早期补救性卵胞浆内单精子注射的临床应用研究

Clinical value of rescue ICSI 6 hours after insemination in conventional IVF

目的探讨早期补救性卵胞浆内单精子注射(ICSI)在常规体外受精(IVF)授精后6 h判断为完全受精失败周期中的临床价值。方法对IVF授精6 h后判断为完全受精失败而行早期补救性ICSI治疗的141个周期(早期补救ICSI组)进行回顾性分析,统计其受精、胚胎卵裂情况以及临床治疗结局,并与同期IVF完全受精失败补行晚期ICSI的15个周期(Late-ICSI组)以及直接行ICSI的183个周期(直接ICSI组)进行比较。结果 1.三组间成熟卵受精率、双原核(2PN)率、多精率、卵裂率等差异无统计学意义(P>0.05);2.早期补救ICSI组与直接ICSI组两组间胚胎种植率、临床妊娠率及孕早中期流产率等差异均无统计学意义(P>0.05),而优质胚胎率(50.00%vS.55.72%)及可利用胚胎率(66.47%vS.71.12%)在早期补救ICSI组显著低于直接ICSI组(P<0.05);3.早期补救ICSI组与Late-ICSI组两组间可利用胚胎率(66.47%vs.47.62%)、胚胎种植率(23.35%vs.5.56%)及临床妊娠率(38.46%vs.10.00%)等有显著性差异(P<0.05)。结论常规IVF授精后6 h通过观察卵母细胞第二极体是否排出确定受精情况,可以避免完全受精失败的发生;对完全受精失败周期,授精后6 h行补救ICSI可以显著增加可利用胚胎数目,明显提高胚胎种植率及临床妊娠率,可获得与直接ICSI相似的临床妊娠结局。

Objective： To investigate the value of rescue ICSI in the cycle of complete fertilization failure 6 hours after insemination in conventional IVF. Methods： The data of the cycles that the fertilization was complete failure and the rescue ICSI was performed immediately （direct ICSI group, 183 cycles）,or at 6 hours （early rescue ICSI group, 141 cycles）, or at 18-20 hours （late rescue ICSI group, 15 cycles） after insemination in conventional IVF were retrospectively analyzed. The parameters including the status of fertilization, cleavage, clinical pregnancy were analyzed and compared among the three groups. Results： 1. There were no significant differences in the rate of fertilization, 2PN, ≥3PN, cleavage among the three groups （P 〈 0.05）. 2. There were no significant differences in the rates of embryo implantation,clinical pregnancy or miscarriage between the early rescue ICSI group and the direct ICSI group （P〈0.05）. However,the high quality embryos rate and available embryos rate in the early rescue ICSI group were significant lower than those in the direct ICSI group （P〈0.05）. 3. Comparing with the late rescue ICSI group, the rates of available embryos, embryo implantation and clinical pregnancy were significant higher in the early rescue ICSI group （P〈0.05）. Conclusions： In the cycles of complete fertilization failure, implementation of early rescue ICSI can significantly improve the rates of embryo quality, embryo implantation and clinical pregnancy comparing with late rescue ICSI,and get the results as good as the direct ICSI.