不同授精方式对不明原因不孕患者妊娠结局的影响

Effect of different fertilization methods on pregnancy outcome of unexplained infertility patients

目的比较体外受精(in vitro fertilization,IVF)和卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)两种不同授精方式对不明原因不孕患者妊娠结局的影响。方法回顾性队列研究分析天津市中心妇产科医院生殖中心2014年7月至2019年7月期间采用IVF或ICSI治疗的不明原因不孕患者的临床资料,按授精方式分为IVF组(299例)和ICSI组(234例),比较两组患者一般情况、受精情况、胚胎发育情况及妊娠结局。结果ICSI组和IVF组双原核(two pronuclei,2PN)受精率、2PN卵裂率、优质胚胎率间差异均无统计学意义(均P>0.05)。ICSI组原发性不孕患者比例较IVF组高[79.5%(186/234)比39.8%(119/299),P<0.001]。按原发性不孕和继发性不孕分层分析后,原发性不孕患者中,ICSI组2PN卵裂率[91.2%(1339/1468)]高于IVF组[87.8%(1646/1844),P=0.062],两组患者2PN受精率、优质胚胎率差异均无统计学意义(均P>0.05),ICSI组临床妊娠率[39.8%(74/186)]及活产率[33.3%(62/186)]均略高于IVF组[37.8%(45/119),31.1%(37/119)],但差异均无统计学意义(均P>0.05)。继发性不孕患者中,两组间2PN受精率、2PN卵裂率、优质胚胎率差异均无统计学意义(均P>0.05),ICSI组临床妊娠率显著低于IVF组[20.8%(10/48)比49.4%(89/180),P<0.001],活产率也显著低于IVF组[18.8%(9/48)比40.0%(72/180),P=0.006]。logistics回归显示,校正女方年龄、不孕年限、体质量指数、基础卵泡刺激素及获卵数等可能影响活产的指标后,原发性不孕患者中不同授精方式有相似的活产率(OR=1.178,95%CI=0.686~2.202),继发性不孕患者中ICSI组活产率显著低于IVF组(OR=0.408,95%CI=0.180~0.924)。结论在不明原因不孕患者中,ICSI并不能显著改善受精情况、胚胎质量及妊娠结局,尤其在继发性不孕患者中,IVF患者妊娠结局显著优于ICSI患者,此类患者行辅助生殖治疗时应首选常规IVF授精。

Objective To compare the clinical pregnancy outcomes of conventional in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI)fertilization in patients with unexplained infertility.Methods A retrospective cohort study was conducted to analyze the clinical data of patients with unexplained infertility from July 2014 to July 2019 in the Assisted Reproductive Center of Tianjin Central Hospital of Gynecology Obstetrics.The patients were divided into IVF group(n=299)and ICSI group(n=234)according to the fertilization methods.The general information,fertilization condition,embryo development and pregnancy outcomes were compared between the two groups.Results There were no statistically significant differences between ICSI group and IVF group in two pronuclei(2PN)fertilization rate,2PN cleavage rate,and high-quality embryo rate(all P>0.05).Infertility type had a statistically difference between the two groups(P<0.001).Stratified analysis was conducted according to the primary and secondary infertility.Among patients with primary infertility,2PN cleavage rate in ICSI group[91.2%(1339/1468)]was higher than that in IVF group[87.8%(1646/1844),P=0.062].There were no statistically significant differences in 2PN fertilization rate and high-quality embryo rate between the two groups(all P>0.05).The clinical pregnancy rate and the live birth rate in ICSI group[39.8%(74/186),33.3%(62/186)]were higher than those in IVF group[37.8%(45/119),31.1%(37/119)]without significant differences(all P>0.05).In the patients with secondary infertility,there were no statistically significant differences in 2PN fertilization rate,2PN cleavage rate and high-quality embryo rate between the two groups(all P>0.05).The clinical pregnancy rate[20.8%(10/48)]and the live birth rate[18.8%(9/48)]of ICSI group were significantly lower than those of IVF group[49.4%(89/180),P<0.001;40.0%(72/180),P=0.006].After adjusting female age,infertility duration,body mass index,basal follicle-stimulating hormone and the number of oocyte retrieved,logistics regression showed that different fertilization methods had similar live birth rate(OR=1.178,95%CI=0.686-2.202)in primary infertility patients,and the live birth rate of ICSI group was significantly lower than that of IVF group(OR=0.408,95%CI=0.180-0.924)in secondary infertility patients.Conclusion In patients with unexplained infertility,ICSI could not significantly improve fertilization rate,embryo quality and pregnancy outcome.Especially in patients with secondary infertility,IVF patients had significantly better pregnancy outcome than ICSI patients,and routine IVF fertilization should be preferred.