透明带形态异常卵母细胞在IVF完全受精失败后行补救ICSI的临床结局

目的:研究透明带形态异常卵母细胞的受精、胚胎发育和临床结局。方法:以在IVF完全受精失败(TFF)周期中透明带形态异常的15名患者为研究组(A组),非透明带形态异常的完全受精失败周期的63例患者为对照组(B组),回顾性分析比较患者的一般临床情况、IVF结局及行补救ICSI(R-ICSI)的临床结局。结果:除受精率组间有显著性差异(65.52%vs 78.86%,P<0.01)外,其余各指标(年龄、不孕年限、不孕类型、不孕原因、基础内分泌水平、基础卵泡数、降调节天数、Gn使用天数、Gn使用总量、hCG注射日直径≥16 mm卵泡数、hCG注射日E2、P和LH水平、获卵数、MII卵数、行R-ICSI的受精率、卵裂率、优质胚胎率、种植率、临床妊娠率和流产率)组间均无统计学差异。结论:IVF完全受精失败周期透明带形态异常卵母细胞行R-ICSI虽受精率较低,但及早发现受精失败并行R-ICSI,可使65.52%的卵子受精,从而改善临床结局。     

卵母细胞内滑面内质网聚集现象对其发育潜能及临床结局的影响

目的探讨卵胞质内单精子注射(ICSI)周期中卵母细胞滑面内质网聚集体(SERC)对胚胎发育的影响及移植后的妊娠结局,判断是否有移植价值。方法回顾性分析2014年1月—2015年12月期间768个ICSI周期。根据所获MⅡ期卵母细胞是否出现SERC分为A组(n=681,所获MⅡ期卵母细胞均未出现SERC)和B组(n=87,至少有1枚MⅡ期卵母细胞出现SERC)。比较A、B两组患者的一般临床情况、Gn使用总量、Gn使用时间、h CG注射日雌激素(E2)、孕酮(P)、黄体生成素(LH)水平、子宫内膜厚度以及获卵数、受精率、优质胚胎率、囊胚形成率、多囊卵巢综合征(PCOS)患者比例、中重度卵巢过度刺激综合征(OHSS)发生率、临床妊娠率、种植率、流产率、活产率和胎儿畸形率。将B组再分为3个亚组,SERC(+)组(n=7),所移植的胚胎均为SERC(+)卵子来源;SERC(+/-)组(n=14),所移植的胚胎1枚为SERC(+)卵子来源的,1枚为SERC(-)卵子来源的;SERC(-)组(n=25),所移植的胚胎均为非SERC卵子来源的。比较其受精率、优质胚胎率和囊胚形成率。结果 B组h CG注射日E2水平[(2 976.6±1 246.3)ng/L]明显高于A组[(2 323.4±871.4)ng/L](P0.05),而P和LH水平以及子宫内膜厚度均无统计学差异(P0.05);B组受精率(65.9%)、优质胚胎率(28.6%)、囊胚形成率(44.2%)显著低于A组(74.9%、33.4%和50.4%)(P0.05),而B组Gn用量[(2 643.6±1 087.5)IU]明显高于A组[(2 256.6±976.4)IU](P0.05)。患者的年龄、Gn使用时间、不孕年限、获卵数、PCOS患者比例、中重度OHSS发生率、临床妊娠率、种植率、流产率、活产率和胎儿畸形率方面组间均无统计学差异(P0.05)。3个亚组间一般临床情况无统计学有差异。SERC(+)亚组卵母细胞的受精率(59.6%)、囊胚形成率(35.7%)显著低于SERC(-)亚组(68.6%,48.1%)(P0.05)。结论卵母细胞SERC会影响早期胚胎的体外发育,但本研究未观察到SERC胚胎对妊娠结局有不良影响,故需慎重对待SERC来源的胚胎。     

