不同受精方式对选择性囊胚培养结局的影响

Effects of IVF versus ICSI on the outcomes of elective blastocyst culture

目的:探讨不同受精方式对选择性囊胚培养结局的影响。方法:回顾性分析2009年1月至2012年12月在我中心接受囊胚培养的IVF组1 153个周期和ICSI组205个周期的囊胚培养结局。结果:IVF组和ICSI组分别有14 748和2 655枚胚胎进行序贯囊胚培养,两组均无因无囊胚可移植而取消周期。IVF组共形成7 871枚囊胚,ICSI组形成1 210枚囊胚;IVF组的优胚率、囊胚形成率和胚胎利用率均显著高于ICSI组(64.77%vs 58.72%,53.37%vs 45.57%,60.06%vs 52.17%,P均<0.05);但IVF组与ICSI组种植率(48.94%vs51.43%)、临床妊娠率(49.03%vs 52.02%)和流产率(11.69%vs 15.56)均无显著差异(P均>0.05)。结论:在同样的选择性囊胚培养纳入标准下,IVF相比于ICSI行囊胚培养的囊胚形成率和胚胎利用率更高,因无囊胚移植取消周期的风险相对更小。针对不同的受精方式可能需要制定相应的选择性囊胚培养纳入标准。

Objective ： To explore the effects of different fertilization methods on the outcomes of elective blastocyst culture. Methods ： We retrospectively analyzed the outcomes of elective blastocyst culture for 1 153 cycles of IVF and 205 cycles of ICSI per- formed between January 2009 and December 2012. Results ： A total number of 14 748 embryos in the IVF group and 2 655 embryos in the ICSI group underwent sequential blastocyst culture, with 7 871 blastocysts formed in the former and 1 210 in the latter. No cy- cles were canceled for no blastocyst formation in either of the two groups. The rates of quality embryos, blastocyst formation and embryo utilization were significantly higher in the IVF than in the ICSI group （64.77 vs 58.72%, 53.37 vs 45.57% , and 60.06 vs 52.17% , all P 〈 O. 05 ）, but the rates of implantation, clinical pregnancy and abortion showed no significant differences between the two groups （48.94 vs 51.43%, 49.03 vs 52.02%, and 11.69% vs 15.56, all P 〉0.05）. Conclusion： With the same inclusion criteria of se- lective blastocyst culture, IVF has a lower risk of cycle cancellation due to no blastocyst formation and therefore may effect higher rates of blastocyst formation and embryo utilization than ICSI. Our study suggested that appropriate inclusion criteria of selective blastocyst culture should be laid down according to different fertilization methods.