反复体外受精方法失败者卵胞浆内单精于注射预后分析

目的 探讨反复常规体外受精—胚胎移植(IVF—ET)方法失败伴受精不良者行卵胞浆内单精子注射(ICSI)预后。方法 收集1999年10月到2002年8月在我院生殖中心接受常规IVF技术治疗至少1个周期以上失败伴受精率低于50％的23例(31个周期)女性不育患者为研究对象，在以后的治疗周期采用ICSI治疗方法。同时选择2001年10月到2002年8月因男性因素不育而行ICSI的30例(32个周期)患者为对照组，对比两组的临床结果。采用常规超排卵治疗长方案治疗，成熟的卵母细胞行单精子显微注射。结果 两组平均获卵数和受精率、四、六细胞卵裂率无显著差异。但八细胞卵裂率、种植率、临床妊娠率，IVF失败组分别为：26．6％、7．5％、21．4％，男性因素不孕组分别为：35.8％、18％、47.2％。两组有显著性差异。同时比较失败组自身前后两种不同受精方法的实验室情况。IVF的受精率，四、六细胞卵裂率无显著差异。但八细胞卵裂率、种植率、临床妊娠率，IVF失败组分别为：26．6％、7．5％、2l、4％，男性因素不孕组分别为：35．8％、18％、47.2％。两组有显著性差异。同时比较失败组自身前后两种不同受精方法的实验情况。IVF的受精率，四、六、八细胞卵裂率分别为48．1％、35.4％、29．9％、26.8％。ICSI的分别为68.9％、53．7％、29．9％、26.6％。其受精率及四细胞卵裂率有显著差异，六、八细胞卵裂率无差异。结论 ICSI可提高反复IVF-ET失败件受精不良患者受精率，并使部分患者妊娠，但其优质胚胎率、种植率及临床妊娠率相对单纯男性因素行ICSI者较低。提示反复IVF-ET失败伴受精不良者可能存在某种配子异常，显然ICSI可使卵子受精，但配子的异常使胚胎的发育受到损害，降低了种植率和临床妊娠率。     

75例常规IVF失败后补救ICSI临床结局分析

目的 对常规IVF周期受精完全失败,行补卵母细胞浆内单精子显微注射(rescue ICSI)的结局分析.方法 回顾分析2005.03-2006.06在我院生殖医学中心接受常规IVF治疗,对卵母细胞完全未受精行ICSI再授精的患者,共75例.在随后治疗中,解冻复苏补救ICSI受精卵的胚胎,共移植10个周期.结果 在75例常规未受精补救ICSI周期中,共有759个未受精卵,其中可注射MⅡ卵有626个,正常受精数332个(受精率53.03%),290个卵裂,形成可移植胚胎199个.在75例补救IcsI周期中,有70例新鲜胚胎移植周期,结果4例临床妊娠(妊娠率为5.71%),均为单胎,分娩4例健康婴儿,2男,2女.解冻复苏补救ICSI受精卵胚胎10周期,结果1例临床,为双活胎(妊娠率为10%),分娩2例健康男婴.结论 ICSI可作为常规IVF失败后所采取的补救措施.     

获单卵周期体外受精和单精子胞浆内注射对IVF-ET结局的影响

目的取卵日仅获单卵周期常规体外受精（IVF）和单精子胞浆内注射（ICSI）两种受精方式对的IVF—ET结局的影响。方法本研究对92个获单卵周期进行比较，分析了在年龄、激素和子宫内膜厚度无差别的情况下ICSI和IVF的结局。就不同年龄段及不同精液质量时，ICSI和IVF受精率、卵裂率及妊娠率进行比较。结果年龄、激素和子宫内膜厚度无差别时，ICSI的受精率和妊娠率分别为81．6％和12.2％，明显高于IVF组的69．8％和4．7％。不同年龄组，当精子正常时，ICSI组和IVF组受精率和卵裂率无统计学差别，但妊娠率在前者高；精子未达正常标准时，ICSI组的受精率、卵裂率及妊娠率均显著高于IVF组。结论精子质量对选用ICSI还是IVF是重要影响因素，未迭正常标准的精子选用ICSI更好。总体说来，对于获单卵周期，ICSI似乎是更好的受精方式。这次结果也为我们在自然周期选择何种受精方式提供了参考。     