微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用

目的:探讨微刺激促排卵在IVF/ICSI卵巢低反应患者中的应用。方法:回顾性分析进行IVF/ICSI助孕的卵巢低反应患者共114个周期,根据用药情况分为3组:A组(来曲唑组,34个周期),B组(克罗米芬组,41个周期),C组(短方案组,39个周期)。比较3组患者的一般情况、Gn使用天数及总量、IVF相关指标及助孕结局。结果:①年龄、体质量指数(BMI)、不孕年限、基础内分泌水平组间比较均无统计学差异(P>0.05)。②A组Gn使用天数及总量、hCG注射日E2水平、优质胚胎率低于C组(P<0.05);hCG注射日LH水平、提前排卵率高于C组(P<0.05);平均获卵数、受精率、卵裂率、着床率、临床妊娠率A组与C组间比较均无统计学差异(P>0.05)。③B组Gn使用天数及总量、hCG注射日E2水平、平均获卵数、卵裂率均低于C组(P<0.05);hCG注射日LH水平高于C组(P<0.05);提前排卵率、受精率、优质胚胎率、着床率、临床妊娠率B组与C组间均无统计学差异(P>0.05)。④B组Gn使用天数及总量高于A组(P<0.05);其余相关指标组间比较均无统计学差异(P>0.05)。结论:微刺激方案可以获得与GnRH-a短方案相近的临床效果,同时降低Gn使用总量,减轻患者单周期治疗费用,是卵巢储备功能低下患者较理想的促排卵方案。     

微刺激促排卵方案在PCOS患者IVF中的应用

目的:探讨微刺激促排卵方案在多囊卵巢综合征(PCOS)患者IVF中的应用。方法:将行IVF-ET的不孕患者分为3组:PCOS长方案组(A组,n=31)、PCOS微刺激组(B组,n=23)和非PCOS长方案对照组(C组,n=25)。比较3组的年龄、不孕年限、基础内分泌、口服避孕药后基础内分泌及IVF结局。结果:①年龄、不孕年限、基础FSH(bFSH)组间比较均无统计学差异(P>0.05);bLH、bLH/bFSH、bT在A组和B组中均明显高于C组(P<0.05);用口服避孕药后A组和B组LH、LH/FSH、T明显降低,使3组间内分泌比较无统计学差异(P>0.05)。②A组的受精率、卵裂率低于C组(P<0.05);Gn使用天数、获卵数、可利用胚胎数、优质胚胎数高于C组(P<0.05);Gn使用总量、种植率、临床妊娠率、流产率A、C组间比较均无统计学差异(P>0.05)。③B组受精率、卵裂率低于C组(P<0.05);Gn使用总量及Gn使用天数比C组明显减少(P<0.05);获卵数、可用胚胎数、优质胚胎数高于C组(P<0.05);B、C组间种植率、临床妊娠率、流产率比较无统计学差异(P>0.05)。④B组Gn使用总量及Gn使用天数比A组明显减少(P<0.05);B组获卵数、受精率、卵裂率、优质胚胎数、可利用胚胎数等指标与A组比较均无统计学差异(P>0.05)。⑤B组hCG注射日E2水平及移植日子宫内膜厚度明显低于A组(P<0.05),但种植率、临床妊娠率、流产率等方面与A组比较均无统计学差异(P>0.05)。结论:①口服避孕药在调整PCOS患者内分泌,降低PCOS患者LH、T方面有较好的作用,能改善PCOS患者内分泌环境;②PCOS患者行IVF时采用克罗米酚(CC)加hMG微刺激可降低hCG注射日E2水平,减少OHSS的发生。③CC加hMG微刺激方案对PCOS患者行IVF促排卵可能是相对经济、有效、安全的方法。     

