常规IVF不受精周期行补救卵母细胞单精子注射

 【目的】探讨常规体外受精胚胎移植（in vitro fertilization and embryo transfer,IVF-ET）不受精时,应用卵母细胞单精子显微注射（intracytoplasmic sperm injection,ICSI）技术进行补救授精的临床意义。【方法】2001年8月～2005年8月,在499个常规IVF-ET周期中有25个周期完全不受精,进行补救ICSI,并与同期实施的179个正常ICSI周期进行比较。【结果】补救ICSI组与正常ICSI组比较,HCG日平均血清雌二醇水平、每个成熟卵泡平均血清雌二醇量、每个周期的获卵数无明显差别,补救ICSI受精率为57.7%,低于正常ICSI组（67.8%）,补救ICSI组平均每个周期获得胚胎数（7.8±3.9）比正常ICSI（10.0±4.9）组少,且有统计学意义（P〈0.01）。补救ICSI组≥4细胞的胚胎占总胚胎数的54.5%,低于正常ICSI组（87.5%）,有统计学意义（P〈0.01）。正常ICSI组妊娠率为38.5%,补救ICSI组无一例妊娠。补救ICSI组中有8例在下一周期行ICSI,有2例妊娠并分娩2个健康女婴。【结论】补救ICSI虽可以避免取消IVF周期，但其受精率和妊娠率低，其临床应用价值还有待于进一步探讨。对于常规IVF不受精的患者，再次治疗时可考虑行ICSI助孕。

Rescue ICSI of Total Unfertilized Oocytes of Conventional IVF Cycles

Objective] To evaluate the effectiveness of delayed oocyte reinsemination by ICSI (rescue ICSI) after total fertilization failure in IVF. Methods] In the total of 499 IVF-ET cycles from August 2001 to August 2005, there were 25 cycles with total fertilization failure and received rescue ICSI, which named rescue ICSI group. A control group with a total of 179 cycles undergoing ICSI during the same period was named ICSI group. Results] There was no significant difference in oocyte recovery or mean serum estradiol level of HCG day between the two groups. A fertilization rate of 57.7% was achieved in rescue ICSI group, compared to 67.8% in the control group (P< 0.01). Likewise, the mean number of embryos obtained per cycle was significantly higher in the control group. The proportion of embryos that more than 4 cell on day 2 after ICSI was significantly lower in rescue ICSI group. The fragmentation and grade of embryo, however, was comparable in both groups. In addition, the pregnancy rate in the control group was 38.5%. Although there was no pregnancy obtained in rescue ICSI group, there were 2 clinical pregnancies resulted among eight patients who underwent ICSI in the following cycles. Conclusions] Although unfertilized oocytes after IVF can be fertilized by rescue ICSI, the developmental potential of the ensuing embryos is very poor; therefore, the clinical value of rescue ICSI needs to be further studied. In addition, ICSI should be recommended in the following cycles for such patients.