早期补救性ICSI在原发不孕患者中的临床应用

目的探讨早期补救性ICSI在原发不孕患者中的临床应用价值及可行性。方法以行常规IVF-ET治疗原发不孕患者203周期为实验组,进行短时授精结合第二极体观察判断受精情况,对受精失败或受精率低下患者行早期补救性ICSI治疗。并与同期93个直接ICSI周期进行比较。结果 203个周期中行早期补救性ICSI周期17个,占周期总数8.4%;与直接ICSI周期比较,早期补救性ICSI的受精率、多PN（≥3PN）、卵裂率、优质胚胎率、妊娠率、种植率等方面差异无统计学意义。结论早期补救性ICSI在无明确ICSI指证的原发不孕患者中可以获得较好的临床效果。     

早期补救卵胞浆内单精子注射在常规体外受精中的临床应用价值探讨

目的探讨早期补救卵泡浆内单精子注射(ICSI)在常规体外受精(IVF)中完全不受精或低受精的临床应用价值。方法回顾性分析2013年3月~2015年5月在本院生殖中心常规IVF治疗受精6h后判断为完全不受精或低受精而行早期补救ICSI的52周期患者,统计其实验室培养指标及临床结局,并与同期因男方因素而直接进行ICSI的127周期进行比较。结果早补救ICSI组的受精率、卵裂率、临床妊娠率及种植率和直接ICSI组比较差异无统计学意义(P0.05),而优胚率、胚胎利用率及囊胚形成率显著低于直接ICSI组,两组差异有统计学意义(P0.05)。结论早补救ICSI可作为常规IVF受精失败的补救措施具有较高的临床应用价值,但由于卵母细胞在体外的培养时间延长导致卵子老化,甚至会影响胚胎的发育潜能。建议对高度怀疑受精障碍尤其高龄(≥37岁)、获卵数≥8患者采用Half-ICSI以提高胚胎利用率和累积妊娠率。     

短时受精后补救ICSI与常规受精失败后补救ICSI的比较

目的探讨在常规IVF-ET受精失败后补救ICSI和短时受精后补救ICSI两种方法在临床中的应用。方法选择常规IVF中受精失败的20个周期行晚期补救ICSI,26个周期行短时受精后补救ICSI,两种方法进行比较。结果早期补救的2PN的受精率,种植率,妊娠率分别为85.28%,13.64%,29.63%,明显高于晚期补救ICSI的50.27%,5%,15.79%（P〈0.01）。结论早期补救ICSI较晚期补救ICSI的2PN的受精率,种植率,妊娠率高,能更好的改善妊娠结局。     

体外受精-胚胎移植中不同受精方式的妊娠结局分析

目的探讨体外受精-胚胎移植中不同受精方式对妊娠结局的影响。方法回顾性分析2014年1月至12月在本院生殖中心接受IVF/ICSI-ET治疗的733个新鲜移植周期,按受精方式分为常规IVF组(605周期)和ICSI组(128周期),比较两组受精率、卵裂率、有效胚胎率、优胚率、胚胎种植率、临床妊娠率、早期流产率、多胎妊娠率、异位妊娠率及胎儿畸形率。结果两组间受精率、卵裂率、有效胚胎率、优胚率、胚胎种植率、临床妊娠率、早期流产率、多胎妊娠率、异位妊娠率及胎儿畸形率差异均无统计学意义(P0.05)。结论 ICSI技术可取得与常规IVF相似的妊娠结局,是治疗男性不育的有效方法。     

