常规体外受精失败后行补救卵胞浆内单精子注射在冻融胚胎移植中的应用价值

Application value of rescue intracytoplasmic sperm injection in frozen-thawed embryo transfer after the failure of conventional in vitro fertilization

目的探讨常规体外受精(IVF)完全失败后行补救卵胞浆内单精子注射(补救ICSI)在冻融胚胎移植(FET)中的临床应用价值。方法选择2013年11月-2015年11月在解放军第455医院生殖医学中心常规接受ICSI治疗的359个周期为常规ICSI组(对照组),62例行补救ICSI者纳入补救ICSI组(在常规IVF完全失败后于受精后16~20 h行补救ICSI)。采取回顾性分析方法,比较两组受精率、卵裂率、胚胎质量及临床结局。结果 (1)该中心2013年11月-2015年11月,共行常规IVF为1 109个周期,受精完全失败62个周期,失败率为5.6%;共行half-ICSI 5个周期,其中1个周期IVF部分受精完全失败,失败率为20.0%。(2)补救ICSI组异常受精率显著高于常规ICSI组、优质胚胎率及可利用胚胎率均显著低于常规ICSI组,差异有统计学意义(χ~2=27.132、118.077、16.914,P<0.01),而两组间MII卵的比例、正常受精率及卵裂率比较,差异均无统计学意义(χ~2=0.622、0.581、1.647,P>0.05)。(3)补救ICSI组新鲜胚胎移植(ET)有1个周期未孕,移植的2个胚胎为八细胞二级和五细胞二级。(4)补救ICSI组行FET的胚胎临床妊娠率(32.1%)及种植率(16.8%)显著低于常规ICSI组(47.2%和26.1%),差异均有统计学意义(χ~2=4.519、7.155,P<0.05)。结论对不孕患者在常规IVF完全失败后,于受精后16~20 h行补救ICSI FET周期可降低周期取消率,可相对改善胚胎发育速度与患者子宫内膜发育的同步性,获得相对较好的临床妊娠率。受精后16~20 h补救ICSI可作为常规IVF完全失败周期的补救措施。

Objective To explore the application value of rescue intracytoplasmic sperm injection （ICSI） in frozen-thawed embryo transfer （FET） after the failure of conventional in vitro fertilization （IVF） . Methods A total of 359 cycles treated by conventional ICSI in Center of Reproductive Medicine in the 455th Hospital of PLA from November 2013 to November 2015 were selected as conventional ICSI group （control group） ; 62 cases treated by rescue ICSI were enrolled into rescue ICSI group, rescue ICSI was performed at 16-20 hours after fertilization. A retrospective analysis was performed to compare the fertilization rates, cleavage rates, embryo quality, and pregnancy out- comes between the two groups. Results From November 2013 to November 2015, 1 109 cycles of conventional IVF were performed, 62 cy- cles failed completely, the failure rate was 5.6%. Five half-ICSI cycles were performed, and one IVF cycle failed, the failure rate was 20. 0%. The abnormal fertilization rate in rescue ICSI group was higher than that in conventional ICSI group, while high-quality embryo rate and available embryo rate in rescue ICSI group were lower than those in conventional ICSI group, there were statistically significant differ- ences （X^2 =27. 132, 118. 077, 16. 914, P〈0. 01 ） . There was no statistically significant difference in the proportion of M II oocytes, nor- mal fertilization rate, and cleavage rate between the two groups （X^2 = 0. 622, 0. 581, 1. 647, P〉0. 05 ） . Among fresh embryo transfer in rescue ICSI group, unpregnancy occurred in one cycle, the two embryos transferred were eight cells of grade two and five cells of grade two. The clinical pregnancy rate and implantation rate of FET in rescue ICSI group were 32. 1% and 16. 8% , respectively, which were statistical- ly significantly lower than those in conventional ICSI group （47.2% and 26. 1% ） （X^2 =4. 519, 7. 155, P〈0. 05） . Conclusion Rescue ICSI performed at 16-20 hours after fertilization in infertile patients failing in conventional IVF can reduce cycle cancellation rate, relatively improve the synchronism of embryo developmental speed and endometrial development, then a relative good clinical pregnancy rate can be a- chieved, rescue ICSI can be used as a remedial measure.