多囊卵巢综合征体外受精-胚胎移植妊娠结局及其影响因素分析

目的探讨多囊卵巢综合征(PCOS)不育患者行体外受精-胚胎移植(IVF-ET)的治疗效果及其影响因素。方法对2006年3月至2009年3月在广州医学院第三附属医院生殖医学中心行IVF的PCOS不孕患者作回顾性分析,观察组(A组)为PCOS不孕患者120例132周期,对照组(B组)为双侧输卵管梗阻不孕患者343例382周期,比较两组HCG日雌二醇(E2)、获卵数、受精率、优质胚胎数、种植率、临床妊娠率、活产率、周期取消率、卵巢过度刺激综合征(OHSS)发生率。PCOS患者根据BMI分为正常体重组(C组)及超重组(D组),比较两组妊娠结局。结果 A、B两组促性腺激素(Gn)用量及HCG日E2水平、每移植周期临床妊娠率、流产率、活产率差异无统计学意义(P0.05);A组与B组比较Gn用时较长,获卵数较多,受精率、卵裂率较高,优质胚胎数较多,种植率较低,OHSS发生率、周期取消率较高,差异有统计学意义(P0.05)。D组与C组比较,Gn总量较多、用时较长,HCG日E2峰值较低,获卵数、优质胚胎数较少,受精率较低,差异有统计学意义(P0.05);种植率较低,流产率、周期取消率及OHSS发生率较高,但差异无统计学意义(P0.05)。结论 IVF-ET是PC0S不孕患者的一种有效治疗方法,但应积极预防OHSS;肥胖及胰岛素抵抗可能对妊娠结局产生不良影响。     

三种促排卵方案对卵巢储备力低下患者助孕效果比较

目的:探讨卵巢储备力低下患者行体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)助孕时较理想的超促排卵方案。方法:将302例行IVF/ICSI-ET助孕的卵巢储备力低下患者分为3组:微刺激方案组(A组,98例)、黄体期促排卵方案组(B组,62例)和超短方案组(C组,142例),比较3组的一般情况、周期取消率、总促性腺激素释放激素(Gn)使用天数(Gn天数)、人绒毛膜促性腺激素(HCG)日血雌二醇(E_2)、促黄体生成素(LH)、孕酮(P)及子宫内膜厚度、平均获卵数、受精率、形成胚胎率、优质胚胎率、临床妊娠率、生化妊娠率。结果:A组的周期取消率均明显高于B、C两组(P0.05);A组的总Gn天数最短,C组的总Gn天数最长(P0.05);A组的HCG日子宫内膜厚度低于B、C组,但差异无统计学意义;A组的HCG日E_2水平、平均获卵数均低于B、C两组,C组的HCG日LH水平均低于A、B两组(P0.05)。3组的一般情况、正常受精率、成胚率、优胚率、临床妊娠率、生化妊娠率均无统计学差异。结论:超短方案可能是较好的卵巢储备力低下超促排卵方案,同时黄体期促排卵亦不失为一种新的有效促排卵方案。     

不同促排卵方案在多囊卵巢综合征患者IVF-ET治疗中的应用分析

目的:探讨GnRH激动剂(GnRH-a)长方案(Ⅰ组,58周期)、GnRH-a短方案(Ⅱ组,52周期)、GnRH拮抗剂(GnRH-A)方案(Ⅲ组,41周期)3组对多囊卵巢综合征(PCOS)患者行体外受精-胚胎移植(IVF-ET)治疗的临床结局,寻求更适宜PCOS患者的促排卵治疗方案。方法:回顾性分析2008年1月~2010年6月行IVF-ET的PCOS患者151周期,根据所采取的不同促排卵方案分成3组,比较各组患者基本特征、Gn用药天数、Gn量、HCG日LH、P、E2水平、获卵数、受精率、优质胚胎率、妊娠率、周期取消率、OHSS发生率等。结果:3组患者基本特征差异无统计学意义(P>0.05);Gn用药天数和Gn量Ⅲ组均显著低于其他两组(P<0.05);3组HCG日LH、P、E2水平、获卵数、受精率、优质胚胎率、流产率的差异无统计学意义(P>0.05);Ⅲ组妊娠率最高(P<0.05);周期取消率Ⅲ、Ⅱ组与Ⅰ组相比显著降低(P<0.05),OHSS发生率Ⅲ组明显低于Ⅰ组与Ⅱ组(P<0.05)。结论:对于行IVF-ET的PCOS患者使用GnRH-A方案有效减少了Gn的用量和天数,提高了妊娠率,降低了周期取消率和OHSS发生率,减轻了患者的经济和心理负担,是PCOS患者行IVF-ET较为适宜的促排卵方案。     

