常规体外受精失败后不同时间进行挽救性卵细胞质内单精子注射的结局比较

Intracytoplasmic Sperm Injection at Different Time Points After Conventional in Vitro Fertilization to Rescue Unfertilized Oocyte

目的探讨常规体外受精(IVF)失败后6h和22h进行挽救性卵胞质内单精子显微注射(ICSI)的效果。方法选取2004年6月至2008年11月在本院进行的共31个完全受精失败的IVF周期为研究对象。其中2004年6月至2007年8月共计15个完全受精失败的IVF周期,对所有成熟二级卵母细胞(MⅡ卵子)在受精22h后进行挽救性ICSI(纳入22h组);2007年8月至2008年11月共计16个完全受精失败的IVF周期,对所有MⅡ卵子在受精6h后进行挽救性ICSI(纳入6h组)。对两组受精率、卵裂率、胚胎移植(ET)数和临床妊娠率进行比较(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,征得该委员会批准)。两组患者的年龄、不孕年限等比较,差异无统计学意义(P>0.05)。结果 6h组的受精率(77.8%,70/90)显著高于22h组(47.5%,58/122),两组比较,差异有统计学意义(P<0.01);6h组的卵裂率(98.6%,69/70)显著高于22h组(79.3%,46/58),两组比较,差异亦有统计学意义(P<0.01);6h组的临床妊娠率(43.8%,7/16)显著高于22h组(0,0/15),两组比较,差异有统计学意义(P<0.05)。结论常规IVF失败6h后进行挽救性ICSI可获得更好的受精率、卵裂率和临床妊娠率。

Objective To compare the outcomes of rescue intracytoplasmic sperm injection （ICSI） in 6 h and 22 h after conventional in vitro fertilization （IVF） to rescue unfertilized oocyte. Methods From June 2004 to November 2008, a total of 31 failure IVF cycles were included into this study. Among them, rescue ICSI was performed on 6 h after initial IVF of 15 failure IVF cycles （between June 2004 and August 2007） （6 h group）, 22 h after initial IVF of 16 failure IVF cycles （between August 2007 and November 2008） （22 h group）. The rates of fertilization and cleavage, embryo quality, implantation, and pregnancy rates after rescue ICSI were analyzed and compared between two groups. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Yantai Yuhuangding Hospital. There had no significant differences between two groups among average, infertility duration, and so on （P〉0. 05）. Results The fertilization rate in 6 h group （77.8%, 70/90） was significant higher than that of 22 h group （47.5%,58/122） （P〈0.01）. The cleavage rate in 6 h group （98.6%,69/70） was also significant higher than that of 22 hgroup （79.3%,46/58） （P〈0.01）. And the clinical pregnancy rate in6 hgroup （43.8%, 7/16） was higher than that of 22 h group （0, 0/15） with significant difference （P〈0.05）. Conclusions It was competitive to rescue ICSI on oocytes with fertilization failure in 6 hours than 22 hours after conventional IVF.