获单卵或双卵周期体外受精方式对治疗结局的影响

Effects of different in vitro fertilization methods on the clinical outcomes of the patients with one or two oocytes retrieved

目的比较常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)两种授精方式对周期获卵数仅为1～2个患者的治疗结局的影响。方法回顾性分析胚胎移植(ET)168个周期获卵数仅为1～2个的卵巢低反应患者的资料,比较常规IVF组和ICSI组的受精率、卵裂率、优质胚胎率和临床妊娠率等情况。结果ICSI组受精率高于IVF组(分别为83.7%和63.8%,P<0.05);IVF组有24.5%周期的卵子全部不受精,高于ICSI组的9.7%(P<0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率两组间差异无统计学意义(P>0.05)。≥35岁、精液参数不正常时,ICSI组受精率高于IVF组(分别为83.9%和55.6%,P<0.05);IVF组有34.8%周期的卵子全部不受精,高于ICSI组的14.3%(P<0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间差异无统计学意义(P>0.05)。≥35岁、精液参数正常时及<35岁、精液参数正常或不正常时受精率、卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间的差异均无统计学意义(P>0.05)。结论鉴于获卵数为1～2个的周期采用ICSI治疗并不能提高其优质胚胎率、临床妊娠率。因此我们不建议全部行ICSI治疗,男方精液参数正常或处于临界状态建议行IVF治疗。

Objective：To compare the clinical efficacy of conventional in vitro fertilization （IVF） and intracytoplasmic sperm injection （ICSI） in the patients with only one or two oocytes available for fertilization. Methods： A total of 168 cycles of poor responders with one or two retrieved oocytes were analyzed retrospectively. IVF group and ICSI group were compared in terms of fertilization rate, cleavage rate, high quality embryo rate and pregnancy rate. Results： Fertilization rate was significantly higher in ICSI group than in IVF group （83. 7% vs. 63.8%） ;24.5% of cycles in IVF group were complete fertilization failure, significantly higher than that in ICSI group （9.7%）. There was no significant difference between two groups in cleavage rate, high quality embryo rate, ET （embryo transfer） cancellation rate or pregnancy rate. In patients≥35 years old and with abnormal semen parameter, ICSI group achieved a significantly higher fertilization rate （83.9% vs. 55.6%） and a significantly lower complete fertilization failure rate （14. 3% vs. 34. 8%） than IVF group, but no significant difference was found between two groups in cleavage rate, high quality embryo rate, ET cancellation rate or pregnancy rate. In the patients ≥35 years old with normal semen parameter and 〈35 years old with normal or abnormal semen parameter, ICSI group and IVF group produced no significant difference in fertilization rate, cleavage rate, high quality embryo rate, ET cancellation rate or pregnancy rate. Conclusions： Our results showed that in the cycles with only one or two retrieved ooeytes, ICSI did not improve high quality embryo rate and pregnancy rate. It is not suggested for all cycles with one or two retrieved oocytes to have ICSI. We suggest IVF for those patients whose partner has normal or borderline semen parameters.