不同受精方式对高龄不育患者胚胎质量及临床结局的影响

Effects of different fertilization methods on embryo quality and clinical outcome in older infertile patients

目的探讨体外受精-胚胎移植(IVF-ET)和卵胞浆内单精子注射(ICSI)两种受精方式对高龄不育患者(年龄≥35岁)胚胎质量及临床结局的影响。方法收集2012年1月至2014年6月在本院生殖中心接受IVF/ICSI-ET助孕治疗的1 917例高龄不育患者(年龄≥35岁),根据受精方式不同分为IVF组(n=1 681)和ICSI组(n=236),回顾性分析两组的各项胚胎指标及临床妊娠率,探讨不同受精方式对高龄不育患者胚胎质量及临床结局的影响。结果IVF组2PN卵裂率(98.78%)、异常受精率(9.83%)显著高于ICSI组(分别为88.62%和2.18%);IVF组胚胎种植率(20.74%)、胚胎冷冻率(48.12%)和取消移植率(23.44%)显著高于ICSI组(分别为12.67%、38.23%、17.80%),临床妊娠率(33.57%)、多胎率(19.21%)和男婴出生率(56.70%)亦显著高于ICSI组(分别为20.62%、10.00%、45.45%),而胚胎停育率(14.59%)、出生缺陷率(0.39%)及女婴出生率(43.30%)则显著低于ICSI组(分别为22.81%、4.55%和54.55%)(P均<0.05);两组的优质胚胎率(47.53%vs.46.57%)和可移植胚胎率(56.47%vs.54.70%)比较无显著性差异(P>0.05)。结论对于年龄≥35岁的高龄不育患者,选择IVF作为助孕方式可能更有益于胚胎发育,进而获得较好的临床结局。

Objective： To investigate the effect of two different fertilization methods （IVF-ET and ICSI） on the embryos quality and clinical outcomes in the older infertile women aged more than or equal to 35 years old. Methods： A total of 1 917 patients aged≥35 years old were treated with IVF-ET or ICSI in our reproductive center from Jan 2012 to Jun 2014. The patients were divided into IVF group（n=1681）and ICSI group（n = 236）. A retrospective study was carried out to analyze the embryonic index and clinical pregnancy rate in the two groups in order to explore the correlation between different fertilization methods and embryo quality ＆ clinical outcomes. Results： The 2PN cleavage rate （98.78% vs. 88.62%）,abnormal fertilization rate （9.83% vs. 2.18 % ） , embryo implantation rate （20.74% vs. 12.67%）,embryo freezing rate （48.12% vs. 38.23%）, transplantation cancellation rate （23.44%vs. 17.80%/00） ,clinical pregnancy rate （33.57% vs. 20. 62%）, multiple pregnancy rate （19.21% vs. 10.00%）,and male baby birth rate （56.70% vs. 45.45%） in IVF group were significantly higher than those in ICSI group（all P〈0. 05） ,but embryo diapause rate（14.59% vs. 22.81%） ,birth defects rate （0.39% vs. 4. 55%） and female baby birth rate （43.30% vs. 54.55%） were significantly lower （47. 53% vs. 46. 57%0） between the two groups than those in in ICSI group（P〈0.05）.Meanwhile, good quality embryos rate and portable embryo rate （56.47%vs. 54.70%） were not significantly different （P〉0.05）. Conclusions： IVF may be more beneficial to older infertile women embryonic development and good clinical outcome forolder infertile women.