辅助生殖技术中短时受精失败结合早期补救ICSI与常规ICSI的临床结局分析

Analysis of clinical outcome of routine ICSI and short-term fertilization failure combined with early rescue ICSI in assisted reproductive technology

目的探讨短时受精失败结合早期补救卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)的临床应用价值。方法回顾性分析2012-01～2016-10在山西医科大学第一医院生殖中心首次接受体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)或ICSI助孕的540对夫妇病历资料,按照是否实施早期补救性ICSI进行分组,分为2组,研究组76个周期,为短时受精失败结合早期补救ICSI周期,对照组464个周期,为常规ICSI周期。比较两组受精率、卵裂率、优质胚胎率、冷冻胚胎率、胚胎种植率、临床妊娠率、流产率、新生儿出生情况等指标。结果研究组受精率、多精受精率和优质胚胎率均明显高于对照组(85. 28%vs 71. 23%,6. 57%vs 1. 58%,38. 74%vs 30. 74%),差异有统计学意义(P <0. 05)。两组间卵裂率、可利用胚胎率、冷冻胚胎率、周期取消率和胚胎种植率等差异均无统计学意义(P> 0. 05)。两组间生化和临床妊娠率、异位妊娠率、早期和晚期流产率、早产率、活产率、双胎出生率、低体重儿出生率、新生儿胎龄等差异均无统计学意义(P>0. 05)。结论短时受精失败结合早期补救ICSI可以获得较高的受精率和优质胚胎率,可预防受精失败的发生,改善临床妊娠结局。

Objective To explore the clinical value of short-term fertilization failure combined with early rescue intracytoplasmic sperm injection(ICSI).Methods The medical records of 540 couples who received IVF or ICSI assisted pregnancy for the first time in the Reproductive Center of the First Hospital of Shanxi Medical University from January 2012 to October 2016 were retrospectively analyzed,and 540 couples were divided into two groups according to the implementation of early rescue ICSI.The 76 cycles in study group were short-term fertilization failure combined with early rescue ICSI cycles,and the 464 cycles in control group were routine ICSI cycles.The fertilization rate,cleavage rate,high quality embryo rate,rate of frozen embryos,embryo implantation rate,clinical pregnancy rate,miscarriage rate and birth status of the newborn were compared between the two groups.Results The fertilization rate,polyspermy rate and high quality embryo rate were higher in study group than in control group(85.28%vs 71.23%,6.57%vs 1.58%,38.74%vs 30.74%,P<0.05).There was no significant difference in the cleavage rate,available embryo rate,rate of frozen embryos,cycle cancellation rate and embryo implantation rate between the two groups(P>0.05).There was no significant difference in the biochemical pregnancy rate,clinical pregnancy rate,rate of ectopic pregnancy,early miscarriage rate,late miscarriage rate,preterm birth rate,live birth rate,twin birth rate,low birth weight baby rate,and neonatal gestational age between the two groups(P>0.05).Conclusion Short-term fertilization failure combined with early rescue ICSI can achieve a high rate of fertilization and embryo quality,prevent the occurrence of fertilization failure,and ameliorate the clinical pregnancy outcome.