卵母细胞质内单精子注射的胚胎形态与临床结局分析

Study on embryo morphology and clinical result of intracytoplasmic sperm injection for Infertility

目的 研究卵母细胞浆内单精子注射（ＩＣＳＩ）技术治疗不育症的胚胎结局。方洁 对我中心１９９９年１月至２００１年 ３月进行的２９１个ＩＣＳＩ治疗周期（实验组）和３５２个常规体外受精（ＩＶＦ）周期（对照组）进行回顾性分析。结果（１）实验 组和对照组的受精率分别为７５．７％和７３．２％，差异不显著（Ｐ＞０．０５）；两组的卵溶解率分别为１０．６％和７．９％，实验组稍 高，但差异不显著（Ｐ＝０．２３８）。（２）实验组和对照组超过２０％碎片的胚胎率分别为４１．２％和３５．６％，两组的差异不显著 （Ｐ＝０．１３７）；两组的囊胚形成率分别为４１．３％和５５．８％，实验组显著低于对照组（Ｐ＜０．００１）。（３）实验组的临床妊娠率为 ３４．７％，略低于对照组３９．９％的结果，但差异不具显著性（Ｐ＝１．７４４）；实验组的宫内胚胎停育和自然流产率，略低于对照 组，但差异亦不具显著性（８．９％ ｖｓ１３．４％，Ｐ＝０．０７９）。结论 实验组可获得较稳定的临床妊娠，是治疗男性不育症等的一 种有效的手段。

Objective To explore the relevance of the embryo morphology with the clinical result of intracytoplasmic sperm injection (ICSI) for infertility treatment. Methods A retrospective analysis was conducted of 291 ICSI and 352 in vitro fertility (IVF) cycles collected during the period from Juanary, 1999 to March, 2001. Results Significant difference was not found in the fertility rates between the 2 groups (75.7% vs 73.2%, P=0.5738), nor in the oocyte lysis rates (10.6% vs 7.9%, P=0.238). The rates of the embryos with more than 20% fragments were similar between the 2 groups (41.2% vs 55.8%, P=0.137), but ICSI group had a significantly lower rate of blastocyst formation (43.1% vs 55.8%, P<0.001). The clinical pregnancy rates and miscarriage rates did not vary significantly between the 2 groups (34.7% vs 39.9%, P=0. 189; 8.9% vs 13.4%, P=0.079). Conclusions ICSI is an effective treatment for male infertility to achieve uneventful clinical pregnancy.