长方案超排卵获卵数对胞浆内单精子注射治疗结局的影响

Effect of the Collected Oocytes by Controlled Ovarian Stimulation (Long Gn RHa Protocol) on Clinical Outcomes of ICSI

目的：比较常规长方案超排卵周期中,获取不同卵母细胞数对胞浆内单精子注射（ICSI）治疗结局的影响。方法：回顾分析广州医科大学附属第三医院生殖医学中心2007年1月—2013年6月因单纯男性因素采用常规长方案超排卵行ICSI治疗的患者资料。根据获卵数目分成4组,获卵数≤4个为G1组（90个周期）,获卵数5-10个为G2组（368个周期）,获卵数11-20个为G3组（449个周期）,获卵数≥21个为G4组（135个周期）。结果：在ICSI治疗中,G1组女方平均年龄高于其他3组（P〈0.01）,但其中〈35岁的患者占57.8%。G1组患者完全受精失败发生率、G4组的卵巢过度刺激综合征（OHSS）发生率以及这2组的移植周期取消率均高于G2组和G3组（P〈0.01）;G1组的临床妊娠率在4组中最低（31.3%,P〈0.05）;4组中G3组的临床妊娠率、胚胎种植率和移植胚胎活产率最高,且后两者差异有统计学意义（P〈0.05）。结论：在ICSI治疗周期中,获卵数≤4个影响ICSI受精结局,完全受精失败发生率升高;获卵数在11~20个时ICSI临床结局最好。

Objective： To investigate the effect of the collected oocytes by controlled ovarian stimulation （COS, long GnRHa protocol） on the clinical outcomes of intracytoplasmic sperm injection （ICSI）. Methods：All couples （1 042 cycles） who underwent ICSI because of male factor were involved in this retrospective study,from January 2007 to June 2013 in our center. Those cycles were divided into 4 groups according to the number of collected oocytes： G1 as ≤4 oocytes（90 cycles）,G2 as 5-10（368 cycles）,G3 as 11-20 oocytes（449 cycles） and G4 as ≥21 oocytes （135 cycles）. Results：In the ICSI treatment cycle,the mean age in GI was highest among 4 groups（P〈0.01 ） ,while 57.8% women were aged 〈35. The total fertilization failure（TFF） rate in G1, the ovarian hyperstimulation syndrome （OHSS） rate in G4 and the rates of cancelled transfer cycles in G1 and G4 were significantly higher than those in G2 and G3 （P〈0.01）. The rate of clinical pregnancy in G1 was the lowest in 4 groups （31.3%,P〈0.05）. The rate of clinical pregnancy, the implant rate and the live birth rate in G3 were the highest in 4 groups （P〈0.05）. Conclusions：In the ICSI treatment cycle, the number of collected oocytes lower than 4 has negative effect on fertilization; the collected oocytes between 11 to 20 have good clinical outcomes.