不同类型不明原因不孕患者的体外受籼胎移植助孕结局探讨

目的：探讨不同类型不明原因不孕（UI）夫妇接受IVF-ET助孕治疗的结局。方法：共纳入212个因UI接受IVF-ET助孕的周期进行回顾性分析。所有周期均采用短时受精,在IVF受精后6h,对低受精率（〈30％）和IVF完全受精失败周期中未出现第二极体的成熟卵立即进行早期补救ICSI。结局按原发不孕（A1组,139例）及继发不孕（A2,组73例）分组进行比较。并将所有获得成熟卵的周期再分为IVF受精（B1组,181例）与补救ICSI受精（B2组,26例）进行比较。结果：1．A1组较A2组年轻,但不孕年限更长,MII卵IVF受精率及2PN受精率较低,补救ICSI受精周期率明显较高（17.04％比4.17％,P值〈0.05）。A1组因异常受精、未受精、未卵裂或胚胎质量差导致的无可移植胚胎周期取消率明显高于A2组（11.79％比2.74％,P值〈0.05）,但两组移植周期种植率、临床妊娠率及活产率无显著差异（P值〉0.05）。2．Bl组比B2组MII卵受精率更高（93.82％比84.78％,P值〈0.05）,但其余指标比较无显著差异。结论：不明原因不孕夫妇中原发不孕者更容易出现IVF受精失败或低受精率。采用短时受精及补救ICSI受精后可以获得与继发不孕夫妇相当的IVF-ETII临床结局。     

反复体外受精方法失败者卵胞浆内单精子注射预后分析

目的　探讨反复常规体外受精 -胚胎移植 (IVF -ET)方法失败伴受精不良者行卵胞浆内单精子注射 (ICSI)预后。方法　收集 1999年 10月到 2 0 0 2年 8月在我院生殖中心接受常规IVF技术治疗至少 1个周期以上失败伴受精率低于5 0 %的 2 3例 (31个周期 )女性不育患者为研究对象 ,在以后的治疗周期采用ICSI治疗方法。同时选择 2 0 0 1年 10月到 2 0 0 2年 8月因男性因素不育而行ICSI的 30例 (32个周期 )患者为对照组 ,对比两组的临床结果。采用常规超排卵治疗长方案治疗 ,成熟的卵母细胞行单精子显微注射。结果　两组平均获卵数和受精率、四、六细胞卵裂率无显著差异。但八细胞卵裂率、种植率、临床妊娠率 ,IVF失败组分别为 :2 6 .6 %、7.5 %、2 1.4 % ,男性因素不孕组分别为 :35 .8%、18%、4 7.2 %。两组有显著性差异。同时比较失败组自身前后两种不同受精方法的实验室情况。IVF的受精率 ,四、六细胞卵裂率无显著差异。但八细胞卵裂率、种植率、临床妊娠率 ,IVF失败组分别为 :2 6 6 %、7 5 %、2 1 4 % ,男性因素不孕组分别为 :35 8%、18%、4 7 2 %。两组有显著性差异。同时比较失败组自身前后两种不同受精方法的实验情况。IVF的受精率 ,四、六、八细胞卵裂率分别为 4 8.1%、35 .4 %、2 9.9%、2 6 .8%。ICSI     

在体外受精中选择性行早期观察的应用探讨

目的对行IVF的周期进行早期观察可对受精障碍（完全不受精和受精率〈30%）尽早发现并行早期补救ICSI可取得良好的妊娠结局。本文通过对常规过夜受精、常规早期观察和有受精障碍高危因素行选择性早期观察的IVF周期进行效果比较,探讨选择性早期观察的在体外受精中的应用价值。方法对本中心2009年5月至11月共506个IVF周期进行阶段性分组,7月至9月的188个周期行常规早期观察,余318个周期中42个行选择性早期观察。结果常规过夜受精与早期观察组的不受精及低受精的发生率差异有显著性（分别为3.6%,6.2%和7.8%,13.5%）,早期观察后补行ICSI受精可以挽救完全不受精周期的卵子,并获得妊娠机会（临床妊娠率33.3%）,减少取消周期。对低受精率组则可以提高卵子利用率,增加取卵周期的累计妊娠率。而选择性早期观察受精障碍发生率更高（14.3%）,与常规过夜组（3.6%）及常规早期观察组（6.4%）比较有显著性差异（P〈0.05）。结论短时受精早期观察可以最大限度的发现受精障碍的病例并及时补救ICSI挽救卵子,降低取消周期,同时可以提高优质胚胎率和妊娠率。但选择性的早期观察也可以获得较好的结果,同时减少人为干扰,保证卵子的正常受精途径,更好的保障下一代的安全性。     

