IVF-ET失败后补救性ICSI的系统评价

System Evaluation of Intracytoplasmic Sperm Injection as A Remedy after Fertilization Failure during Conventional In Vitro Fertilization Andembryo Transfer

目的探讨常规体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)受精失败后补救性卵母细胞浆内单精子显微注射(intracytoplasmic sperm injection,ICSI)的临床价值。方法计算机检索1990年1月—2009年2月Ovid MEDLINE,EMBASE及CNKI等数据库中关于IVF-ET受精失败后行补救性ICSI所有相关随机对照试验(RCT)研究文献,同时手工检索纳入文献的参考文献。对最终获取的文献进行质量评价后行Meta分析。结果最终纳入文献10篇,7篇为补救性ICSI与正常ICSI的RCT研究,3篇为早期补救性ICSI与晚期补救性ICSI的RCT研究,文献质量B级及C级各5篇。①补救性ICSI组较正常ICSI组受精率、卵裂率及妊娠率低,异常受精率高,差异均有统计学意义(P<0.05)。②早期补救性ICSI组较晚期补救性ICSI组受精率、优质胚胎率及妊娠率高,差异有统计学意义(P<0.05);异常受精率低、卵裂率高,但差异无统计学意义(P>0.05)。结论晚期补救性ICSI的受精率、卵裂率、优质胚胎率和妊娠率均较低,异常受精率高,妊娠结局不理想。早期补救性ICSI有取代晚期补救性ICSI的趋势,但尚需更多研究来证实其临床应用价值。

Objective To explore the clinical value of intracytoplasmic sperm injection（ICSI） as a remedy after fertilization failure during conventional in vitro fertilization andembryo transfer（IVF-ET）.Methods Literature about ICSI in rescue after fertilization failure during conventional IVF-ET during January 1990 and February 2009 were retrieved from Ovid MEDLINE,EMBASE and CNKI by randomized controlled trials（RCT）,and reference documents of selected literature were also retrieved by hand.The quality evaluation of selected literature was performed,and Meta analysis was made.Results A total of 10 literature were included,among which 7 were RCT research between rescue ICSI and normal ICSI,the other 3 were RCT research between early remedy ICSI and late rescue ICSI.There were 5 literature of quality B and 5 of quality C.The fertilization rate,merogenesis rate and pregnancy rate in remedy ICSI group were significantly lower than those in normal ICSI group,while the abnormal fertilization rate was significantly higher than that in normal ICSI group（P 0.05）.The fertilization rate,the high-quality embryo rate and the pregnancy rate were higher in early remedy ICSI group than those in late remedy ICSI group,and the difference was statistical significance（P 0.05）;The abnormal fertilization rate and merogenesis rate were higher in early remedy ICSI,but the differences had no statistical significance（P 0.05）.Conclusion The rates of fertilization,merogenesis,high-quality embryo,and pregnancy are low,while the abnormal fertilization rate is high,and the pregnancy outcome is unsatisfactory in late remedy ICSI group.Early remedy ICSI tends to replace the late remedy ICSI,but more evidence is needed.