早期补救及后续卵胞浆内单精子显微注射在常规体外受精受精失败及低受精率周期的应用

Use of early rescue intracytoplasmic sperm injection and subsequent intracytoplasmic sperm injection in patients with previous fertilization failure or low fertilization rate after conventional IVF.

目的探讨短时受精联合早期补救卵胞浆内单精子显微注射(R-ICSI)在常规体外受精(IVF)完全受精失败及低受精率周期的临床价值,及其后续ICSI的临床效果。方法 2011年1-12月在河北医科大学第二医院生殖医学科,回顾性分析行早期R-ICSI周期(A组),部分卵胞浆内单精子显微注射(Half-ICSI)周期(B组),后续ICSI周期(C组),并以ICSI周期(D组)作为对照组。分别比较A、B、D三组和C、D两组的临床、实验室及妊娠结局等指标。结果 (1)A组与B组比较,种植率和妊娠率分别为(17.02%vs.32.41%,25.00%vs.46.15%),差异均有统计学意义(P<0.05)。B组与D组比较,正常受精率和可利用胚率分别为(74.97%vs.88.50%,32.33%vs.40.31%),差异均有统计学意义(P<0.05)。(2)C、D两组比较,冷冻周期率和种植率分别为(32.26%vs.53.03%)和(13.92%vs.33.03%),差异均有统计学意义(P<0.05)。C组流产率虽高于D组,正常受精率和妊娠率低于D组,但差异无统计学意义。结论 (1)短时受精联合早期R-ICSI结合应用Half-ICSI,可能及早发现IVF完全受精失败及低受精率,并获得较好的临床结局。(2)后续ICSI可显著提高受精率,改善临床结局,但胚胎种植率较低,表明其至少部分原因是由于卵子异常而导致胚胎发育潜能的下降。

Objective To evaluate the clinical outcomes of the combination of short-period fertilization with early rescue intraeytoplasmie sperm injection（R-1CSI） in patients after complete fertilization failure and low fertilization rate in conventional in vitro fertilization（IVF） procedures and to analyze the clinical outcomes of ICSI in those patients. Methods A retrospective study was carried out from the Center of Reproductive Medicine of the Second Hospital of Hebei Medical University between January 2011 and December 2011, including cycles of R-ICSI （ Group A） , cycles of conventional IVF and ICSI in one cycle（Half-ICSI） （Group B）, ICSI cycles （Group C ） following a previous fertilization failure and low fertilization rate in conventional IVF, and direct ICSI cycles （group D） at the same period were performed. The clinical outcomes and laboratory parameters were compared in Group A, B, D and in Group C, D were analyzed. Results （ 1 ） The implantation rates and pregnancy rates in group A showed significant differences from those in group B [ （ 17.02% vs. 32. 41% ） and （25.00% vs. 46. 15% ） , respectively, P 〈0. 05]. The percentage of diploid zygotes and percentage of embryos can be utilized in group B showed significant differences from those in group D[ （74. 97% vs. 8g. 50% ） and （32. 33% vs. 40. 31% ） , respectively, P 〈0. 05]. （2）The percentage of embryo frozen cycles and implantation rates in group C showed significant differences from those in group D[ （32. 26% vs. 53.03% ） and （13.92% vs. 33.03% ） , respectively, P 〈 0. 05 ]. The abortion rates in group C was higher than that of group D and the percentage of diploid zygotes, pregnancy rates were lower than those of group D, but there were no significant differences. Conclusions （ 1 ） The combination of short-period fertilization with early R-ICSI combined Half-ICSI can find and rescue complete fertilization failure and low fertilization rate in conventional IVF procedures timely, and get better clinical effect. （ 2 ） ICSI maybe a good choice to owercome previous fertilization failure, but the implantation rate is lower. It suggests it may be due at least partly to oocyte abnormality, which results in the descent of embryo development potential.