早期补救ICSI对首次IVF助孕周期临床结局的影响

Effects of early rescue ICSI on the clinical outcome in initial IVF cycles

目的探讨早期补救ICSI对首次IVF周期临床结局的影响。方法回顾性分析2008年1月至2012年12月于本中心行首次IVF治疗的5 029个取卵周期,IVF受精4-6h后根据第二极体的排出情况判断受精与否,对半数以上卵母细胞未受精的患者实施补救ICSI,其余患者继续行常规IVF,比较补救ICSI组（n=413）及常规IVF组（n=4 616）患者的基本情况及临床结局,并计算早期补救ICSI对首次IVF周期临床结局的贡献值。结果早期补救ICSI组原发性不孕患者的比例及不育年限显著高于常规IVF组,输卵管及盆腔因素患者的比例显著低于常规IVF组,基础FSH显著低于常规IVF组,窦卵泡数显著高于常规IVF组（P均〈0.01）;补救ICSI组获得了较多的卵母细胞数[（9.65±5.20）vs.（8.89±5.48）个]及成熟卵数[（8.36±4.56）vs.（7.88±5.01）个]（P〈0.01）,但受精数[（6.22±3.70）个]与优质胚胎数[（2.94±2.76）个]均显著低于常规IVF组[分别为（7.05±4.74）个、（3.40±3.03）个]（P〈0.05）,同时多原核（≥3PN）胚胎率（5.85%）也显著低于常规IVF组（8.26%）（P〈0.01）;两组患者的种植率、临床妊娠率及流产率比较无统计学差异（P〉0.05）;早期补救ICSI对首次IVF周期双原核（2PN）受精率的贡献值为4.25%,对优质胚胎率的贡献值为3.67%,对临床妊娠率的净贡献值为2.72%,总贡献值为3.49%。结论早期补救ICSI取得了和常规IVF相似的临床结局,有效提高了首次IVF周期的临床妊娠率,是针对IVF周期受精完全失败或低受精的有效治疗手段。

Objective： To investigate the effects of early rescue ICSI on the clinical outcome of patients undergone the first cycle of IVF treatment.Methods： The data of 5 029 cycles initially performed IVF treatment in our center from 2008 to 2012were retrospectively analyzed.The oocyte fertilization is estimated 4-6hours after oocyte-sperm incubation by observing discharge of the second polar body.Then the early rescue ICSI was performed for the patients with less than 50% oocytes fertilized,and the rest patients were performed conventional IVF treatment.Basic characteristics,clinical pregnancy outcome of the early rescue ICSI group（n=413）and conventional IVF group（n=4 616）were compared,and the contribution of early rescue ICSI to initial IVF cycle clinical outcomes were calculated.Results： Compare with the conventional IVF group,the proportion of patients with primary infertility was higher and their infertility duration was longer significantly,and the proportion of patients＇ infertility due to the etiology of fallopian tube or pelvic cavity was significantly lower in the rescue ICSI group（all P〈0.01）.Furthermore,the basic FSH level was significantly lower and antral follicle count was significantly higher in the rescue ICSI group（all P〈0.01）.The rescue ICSI group obtained significantly more oocytes[（9.65±5.20）vs.（8.89±5.48）]as well as mature oocytes [（8.36±4.56）vs.（7.88±5.01）]（P〈0.01）,but fertilized embryo number[（6.22±3.70）vs.（7.05±4.74）],high quality embryo number[（2.94±2.76）vs.（3.40±3.03）]and the rate of≥3PN embryo were significantly lower（5.85%vs.8.26%）in the rescue ICSI group（P〈0.01）.There was no statistical difference in the clinical pregnancy rate,implantation rate and abortion rate between the two groups（P〉0.05）.The contribution value of early rescue ICSI for 2PN fertilization rate was 4.25%,3.67% for high quality embryo rate,and2.72%for clincal pregnancy rate.The total contribution value was 3.49%in the initial IVF cycles.Conclusions： Early rescue ICSI can achieve similar clinical pregnancy rate compared to conventional IVF cycles,and it can efficiently increase the total pregnancy outcome of initial IVF cycles.It is an effective method for initial IVF cycles with total failure fertilization or low fertilization rate.