryos were selected for embryo transfer and 7 patients had clinical pregnancy with a rate of 41.2%. In ICSI group, the clinical pregnancy rate was 40.0% （8/15）, and for IVF ＋ ICSI group. The rate was 37.5% （6/16）. There was no significant difference in implantation rate and pregnancy rate of the embryos obtained with either technique. Conclusion ICSI should be carried out at the same time with IVF for those with suspect or high risk of IVF failure.