体外受精-胚胎移植周期透明带透亮致密患者的受精与临床结局

Fertilization Results and Clinical Outcome of Oocyte with Abnormal Zona Pellucida in IVF-ET

目的:探讨卵子透明带透亮致密患者行常规体外受精(IVF)或卵胞质内单精子显微注射(ICSI)后受精、胚胎发育情况及临床结局。方法:回顾性分析体外受精过程中卵子出现透明带透亮致密的43个周期,其中IVF周期27例,ICSI周期16例,比较受精率与正常受精比例、胚胎质量、临床妊娠结局。结果:27例IVF周期均未受精,行早期补救ICSI,其中23例完全不受精。补救后IVF总体受精率达64.83%,正常受精率59.32%;16例ICSI周期均受精,受精率和正常受精率分别为85.11%和79.01%,均显著高于IVF组(P<0.05)。IVF组和ICSI组卵裂率分别为97.96%、95.65%,优质胚胎率分别为52.67%、43.75%,组间差异无统计学意义(P>0.05)。IVF组妊娠率为37.04%,种植率为33.33%;ICSI组妊娠率为31.25%,种植率为25.00%,组间临床结局相近,无统计学差异(P>0.05)。结论:透明带透亮致密患者的自然受精能力下降,需要采用ICSI方式授精。常规IVF受精失败后采用早期补救ICSI或直接行ICSI能明显改善透明带透亮致密患者的受精结局,但不能改善妊娠结局。

Objective： To explore the fertilization result, embryo development and the clinical outcome of oocytes with abnormal zona pellucida after conventional in vitro fertilization （IVF） or intracytoplasmic sperminjection （ICSI）. Methods： A retrospective analysis was performed on a total of 43 cycles with abnormal zona pellucida. There were 27 IVF cycles and 16 ICSI cycles. The fertilization rate, the normal fertilization rate, the quality of the embryo and the clinical pregnancy rate were compared between IVF and ICSI. Results： Recuse ICSI was applied to 27 IVF cycles which failed to extrude the second polar body after conventional IVF, and of which 23 IVF cycles completely failed; but all the ICSI cycles succeeded to fertilize. The fertilization rate and the normal fertilization rate of IVF （64.83%, 59.32%） were significantly lower than those of ICSI （85.19%, 79.01%）, and the cleavage rate （97.96%） was higher than that of ICSI group （95.65%）, but no significant difference was observed （P〉0.05）. The formation rate of good-quality embryos resulting from the oocytes with abnormal zona pellucida in IVF group was 52.67%, while that of ICSI was 43.75%, no significant difference was observed （/9〉0.05）. The pregnancy rate and the implantation rate of IVF group （37.04%, 33.33%） were higher than those of ICSI group （31.25%, 25.00%, P〉0.05）, with no significant difference. Conclusion： ICSI and rescue ICSI should be carried out for those oocytes with abnormal zona pellucida for high risk of IVF failure. Recuse ICSI improves the fertilization results, but it can not improve the clinical outcome of oocytes with abnormal zona pellucida.