体外受精失败患者行早期补救性单精子卵胞浆内显微注射治疗结局分析

Outcome analysis of early rescue single sperm intracytoplasmic microinjection in patients with failed in vitro fertilization

目的 分析常规体外受精(in vitro fertilization, IVF)失败后采用早期补救性单精子卵胞浆内显微注射(early rescue intracytoplasmic sperm injection, R-ICSI)治疗患者的临床结局。方法 回顾性分析2016年1月至2020年12月在成都市妇女儿童中心医院接受助孕治疗的1 538例患者的临床资料,根据受精方式将患者分为3组:R-ICSI组为IVF失败后行R-ICSI治疗的患者,共146例;ICSI组为直接行ICSI治疗的患者,共173例;IVF组采用常规IVF受精方式治疗,共1 219例。比较3组患者的基本情况、体外受精及临床结局情况。结果 R-ICSI组的精子密度、活率、前向运动率和精子形态正常率[(67.47±59.21)×10^(6),(62.46±20.77)%,(46.45±17.96)%,(2.31±1.51)%]较ICSI组[(43.02±49.81)×10^(6),(50.20±28.19)%,(37.59±23.36)%,(1.90±1.32)%]高,但低于IVF组[(86.70±59.33)×10^(6),(74.08±18.13)%,(56.78±15.44)%,(3.03±1.52)%],差异有统计学意义(P<0.05);R-ICSI组的受精率、卵裂率及可用胚胎率(85.32%,97.51%,63.42%)与ICSI组(84.69%,97.79%,60.85%)比较,差异无统计学意义(P>0.05),但优胚率(31.40%)较IVF组(36.82%)有下降(P<0.05);胚胎种植率和临床妊娠率(29.63%,42.62%)低于ICSI组(35.50%,54.91%)(P<0.05),流产率有所增加,但差异无统计学意义(P>0.05);R-ICSI组和ICSI组原发不孕患者占比高于IVF组,差异有统计学意义(P<0.05)。结论 对IVF失败患者行R-ICSI治疗可增加可利用胚胎数目,获得与直接ICSI相似的临床结局,但胚胎种植率和临床妊娠率有下降;对精液质量处于临界状态的原发不孕患者应直接采用ICSI治疗以避免受精失败的发生,改善临床结局。

Objective To analyze the clinical outcomes of patients treated with early rescue intracytoplasmic sperm injection(R-ICSI) after failure of conventional in vitro fertilization(IVF).Methods The clinical data of 1 538 patients who received pregnancy-assisted treatment in Chengdu Women and Children’s Central Hospital from January 2016 to December 2020 were retrospectively analyzed.The patients were divided into three groups according to the method of fertilization.The R-ICSI group included 146 patients who underwent R-ICSI treatment after IVF failure.In ICSI group, 173 patients were directly treated with ICSI.In the IVF group, 1 219 cases were treated by conventional IVF.The basic information, in vitro fertilization and clinical outcomes of the three groups were compared.Results The sperm density, motility rate, forward motile sperm count and normal sperm morphology rate in R-ICSI group [(67.47±59.21) ×10^(6),(62.46±20.77) %,(46.45±17.96) %,(2.31±1.51) %] were significantly higher than those in ICSI group [(43.02±49.81)×10^(6),(50.20±28.19) %,(37.59±23.36) %,(1.90±1.32) %],but lower than IVF group [(86.70±59.33)×10^(6),(74.08±18.13) %,(56.78±15.44) %,(3.03±1.52) %],the difference was statistically significant(P<0.05).The fertilization rate, cleavage rate and usable embryo rate of R-ICSI group(85.32%,97.51%,63.42%) and ICSI group(84.69%,97.79%,60.85%) had no significant difference(P>0.05).However, the rate of excellent embryo(31.40%) was lower than that of IVF group(36.82%)(P<0.05).The embryo implantation rate and clinical pregnancy rate(29.63%,42.62%) were lower than those in ICSI group(35.50%,54.91%)(P<0.05),and the abortion rate was increased, but the difference was not statistically significant(P>0.05).The proportion of primary infertility patients in R-ICSI group and ICSI group was higher than that in IVF group, and the difference was statistically significant(P<0.05).Conclusion R-ICSI treatment for IVF failure patients can increase the number of available embryos and achieve similar clinical outcomes as direct ICSI,but the embryo implantation rate and clinical pregnancy rate are decreased.Primary infertility patients with critical semen quality should be treated with ICSI directly to avoid the occurrence of fertilization failure and improve clinical outcomes.