注射HCG后不同授精时间对ICSI助孕临床结局的影响

Impact of insemination in different time after injecting HCG on clinical outcomes in ICSI treatment

目的探讨HCG注射后不同授精时间对卵胞浆内单精子注射（ICSI）助孕周期临床结局的影响,分析最佳显微操作时机,以便更合理地安排胚胎实验室工作。方法回顾性分析2013年9月至2015年6月在河南省人民医院生殖医学研究所接受ICSI助孕患者的治疗周期,纳入病例均采用常规长方案促排卵,HCG诱导排卵,女方年龄≤38岁,5个≤获卵数≤20个;均因男方因素行ICSI助孕治疗,共计831个周期,根据授精时间不同分为5组。A组：注射HCG后〈40h授精（n=44）;B组：注射HCG后40~〈41h授精（n=162）;C组：注射HCG后41~〈42h授精（n=313）;D组：注射HCG后42~〈43h授精（n=243）;E组：注射HCG后≥43h授精（n=69）。统计分析各组患者的一般情况、获卵数、卵母细胞成熟情况、受精及胚胎发育情况并随访至孕早期,记录各项数据指标。结果 5组患者的年龄、获卵数、MⅡ卵数、正常受精数、可利用胚胎数、平均移植胚胎数、临床妊娠率、胚胎种植率、早期流产率比较各组间均无统计学差异（P〉0.05）,但HCG后41~42h行ICSI授精的临床结局有优于其他组的趋势。结论在临床工作中可以选择HCG注射后41~42h行ICSI操作。但后期尚需进一步研究验证。

Objective： To explore the effects of the insemination in different time after injecting HCG on the clinical outcome of ICSI treatment.Methods： A total of 831 cycles undergone long protocol of ICSI treatment in People＇s Hospital of Henan Province from September 2013 to June 2015 were analyzed retrospectively.All the women less than38 years old received conventional long-term protocol to promote ovulation HCG induced ovulation,and their number of oocytes retrieved was between 5and 20.All of them were assisted by ICSI due to the factors of men.The cycles were categorized into five groups based on the different time after injecting HCG：group A（40hours,n=44）,group B（≥40hours ＆〈41hours,n=162）,group C（≥41hours 42hours,n=313）,group D（≥42hours ＆〈 43hours,n=243）,group E（≥43hours,n=69）.Baseline parameters and clinical outcomes were compared among the groups.Results： The age,number of oocytes retrieved,number of MⅡoocytes,number of available embryos,number of transferrable embryos,implantation rate,clinical pregnancy rate and early miscarriage rate were not significantly different among the five groups（P〈0.05）.Although there was no significant difference among the five groups,the clinical outcomes of ICSI insemination at 41-42 hours after injecting HCG was superior to those of other groups.Conclusions：ICSI insemination can be performed at 41 to 42hours after HCG injection,but it needs more studies to verify.