冷冻精子复苏后授精方式的选择对供精IVF/ICSI助孕妊娠结局的影响

Influence of different insemination methods on IVF/ICSI outcome with donor cryopreserved-thawed sperm

目的探讨冷冻精子复苏后授精方式的选择对供精IVF/ICSI妊娠结局的影响。方法回顾性分析2019年1月至2022年7月在兰州大学第一医院生殖中心接受供精IVF/ICSI助孕的237例患者(共243个取卵周期)的临床资料。根据授精方式不同分为IVF组(108个取卵周期)、ICSI组(67个取卵周期)及早期补救ICSI(R-ICSI)组(68个取卵周期)。比较3组患者的一般资料、促排卵情况、胚胎发育指标及妊娠结局。结果3组患者间年龄、体质量指数(BMI)、基础窦卵泡数(AFC)、不孕年限、不孕类型、抗苗勒管激素(AMH)、基础性激素(FSH、LH、E_(2))水平比较均无显著性差异(P>0.05)。3组患者间Gn天数、Gn用量、HCG日E_(2)水平、HCG日孕酮(P)水平、获卵数、MⅡ卵数、2PN数、受精率及优质胚胎率比较均无显著性差异(P>0.05);ICSI组及R-ICSI组患者精子浓度、活动率、非前向运动精子显著低于IVF组(P<0.05);ICSI组的前向运动精子显著低于IVF组及R-ICSI组,而不动精子显著高于IVF组及R-ICSI组(P均<0.05)。ICSI组患者的可利用胚胎数和优质胚胎数显著低于IVF组及R-ICSI组(P<0.05)。3组患者间移植胚胎数、移植日子宫内膜厚度及异位妊娠率比较均无显著差异(P>0.05)。ICSI组临床妊娠率及累积活产率略低于IVF组及R-ICSI组,流产率及胚胎停育率略高于其他两组,但差异尚无统计学意义(P>0.05)。结论冷冻精子复苏后行ICSI助孕的胚胎质量及助孕结局较常规IVF及R-ICSI略差,R-ICSI助孕的胚胎质量及妊娠结局与IVF相似。建议行供精助孕治疗时尽可能选择IVF授精,若预计IVF受精率低下时可选择R-ICSI助孕。

Objective:To explore the impact of different insemination methods on the IVF/ICSI pregnancy outcome with donor cryopreserved-thawed sperm.Methods:The clinical data of 237 patients(243 oocyte retrieval cycles)who received IVF/ICSI assisted pregnancy with donor cryopreserved-thawed sperm at the Reproductive Medicine Center of the First Hospital of Lanzhou University from January 2019 to July 2022 were retrospectively analyzed.According to the insemination method,the cycles were divided into IVF group(108 oocyte retrieval cycles),ICSI group(67 oocyte retrieval cycles),and rescue ICSI(R-ICSI)group(68 oocyte retrieval cycles).The general information,ovulation induction status,embryonic development indicators and pregnancy outcomes of three groups of patients were analyzed.Results:There were no significant differences in age,body mass index(BMI),basal antral follicle count(AFC),duration of infertility,type of infertility,anti-Mullerian hormone(AMH),and basal sex hormones(FSH,LH,E_(2))among the three groups of patients(P>0.05).There were no significant differences in Gn days,Gn dosage,E_(2)and progesterone levels on HCG day,number of oocytes retrieved,MⅡoocyte number,2PN number,fertilization rate,and high-quality embryo rate among the three groups of patients(P>0.05).The semen concentration,motility,and non-progressive motility sperm of patients in the ICSI and R-ICSI groups were significantly lower than those in the IVF group(P<0.05).The progressive motility sperm of the ICSI group was significantly lower than that of the IVF and R-ICSI groups(P<0.05),while the immobile sperm was significantly higher than that of the IVF and R-ICSI groups(P<0.05).The number of available embryos and high-quality embryos in the ICSI group was significantly lower than that in the IVF and R-ICSI groups(P<0.05).There were no significant differences in the number of embryos transferred,endometrial thickness on the transfer day and the ectopic pregnancy rate among the three groups(P>0.05).The clinical pregnancy rate and cumulative live birth rate in the ICSI group were slightly lower than those in the IVF and R-ICSI groups,while the abortion rate and embryo demise rate were slightly higher than those in the other two groups,but the difference was not significant(P>0.05).Conclusions:The embryo quality and pregnancy outcome of ICSI assisted pregnancy with cryopreserved-thawed sperm are slightly worse than those of conventional IVF and R-ICSI.The embryo quality and pregnancy outcome of R-ICSI assisted pregnancy are similar to those of IVF.It is recommended to choose IVF insemination as much as possible during the treatment of assisted pregnancy with donor sperm.If the expected IVF fertilization rate is low,R-ICSI assisted fertilization can be chosen.