Rescue ICSI of unfertilized oocytes after IVF

BACKGROUND: Failed fertilization after IVF occurs in 10-20% of cycles. Conflicting results of rescue fertilization by ICSI have been reported. We therefore compared the success rate in terms of fertilization and pregnancy of cycles in which rescue ICSI was performed with those from a matched control group of primarily ICSI cycles. METHODS: Unfertilized oocytes from IVF cycles with total fertilization failure where at least four metaphase II oocytes were available were treated by ICSI (group I; n = 120). A matched control group was established with patients undergoing ICSI during the same period (group II; n = 280). RESULTS: Both fertilization rate and the proportion of embryos with four blastomeres on day 2 after ICSI were significantly higher in the control group (P < 0.05). Embryo quality, however, was comparable in both groups. The pregnancy rate in the control group was 25.3% whereas in group I with rescue ICSI, no pregnancy was obtained. CONCLUSIONS: Although unfertilized oocytes after IVF can be fertilized by ICSI, the developmental potential of the ensuing embryos is very poor. Therefore, rescue ICSI after total failure of fertilization is not recommended.     

部分卵胞浆内单精子显微注射112例分析

目的分析本中心行部分卵胞浆内单精子显微注射的病例,探讨half-ICSI的指征的可行性。方法选择2004年1月至2008年12月在本中心行half-ICSI的112个周期,按适应症分三组,A组为男方中度少弱畸精子症,B组为前次IVF受精失败或低下(30%),C组为不明原因不孕,以同期常规IVF治疗的1377个周期为对照,分别比较三组中发生受精失败或低下发生率(受精率30%)情况的比例,以及half-ICSI的效果。结果 half-ICSI的112个周期共获卵1633个,行IVF766个卵,受精率为54.7%,其中完全不受精27个周期,受精低下(30%)11个周期,行ICSI部分867个卵,MII765个,受精645个,受精率84.3%,移植周期临床妊娠率为39.4%(其中IVF完全不受精者临床妊娠率为32.0%)。112个周期有38个周期发生受精失败或低下,发生率为33.9%(38/112),其中A组发生率31.8%,B组50.0%,C组30.8%。对照组发生受精失败或低下率为7.0%(96/1377),结果有显著性差异(P0.05)。结论对存在高危因素的病人在同一治疗周期中行half-ICSI可明显减少因不受精无胚胎移植的情况出现,从而提高妊娠率,又因有IVF胚胎移植,可减少ICSI子代遗传和先天缺陷的风险。     

常规IVF受精失败补救ICSI后行冻融胚胎移植的临床价值

目的探讨冻融胚胎移植在常规体外受精(IVF)失败后补救卵胞浆内单精子注射(L-ICSI)中的应用价值。方法在12个常规体外受精失败周期中应用ICSI对未受精的MⅡ期卵子进行显微授精,将获得的优质胚胎进行冷冻,再择期行冻融胚胎移植。结果对93个未受精的MⅡ卵子接受L-ICSI,受精63枚,受精率为67.7%(63/93),异常受精3枚(2枚1PN,1枚3PN),57个正常受精卵发生卵裂,卵裂率为95.0%(57/60),优质胚胎率为43.9%(25/57),10例患者冷冻胚胎25枚,其中4例采用程序化冷冻,6例采用玻璃化冷冻。9个患者行冻融胚胎移植,共移植胚胎18枚(其中解冻后胚胎碎裂死亡5枚),其中1个周期因冻融后2个胚胎碎裂放弃移植,2例获得临床妊娠,1例分娩出正常婴儿,1例正在妊娠中,临床妊娠率为22.2%。结论 ICSI可使常规体外受精失败的卵子再受精,冻融胚胎移植可以解决胚胎与子宫内膜不同步的问题,获得相对满意的临床结局,具有一定的应用价值。     

Comparison between intracytoplasmic sperm injection and in-vitro fertilization (IVF) with high insemination concentration after total fertilization failure in a previous IVF attempt.