长方案超促排卵过程中LH变化趋势对IVF/ICSI-ET结局的影响

目的:探讨控制性超促排卵(COH)周期中LH变化趋势对体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。方法:回顾性分析228个IVF/ICSI长方案周期,1按h CG注射日与降调节后Gn启动前血清LH水平的变化趋势,分为降低趋势组和升高趋势组;2将升高趋势组及降低趋势组根据COH中期与降调节后LH水平变化趋势分为A组和B组(升高趋势中的降低组和升高组),C组和D组(降低趋势中的降低组和升高组);3按照LH降低幅度将A组和C组分为A1组(下降幅度50%)和A2组(下降幅度≥50%)、C1组(下降幅度50%)和C2组(下降幅度≥50%),比较各组IVF/ICS-ET结局的差异。结果:1降低趋势组与升高趋势组获卵数、胚胎数、总的受精率、卵裂率、可利用胚胎率、优质胚胎率比较,差异均无统计学意义(P0.05),而胚胎种植率(26.09%vs 35.22%,P0.05)、临床妊娠率(45.11%vs 58.67%,P0.05)显著较升高趋势组低,早期流产率较升高组略高(26.08%vs 15.91%),但差异无统计学意义(P0.05)。2A组与B组、C组与D组相比较IVF/ICSI结局均无统计学差异。3 A1组、A2组的受精率、临床妊娠率、胚胎种植率、可利用胚胎率组间比较,差异均无统计学意义,但优质胚胎率A1组较高(65.48%vs40.68%,P0.05);C1组、C2组IVF/ICSI结局相比无统计学差异。结论:IVF/ICSI-ET长方案,h CG注射日较Gn启动前血清LH升高,有助于提高胚胎种植率、临床妊娠率,且在COH中期LH下降幅度50%,能显著提高优质胚胎率。故在COH的过程中适时添加LH,选择合适的血清LH水平启动COH,有助于改善助孕结局。     

早期补救ICSI应用价值的初步探讨

目的:探讨早期补救ICSI的应用价值。方法:回顾性分析IVF受精失败、取卵后20h行补救ICSI者19例(晚补救ICSI,A组)及加精子(IVF)4~6h后未见第二极体(Pb2)的成熟卵行补救ICSI者31例(早补救ICSI,B组),并与544例同期常规ICSI(C组)进行比较,观察受精率、卵裂率、有效胚胎率、优质胚胎率、胚胎种植率、临床妊娠率,评价早补救ICSI有效性。结果:3组年龄及基础FSH均无统计学差异,B组正常受精率显著高于A组,但显著低于C组(71.27%vs55.69%vs81.08%,P<0.05),>2原核(PN)率A、B组间无统计学差异,但显著高于C组(7.73%vs7.78%vs2.73%,P<0.01),卵裂率B组显著高于A组(100%vs94.62%,P<0.05),有效胚胎率3组间无统计学差异,优质胚胎率B组显著高于A组,但低于C组(51.16%vs22.73%vs60.19%,P<0.01),胚胎种植率B组显著高于A组(1.75%vs17.54,P<0.05),与C组比较无统计学差异(17.54%vs18.90%,P>0.05),3组临床妊娠率分别为5.26%,26.67%和34.57%,与C组比,A组临床妊娠率显著下降(P<0.01)。结论:与晚补救ICSI相比,早补救ICSI获得了更高的受精率、卵裂率、优质胚胎率及种植率,但多PN率高于常规ICSI,优质胚胎率仍低于常规ICSI。     

