早期补救ICSI应用价值的初步探讨

Primary Study of Early Rescue ICSI of Oocytes that Failed Extrude the Second Polarbody after Conventional IVF

目的：探讨早期补救ICSI的应用价值。方法：回顾性分析IVF受精失败、取卵后20h行补救ICSI者19例（晚补救ICSI,A组）及加精子（IVF）4-6h后未见第二极体（Pb2）的成熟卵行补救ICSI者31例（早补救ICSI,B组）,并与544例同期常规ICSI（C组）进行比较,观察受精率、卵裂率、有效胚胎率、优质胚胎率、胚胎种植率、临床妊娠率,评价早补救ICSI有效性。结果：3组年龄及基础FSH均无统计学差异,B组正常受精率显著高于A组,但显著低于C组（71.27%vs55.69%vs81.08%,P〈0.05）,〉2原核（PN）率A、B组间无统计学差异,但显著高于C组（7.73%vs7.78%vs2.73%,P〈0.01）,卵裂率B组显著高于A组（100%vs94.62%,P〈0.05）,有效胚胎率3组间无统计学差异,优质胚胎率B组显著高于A组,但低于C组（51.16%vs22.73%vs60.19%,P〈0.01）,胚胎种植率B组显著高于A组（1.75%vs17.54,P〈0.05）,与C组比较无统计学差异（17.54%vs18.90%,P〉0.05）,3组临床妊娠率分别为5.26%,26.67%和34.57%,与C组比,A组临床妊娠率显著下降（P〈0.01）。结论：与晚补救ICSI相比,早补救ICSI获得了更高的受精率、卵裂率、优质胚胎率及种植率,但多PN率高于常规ICSI,优质胚胎率仍低于常规ICSI。

Objective： To investigate the value of early rescue ICSI. Methods： Rescue ICSI 22 h after oocyte retrieval was performed on 19 IVF patients （late rescue ICSI, group A） early rescue ICSI was performed on the oocytes that failed extrude second polar body 6 h after conventional IVF in 31 patients （early rescue ICSI, group B）, 544 cycles of routine ICSI as group C. Rates of fertilization, cleavage, transferable embryo, good quality embryo, implantation, and pregnancy were analyzed retrospectively. Results： Normal fertilization of early rescue ICSI was significantly increased compared with that of group A, but lower than that of group C （71.27% vs 55.69% vs 81.08%, P〈0.01）, there was no difference in 〉2PN rate between the two rescue groups, but significantly higher than that of group C （P〈0.01）, both the cleavage and good quality embryo rate in group B were higher than those of group A （P〈0.05）, the rate of good quality was lower than that of group C （P〈0.01）, the implantation rate of group B was significantly higher than that of group A. Condusion： Early rescue ICSI 6 h after insemination gave better results than late rescue ICSI （20 h） despite higher 〉2PN rate and lower good quality embryo rate compared with routine ICSI.