The aim of this prospective study was to evaluate whether couples with total fertilization failure in a previous in-vitro fertilization (IVF) attempt should be offered an additional IVF treatment with elevated insemination concentration or should be treated with intracytoplasmic sperm injection (ICSI). In 23 cycles 228 sibling metaphase II (MII) oocytes were randomly divided: 143 and 85 oocytes were utilized for ICSI and IVF respectively. Of the 143 injected (ICSI) oocytes, 90 (62.9%) were normally fertilized (two pronuclei), whereas 21 (14.7%) oocytes were damaged by the ICSI procedure. Of the fertilized oocytes 72 (80%) developed into transferable embryos. No fertilization at all was observed in the 85 sibling MII oocytes which were inseminated (P < 0.001). In all 23 cycles at least one embryo, obtained by ICSI, could be replaced. Eight pregnancies were achieved of which six resulted in the delivery of nine healthy children. In conclusion, for couples with no or almost no fertilization of oocytes in previous IVF attempts, ICSI appeared to be far superior to an additional IVF attempt with further elevated insemination concentrations.     

Comparison of fertilization, cleavage and pregnancy rates of oocytes from large and small follicles

Ovarian stimulation for in-vitro fertilization (IVF) causes development of several cohorts of follicles. At the time of oocyte collection, oocytes are thus retrieved from a wide range of follicles of different sizes and developmental stages. A relationship between size of follicles and pregnancy rates has earlier been demonstrated. The aim of the present study was to compare fertilization, cleavage and pregnancy rates between oocytes retrieved from large and small follicles in conventional IVF and intracytoplasmic sperm injection (ICSI). A total of 200 conventional IVF patients and 175 ICSI patients underwent oocyte retrieval where oocytes from both large and small follicles were collected. A follicle with a volume of > or = 2 ml, corresponding to a follicular diameter > or = 16 mm as determined by ultrasound, was regarded as a large follicle. Only one cycle from each patient was included. Fertilization and cleavage rates were calculated per patient for oocytes from large and small follicles. The mean fertilization and cleavage rates for conventional IVF and ICSI cycles were calculated. Comparison of pregnancy rates was performed for patients receiving embryos derived from oocytes of only large or only small follicles. For conventional IVF patients, fertilization rates were 71.4 and 58.1% (P < 0.01, Wilcoxon paired test) for oocytes of large and small follicles respectively. The corresponding cleavage rates were 95.4 and 93.9% respectively. The pregnancy rate for the two groups was 47% (60/127) and 15% (2/13) (P < 0.05, chi2 test). For ICSI patients the fertilization rate was 72.0 and 71.1% for oocytes of large and small follicles respectively. The corresponding cleavage rate was 93.0 and 91.1%. The pregnancy rate in the two groups was 41% (46/113) and 42% (5/12). The results show that oocytes from smaller follicles also yield fertilization and pregnancies, although in conventional IVF to a lesser extent than oocytes from larger follicles. For IVF cycles, a higher proportion of immature oocytes (which are normally not included in the ICSI procedure) in the group of oocytes from small follicles is most probably the explanation for the lower fertilization rate. The decrease in pregnancy rate with oocytes from small follicles in the IVF cycles was not observed in the ICSI cycles. The possibility of evaluating the degree of oocyte maturation prior to fertilization may be an advantage of the ICSI technique. This suggests that the disadvantages of oocytes from small follicles might be overcome by means of ICSI.      

Rescue ICSI of oocytes that failed to extrude the second polar body 6 h post-insemination in conventional IVF

BACKGROUND: Attempts to 'rescue' by ICSI oocytes that remained unfertilized 24 h after conventional IVF have generally resulted in poor outcomes. The aim of the present study was to compare the outcome of rescue ICSI performed on one group of patients 6 h after initial insemination with those of another group where rescue ICSI was performed 22 h after initial insemination. METHODS: Twenty-five patient IVF cycles provided the oocytes for rescue ICSI 6 h after initial insemination, and 20 cycles provided the oocytes for rescue ICSI 22 h after initial insemination in this retrospective study. Fertilization and cleavage rates, embryo quality, implantation, and pregnancy rates after rescue ICSI were the main outcome measures. RESULTS: A fertilization rate of 70.3% was achieved with 6 h rescue ICSI compared with 48.5% with 22 h rescue ICSI (P < 0.0001). From 6 h rescue ICSI, 12 clinical pregnancies (48.0%) resulted in three sets of twins, eight singletons and one abortion. From 22 h rescue ICSI there was one (5.0%) singleton pregnancy and delivery of a healthy baby. Likewise, the implantation rate was 20.2% from 6 h rescue ICSI compared with 1.72% from 22 h rescue ICSI (P < 0.02). CONCLUSIONS: Rescue ICSI after 6 h post-insemination (46 h post-HCG) gave better fertilization, pregnancy and implantation rates compared with rescue ICSI after 22 h when oocytes have become aged.     