不同预处理促性腺激素拮抗剂方案在超促排卵中应用的临床分析

目的:探讨如何在体外受精-胚胎移植(IVF-ET)周期中更有效地运用拮抗剂方案。方法:回顾性分析319个使用拮抗剂方案进行IVF-ET无输卵管积液、无内膜息肉及无子宫解剖结构异常的新鲜移植周期。根据拮抗剂治疗前使用短效激动剂(n=125,A组)、口服避孕药(达英-35)(n=113,B组)和未处理组(n=81,C组)分组,比较各组患者的年龄、促性腺激素(Gn)使用天数和剂量、注射hCG日LH和E2水平、获卵数、优质胚胎率、临床妊娠率等。同时以261个促性腺激素激动剂长方案移植周期为对照组(D组)作进一步对比。结果:C组年龄(32.9±4.8岁)较其它组年龄明显偏大,P<0.05;A和B组Gn使用剂量大于C组,其中A组明显增多(P<0.01);A和B组hCG注射日LH水平均较C组明显低,其中A组LH值最低(P<0.01);A组获卵数最多(P<0.05);B组子宫内膜最薄(P<0.01)。3组的受精率、优质胚胎率均无统计学差异(P>0.05)。A组、B组和C组临床妊娠率分别为:32.8%、17.7%和37.0%,B组临床妊娠率显著低于A、C组(P<0.01)。C组、D组间临床妊娠率比较无统计学差异(37.0%vs 40.2%,P>0.05);C组Gn使用的时间和剂量均比D组明显减少(P<0.05)。结论:在IVF-ET中GnRH拮抗剂治疗前使用达必佳预处理未能提高妊娠率,使用过达因-35避孕的患者妊娠率明显下降,而未使用任何药物的患者接受GnRH拮抗剂超促排卵方案,能获得比较好的临床结局。     

体外受精治疗不明原因不孕受精方法的探讨

目的:探讨不明原因不孕患者体外受精方式的选择。方法:将每例不明原因不孕患者(35例)超促排卵获取的卵母细胞随机分为二组,分别行常规体外受精(A组)和ICSI受精(B组),比较二组的受精结局、妊娠率及着床率。结果:A组受精率(51.2%)低于B组(61.3%,P<0.05);而完全受精失败率(20.0%)明显高于B组(2.8%,P<0.05);二组的优质胚胎率、临床妊娠率、着床率无差异。结论:不明原因不孕患者行首次IVF治疗时,采用部分卵母细胞常规受精、部分卵母细胞ICSI的方法,可降低完全受精失败风险。     

成熟卵泡获卵率对体外受精结局的影响

目的比较在体外受精-胚胎移植/卵细胞浆内单精子注射（IVF-ET/ICSI）过程中,控制性超促排卵（COH）后成熟卵泡获卵率对IVF-ET/ICSI的实验室和临床结局的影响。方法回顾性分析2010年5月至2010年12月四川大学华西第二医院行IVF-ET/ICSI治疗的693例患者,共746个周期,根据获卵率将患者分为A组：获卵率≥80%;B组：获卵率50%～79%;C组：获卵率30%～49%;D组：获卵率〈30%。比较4组患者的临床和实验室结局。结果 A、B组卵子成熟率、受精率、卵裂率和可移植胚胎形成率等各项临床和实验室结局比较,差异均无统计学意义（P〉0.05）。随着获卵数的减少,获卵数最低的D组的卵子成熟率、受精率、卵裂率和可移植胚胎形成率与A组和B组比较,差异有统计学意义（P〈0.05）;同时,D组的临床妊娠率、胚胎种植率和累积妊娠率明显低于其他各组（P〈0.05）。C组受精率、卵裂率、可移植胚胎形成率和临床妊娠率也显著低于A组（P〈0.05）,C组卵裂率、临床妊娠率低于B组（P〈0.05）,但C组的累积妊娠率与A组和B组相似（P〉0.05）。结论获卵率减少可导致卵子成熟率、受精率、卵裂率和可移植胚胎形成率下降,直接导致临床妊娠率下降。     

