原发性不孕患者行早期补救ICSI和常规ICSI的临床应用分析

Clinical analysis of early rescue ICSI and conventional ICSI in patients with primary infertility

目的探讨早期补救卵胞浆内单精子注射(r-ICSI)和常规卵胞浆内单精子注射(ICSI)对原发性不孕患者临床结局的影响。方法回顾性分析2017年12月至2021年6月于山西医科大学第一医院生殖医学中心行常规ICSI治疗或因IVF全部/部分受精失败行早期r-ICSI治疗、年龄<35岁的原发性不孕患者的临床资料,共479个周期。根据授精方式的不同,分为r-ICSI组(行早期r-ICSI,共77个周期)和常规ICSI组(共402个周期);再根据患者的精液质量,将常规ICSI组分为精液参数正常的ICSI-1组(共144个周期)和精液参数异常的ICSI-2组(共258个周期)。比较3组患者的一般资料、实验室指标及妊娠结局。结果3组患者间女方年龄、男方年龄、体质量指数(BMI)、不孕年限、基础FSH水平比较均无显著性差异(P>0.05)。r-ICSI组的MⅡ卵母细胞率、受精率、2PN率、可利用胚胎率、优质胚胎率显著高于ICSI-1组(P<0.05),而周期取消率显著低于ICSI-1组(P<0.001);r-ICSI组的MⅡ卵母细胞率、受精率、可利用胚胎率显著高于ICSI-2组(P<0.05),而周期取消率、胚胎种植率显著低于ICSI-2组(P<0.05);ICSI-1组的MⅡ卵母细胞率显著高于ICSI-2组(P<0.001),受精率、2PN率、可利用胚胎率及优质胚胎率显著低于ICSI-2组(P<0.05)。3组间生化妊娠率、临床妊娠率、活产率、早期流产率及异位妊娠率比较均无显著性差异(P>0.05)。结论对于<35岁的原发性不孕患者,短时授精联合早期r-ICSI不失为一种安全有效的治疗方式,其可以显著改善患者的受精率和优质胚胎率,有效避免周期取消。

Objective:To investigate the effect of early rescue ICSI(r-ICSI)and conventional ICSI on the clinical outcome of primary infertility patients.Methods:A retrospective analysis was performed on the primary infertility patients(479 cycles)with less than 35 years old who underwent conventional ICSI or r-ICSI treatment due to IVF full/partial fertilization failure from December 2017 to June 2021.The cycles were divided into r-ICSI group(n=77)and conventional ICSI group(n=402)according to different fertilization methods.According to the semen quality of patients,the conventional ICSI group was further divided into ICSI-1 group with normal semen parameters(n=144)and ICSI-2 group with abnormal semen parameters(n=258).The general information,laboratory indicators and clinical outcomes were compared among the three groups.Results:There were no significant differences in the female&male age,BMI,infertility years,and basal FSH level among the three groups(P>0.05).The MⅡoocyte rate,fertilization rate,2PN rate,available embryo rate and high-quality embryo rate in r-ICSI group were significantly higher than those in ICSI-1 group(P<0.05),and the cycle cancellation rate was significantly lower than that in ICSI-1 group(P<0.001).The MⅡoocyte rate,fertilization rate and embryo availability rate in r-ICSI group were significantly higher than those in ICSI-2 group(P<0.05),and the cycle cancellation rate and embryo implantation rate were significantly lower than those in ICSI-2 group(P<0.05).The MⅡoocyte rate in ICSI-1 group was significantly higher than that in ICSI-2 group(P<0.001),while the fertilization rate,2PN rate and available embryo rate and high-quality embryo rate were significantly lower than those of ICSI-2 group(P<0.05).The rates of biochemical pregnancy,clinical pregnancy,live birth,early miscarriage and ectopic pregnancy were not significantly different among the three groups(P>0.05).Conclusions:For primary infertile patients under 35 years old,short-term insemination combined with early r-ICSI is a safe and effective treatment,which can significantly improve the fertilization rate and high-quality embryo rate of patients,and effectively avoid cycle cancellation.