体外受精过程中胚胎污染的临床结局分析（附精液反复污染改行ICSI妊娠一例）

目的对体外受精过程中发生胚胎污染后的临床结局的探讨和分析。方法回顾性分析1997年3月至2007年12月,在本中心接受体外受精-胚胎移植（IVF-ET）治疗1634个周期中,体外受精过程中发生胚胎污染10个周期的临床结局。结果10例胚胎污染周期中移植8个周期18个胚胎,均未妊娠。其中1例精液反复污染,改行卵胞浆内单精子注射（ICSI）,移植3个胚胎,双胎妊娠。结论体外受精过程中发生胚胎污染会造成IVF-ET失败,胚胎污染的病人下一周期可改行ICSI治疗。     

Outcome of conventional IVF and ICSI on sibling oocytes in mild male factor infertility

BACKGROUND: Decisions concerning the treatment choice for assisted reproduction (IVF or ICSI) are usually made after the evaluation of male fertility factors, or after taking into account the results of previous IVF attempts. There are no widely accepted criteria, so decisions for couples with male subfertility are often empirical and may lead to complete fertilization failure after IVF, or to the unnecessary use of ICSI. METHODS: A study was conducted in which half the oocytes from each of 58 couples with moderate oligo +/- astheno +/- teratozoospermia were inseminated (conventional IVF) and the other half microinjected (ICSI). The technique used for subsequent cycles depended on the results of the first cycle. RESULTS: Nineteen of the 58 IVF/ICSI attempts resulted in fertilization after ICSI only (32.8%) and 39 in fertilization after IVF and ICSI (67.2%). For patients with oocyte fertilization only after ICSI, 61.5% of the oocytes microinjected were fertilized. A mean of 2.2 embryos per patient were transferred, leading to eight clinical pregnancies (42.1%).The implantation rate was 21.4%. All subsequent cycles were carried out with ICSI. Couples with oocyte fertilization after both IVF and ICSI had slightly better semen characteristics than those with oocyte fertilization only after ICSI, but this difference was not significant. Overall, no statistically significant difference was observed between IVF and ICSI in sibling oocytes for any of the variables studied: fertilization rate, embryo morphology and rates of development, pregnancy and implantation. Although only small numbers of oocytes or embryos were available for each couple, six couples had lower fertilization rates after IVF and eight had lower embryo quality after IVF. Eight patients had lower sperm quality in the second cycle, and only seven couples underwent subsequent IVF cycles. CONCLUSIONS: This strategy enabled us to avoid 32.8% of complete fertilization failures after IVF, but not to decrease significantly the number of ICSI attempts in subsequent cycles. However, the uncertainties concerning the safety of ICSI suggest that ICSI should be used cautiously and judiciously.     

IVF versus ICSI in sibling oocytes from patients with polycystic ovarian syndrome: a randomized controlled trial

BACKGROUND: This study compares the fertilization rate and embryonic development of oocytes randomly inseminated by conventional IVF or ICSI in patients with polycystic ovarian syndrome (PCOS) and normozoospermic semen during IVF cycles. METHODS: Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Fertilization rate (two pronuclei/COC), day 2 embryonic morphology and rate of development were assessed. RESULTS: A total of 1089 cumulus-oocyte complexes (COC) were collected in 60 cycles (mean+/-SD, 18.2 +/- 7.2). Totals of 541 and 548 COC were inseminated by IVF and ICSI respectively, with a significantly higher fertilization rate in the ICSI group (ICSI versus IVF, 72.3 +/- 15.5 versus 44.8 +/- 25.1%). No fertilization failure occurred in the group of oocytes inseminated by ICSI, whereas the COC in nine patients (15%) inseminated by IVF had complete fertilization failure. The day 2 embryonic morphology and rate of development were not different regardless of the insemination method. CONCLUSIONS: Our results suggested that another randomized controlled study, randomizing patients instead of sibling oocytes, should be undertaken to compare the pregnancy rate per started cycle and to see whether ICSI should be performed on all, or at least on a portion of, oocytes for patients with PCOS undergoing IVF cycles.