偏振光显微镜分析人卵透明带与胚胎发育潜能的关系

目的:探讨IVF胚胎的发育潜能。方法:共对49个周期的267个卵子在ICSI前用偏振光显微镜下摄像进行透明带厚度(ZPT)和密度(ZPD)分析。结果:①年龄<37岁组与≥37岁组卵子比较,组间各层ZPD、ZPT及全层ZPT均无显著差异;②优质胚胎组卵子全层ZPT(15.96±2.21μm)显著低于劣质胚胎组(16.89±2.34μm),P<0.05;③妊娠组卵子内层ZPD(2.02±0.47nm)和全层ZPT(15.97±2.45μm)均低于未妊娠组(2.24±0.57nm)和未妊娠组(17.09±2.46μm),差异有统计学意义,P<0.05。结论:偏振光显微镜能够检测透明带厚度和密度,卵子透明带结构与胚胎质量及妊娠率有相关性,与年龄无关,偏振光显微镜测定卵子透明带结构可预测卵子及胚胎的发育潜能。     

The effect of immature oocytes quantity on the rates of oocytes maturity and morphology, fertilization, and embryo development in ICSI cycles

Purpose

The goal was to evaluate the role of the number of retrieved immature oocytes on mature oocyte counts and morphology, and also the rates of fertilization and embryo development in ICSI cycles.

Methods

101 ICSI cycles were included in this prospective evaluation. Patients were divided into 2 groups of A (≤ 2 immature oocytes) and B (> 2 immature oocytes). In sub-analysis, the impacts of the number of GV and MI oocytes were assessed on the rates of fertilization and embryo development. Also, correlations between the numbers of immature and mature oocytes, as well as maternal age between two groups were analyzed. Assessments of oocyte morphology, fertilization, embryo quality and development were done accordingly.

Results

There was no correlation between the immature oocytes quantity with the number of mature ones. There were insignificant differences for embryo development between two groups, but fertilization rate was higher in group A (P = 0.03). In sub-analysis, insignificant differences were observed between two groups of ≤ and >2 GV and MI oocytes for rates of fertilization and embryo development. Also, the rates of clinical pregnancy and delivery were insignificant between groups. The rate of morphologically abnormal oocytes had no significant difference between two groups, except for wide perivitelline space (PVS) which was higher in group A (P = 0.03). There was no significant difference for maternal age between two groups.

Conclusions

In cases with few retrieved immature oocytes, rates of fertilization and incidence of wide PVS may increase, although immature oocytes may not have any negative impacts on early embryo development, or the rates on number of mature oocytes.     

Conventional IVF versus ICSI in sibling oocytes from couples with endometriosis and normozoospermic semen

Purpose

This study compares the fertilization rate and embryonic development of oocytes randomly inseminated by conventional IVF or ICSI in patients with endometriosis and normozoospermic semen during IVF cycles.

Methods

Sibling oocytes were randomized to be inseminated either by ICSI or IVF. Rates of fertilization, cleavage, blastulation and embryonic morphology were assessed.

Results

A total of 786 sibling cumulus-oocyte complexes (COC) were randomized between insemination by conventional IVF (387 COC) or ICSI (399 COC). A significantly higher fertilization rate was found in the ICSI group (ICSI versus IVF, 73.3±23 % versus 54.7±31.9 % respectively; P=0.003), yielding a higher mean number of day 2 embryos (5.2±3.4 versus 3.6±2.9 respectively; P=0.002). Triploid fertilization rate (3PN/COC) was significantly higher in the IVF group compared to the ICSI group (3.9±8.7 % versus 0.9±3.1 % respectively; P=0.02). The morphology score and rate of development of day 2 and 3 embryos were not different between the two groups. Comparison of embryo transfer cycles in which either IVF or ICSI only embryos were transferred did not reveal any statistically significant differences in pregnancy or implantation rates.

Conclusion

ICSI appears to be a better treatment option than conventional IVF in endometriosis-associated infertility, since it offers the advantages of higher fertilization rate and mean number of embryos and lower rate of total fertilization failure and triploid fertilization.     

