非男性因素不孕体外受精失败行卵胞浆内单精子注射的结局分析

Clinical Analysis of Intracytoplasmic Sperm Injection to Low Fertilization after Conventional in vitro Fertilization in Non-male Infertility

目的:探讨卵胞浆内单精子注射(ICSI)对非男性因素不孕IVF失败患者治疗结局的影响。方法:回顾性分析由于第一周期常规IVF治疗中卵子完全不受精或受精率≤25%,行补救性ICSI的10个周期(补救性ICSI组),以及因前次受精失败而在随后的治疗周期中采取ICSI方法受精的19个周期(后续性ICSI组)的ICSI治疗结局,并以因男方少弱精子症进行第1次ICSI治疗的133个周期为对照组。结果:后续性ICSI组受精率、植入率、妊娠率和分娩率均高于补救性ICSI组,但差异均无统计学意义(P>0.05)。后续性ICSI组优胚率显著高于补救性ICSI组(P<0.05);补救性ICSI组受精率(48.9%)、优质胚胎率(29.2%)、植入率(0%)、妊娠率(0%)、分娩率(0%)均显著低于对照组(分别为72.1%、46.6%、21.2%、45.1%、39.1%);后续性ICSI组受精率、植入率、妊娠率、分娩率分别为55.4%、8.8%、21.1%、15.8%,均低于对照组(P<0.05或P<0.01)。优质胚胎率后续性ICSI组(44.2%)低于对照组,但无统计学差异。结论:对于非男性因素不孕IVF失败患者,ICSI能避免受精失败,但是受精率以及妊娠结局受到卵母细胞隐匿性异常的影响。

Objective：To analyze the clinical outcome of intracytoplasmic sperm injection（ICSI） in patients with rescue and previous fertilization failure after conventional IVF.Methods： Data from 10 rescue-ICSI cycles with the normospermia fertilization failure and low fertilization（defined as lower than 25% fertiliza tion） after conven-tional IVF and data from 19 subsequent-ICSI cycles with the previous complete failure of fertilization or withfertilization rate≤25% were retrospectively analyzed.The control group consisted of 133 ICSI cycles for malefactor infertility.Results： The fertilization rate,implantation rate,pregnancy rate and delivery rate increased insubsequent-ICSI compared with rescue-ICSI treatment,but there were no significant differences（P〈0.05）.Andgood quality embryo rate in the subsequent-ICSI group was significantly higher than that in the rescue-ICSIgroup（P〈0.05）.There were significantly lower fertilization rate（48.9%）,good quality embryo rate（29.2%）,implantation pre gnancy rate（0%）,and delivery rate（0%） in rescue-ICSI group than those in the control（72.1%,46.6%,21.2%,45.1%,39.1%,respectively）.Fertilization rate,implantation rate,pregnancy rate and delivery rate inthe subsequent-ICSI group were 55.4%,8.8%,21.1%,15.8%,respectively,which were significantly differentfrom the control of 72.1%,21.2%,45.1%,39.1%（P〈0.05 or P〈0.01）.Good quality embryo rate in the subsequent-ICSI group（44.2%） was lower than that in control group（46.6%）,but there were no significant differences.Conclusion： ICSI can overcome fertilization failure with conventional IVF in non-male infertility,but fertilization rate and pregnancy outcome were still affected by the potential oocyte abnormality.