常规体外受精失败后行补救性卵胞浆内单精子注射的应用效果

Application effects of remedial intracytoplasmic sperm injection after conventional in vitro fertilization failure

目的:观察常规体外受精(IVF)失败后行补救性卵胞浆内单精子注射(R-ICSI)的应用效果。方法:回顾性分析2016年1月至2020年12月该院收治的1673个周期的临床资料,按照受精方式不同将其分为IVF组(1042个周期)、R-ICSI组(131个周期)、卵胞浆内单精子注射(ICSI)组(500个周期)。比较三组实验室指标[成熟卵(MⅡ)获取率、受精率、2原核(PN)率、多PN率、优质胚胎率、可用胚胎率]水平、临床结局(妊娠率、活产率)。结果:R-ICSI组MⅡ获取率均低于IVF组与ICSI组,差异有统计学意义(P<0.05);R-ICSI组2PN率低于ICSI组,但高于IVF组,差异有统计学意义(P<0.05);R-ICSI组多PN率低于IVF组,但高于ICSI组,差异有统计学意义(P<0.05);R-ICSI组与ICSI组优质胚胎率、可用胚胎率均低于IVF组,差异有统计学意义(P<0.05);R-ICSI组活产率高于IVF组、ICSI组,差异有统计学意义(P<0.05);三组受精率、妊娠率比较,差异无统计学意义(P>0.05)。结论:IVF失败后行R-ICSI的活产率高于IVF、ICSI;优质胚胎率和可用胚胎率低于IVF;多PN率低于IVF,高于ICSI;2PN率低于ICSI,高于IVF;MⅡ获取率低于IVF和ICSI。

Objective:To observe application effects of remedial intracytoplasmic sperm injection(R-ICSI)after conventional in vitro fertilization(IVF)failure.Methods:The clinical data of 1673 cycles in this hospital from January 2016 to December 2020 were retrospectively analyzed.According to different fertilization methods,they were divided into IVF group(1042 cycles),R-ICSI group(131 cycles)and intracytoplasmic sperm injection(ICSI)group(500 cycles).The levels of laboratory indexes[mature egg(MII)acquisition rate,fertilization rate,2 pronucleus(PN)rate,multiple PN rate,high quality embryo rate,available embryo rate]and the clinical outcomes(pregnancy rate,live birth rate)were compared among the three groups.Results:The MII acquisition rate of the R-ICSI group was lower than that of the IVF group and the ICSI group,and the differences were statistically significant(P<0.05).The 2PN rate of R-ICSI group was lower than that of ICSI group,but higher than that of IVF group,and the differences were statistically significant(P<0.05).The rate of multiple PN in R-ICSI group was lower than that in IVF group,but higher than that in ICSI group,and the differences were statistically significant(P<0.05).The high quality embryo rate and the available embryo rate between the R-ICSI group and the ICSI group were lower than those of the IVF group,and the differences were statistically significant(P<0.05).The live birth rate of R-ICSI group was higher than that of IVF group and ICSI group,and the differences were statistically significant(P<0.05).There were no significant differences in the fertilization rate and the pregnancy rate among the three groups(P>0.05).Conclusions:The live birth rate of R-ICSI after IVF failure is higher than that of IVF and ICSI;the high quality embryo rate and the available embryo rate are lower than IVF;the multiple PN rate is lower than IVF and higher than ICSI;the 2PN rate is lower than that of ICSI and higher than that of IVF;and the MII acquisition rate is lower than that of IVF and ICSI.