早期补救卵胞浆内单精子注射妊娠结局及新生儿出生结局评估

The Pregnant Outcome and Birth Assessment of the Neonate after Early Rescue Intracytoplasmic Sperm Injection

目的:对常规体外受精(IVF)失败的周期行早期补救性卵胞浆内单精子注射(ICSI)后的妊娠结局及新生儿出生情况进行探讨和分析。方法:常规IVF后6小时未发现明确双极体者判断为完全受精失败,予以早期补救ICSI,纳入早期补救ICSI组(204个周期),随机选择与早期补救ICSI组患者同一日或前一日因男性因素而直接进行ICSI的204例患者纳入ICSI组(204个周期)。回顾性分析两组患者的累计临床妊娠率、流产率、异位妊娠率、累计活产率、分娩孕周及新生儿的单双胎比例、男女性别比例、出生体质量、出生缺陷等指标的差异性。结果:早期补救ICSI组与ICSI组的累计临床妊娠率、流产率、异位妊娠率、累计活产率、新生儿性别比例、新生儿出生体质量等指标的比较差异均无统计学意义(P>0. 05)。早期补救ICSI组产妇的分娩孕周较ICSI组略长,双胎比率较ICSI组少,差异有统计学意义(P<0. 05)。将分娩孕周分为单胎和双胎分别进行比较,则发现两组间差异无统计学意义(P>0. 05)。早期补救ICSI组的活婴中出现1例先天性心脏病出生缺陷,ICSI组的活婴中未发现出生缺陷。结论:早期补救ICSI没有增加胎儿流产及新生儿出生缺陷的风险,双胎率明显下降,怀孕周期略长,可作为常规IVF失败时的一种安全有效的补救方法。

Objective： To investigate the pregnancy and newborn outcomes in cycles received early rescue intracytoplasmic sperm injection（ ICSI） because of the failure of conventional in vitro fertilization（ IVF）.Methods： A complete fertilization failure was defined if there was no bipolar 6 hours after conventional insemination.204 Cycles with conventional fertilization failure received early rescue ICSI,which were enrolled as the groups of early rescue ICSI.204 patients received direct ICSI for male reasons on the same day or the previous day were randomly selected as the ICSI group.The data of cumulative clinical pregnancy rate,abortion rate,ectopic pregnancy rate,cumulative live birth rate,gestational time,neonatal single and twin ratio,sex ratio,birth weight and birth defects in both groups was analyzed retrospectively.Results： There was no significant difference in cumulative clinical pregnancy rate,abortion rate,ectopic pregnancy rate,cumulative live birth rate,neonatal single and twin ratio,sex ratio or birth weight between the group of early rescue ICSI and conventional ICSI（ P〉0. 05）.The gestational time in early rescue ICSI group was longer than that in conventional ICSI group（ P〈 0. 05）. The furthermore analysis showed that the twin ratio in early rescue ICSI group was lower than that in conventional ICSI group（ P〈0. 05）.There was no difference in gestational time between the two groups if considering singleton and twin pregnancy separately（ P〈0. 05）.There was one newborn baby with obvious birth defect of congenital heart disease in early rescue ICSI group,while there was no birth defect in conventional ICSI group.Conclusions： Early rescue ICSI may not increase the risk of abortion or birth defects.It could decrease the ratio of twin pregnancy and increase the gestational time.Thus,early rescue ICSI is a safe and effective rescue method in cycles with conventional fertilization failure.