Influence of female age on pregnancy outcome in in vitro fertilization and embryo transfer patients undergoing intracytoplasmic sperm injection

PURPOSE: To determine the influence of female age on the outcomes of ICSI in IVF-ET patients. METHODS: One hundred and seventy-five couples underwent 352 cycles of ICSI. The quality of oocytes and embryos, fertilization rate, and pregnancy outcomes were retrospectively evaluated according to female age; < 30 years in Group A (49 cycles), 30-34 in Group B (177 cycles), 35-39 in Group C (97 cycles), and > or = 40 in Group D (29 cycles). RESULTS: The fertilization rates were not significantly different among the age groups. Significant negative linear correlations were observed between female age and the numbers of oocytes retrieved and embryos transferred, and cumulative embryo score. Clinical pregnancy rates were significantly decreased and spontaneous abortion rate increased with advancing age. CONCLUSIONS: Female age may be a prognostic indicator in ICSI program.     

卵胞质内单精子显微注射后异常受精的影响因素分析

目的:探讨卵胞质内单精子显微注射(ICSI)后异常受精发生的影响因素。方法:回顾性分析299个ICSI周期,按照是否有异常受精分为异常受精组(n=118)和正常对照组(n=181),异常受精组至少发生1个非2原核(2PN)的受精卵。比较分析异常受精组和对照组临床和实验室资料。结果:异常受精组hCG注射日E2水平(14 097±3 066 pmol/L)高于对照组(1 2461±6 836 pmol/L),差异有统计学意义(P<0.05);异常受精组获卵数及成熟卵数分别为17.8±7.2个、15.3±6.1个,多于对照组的13.6±7.0个、10.2±5.3个,差异均有统计学意义(P<0.01);卵子成熟率(81.7%vs76.4%)、2PN受精率(78.4%vs 86.9%),组间比较差异均有统计学意义(P<0.01);而患者年龄、基础激素水平、促性腺激素(Gn)使用总量、精子来源及质量、着床率、临床妊娠率组间比较,差异均无统计学意义(P>0.05)。结论:卵巢对Gn刺激的高反应性可能与ICSI后异常受精的发生有关。异常受精卵的发生虽对临床结局无明显影响,但减少异常受精发生率,增加卵子利用率,可能会提高累积妊娠率。     

Comparison of intracytoplasmic sperm injection with testicular spermatozoa success in infertile men with obstructive and non-obstructive azoospermia; a retrospective analysis

The aim of this study was to compare the outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer between couples with infertility due to male non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). A retrospective analysis of 234 couples with azoospermia who were treated by ICSI and embryo transfer between January 2007 and October 2010 was performed. There were 61 couples in NOA group and 173 couples in OA group. Fertilization rates, pregnancy and clinical pregnancy rates were the main outcome measures. The number of retrieved mature oocytes, injected oocytes, metaphase II (MII) oocytes, two distinct pronuclei oocytes, cleavage embryos and embryos transferred was not significantly different between the groups. The fertilization rate was significantly lower in NOA group when compared to OA group (56.2 vs. 66.7%, respectively; p?=?0.013) and the pregnancy rate was significantly lower in NOA group than OA group (36.1 vs. 50.9%, respectively; p?=?0.046). The clinical pregnancy rates were not statistically different between the patients with NOA and OA azoospermia groups (24.6 vs. 36.4%, respectively; p?=?0.09). This study suggests that ICSI and embryo transfer together with testicular sperm extraction results in statistically significant lower fertilization and pregnancy rates in men with NOA when compared to men with OA.     

Oocyte and embryo quality in polycystic ovary syndrome

OBJECTIVE: To compare oocyte and embryo quality in women with Polycystic Ovary Syndrome (PCOS) and in women with normal ovulation. PATIENTS AND METHODS: Forty women with PCOS underwent a total of 67 In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) cycles. The control group consisted of women, of the same age, who underwent IVF (for tubal infertility) or ICSI (for male factor infertility) in the same period. RESULTS: The average number of oocytes recovered was higher in the PCOS group (12,1) than in the control group (9.6) as was the rate of immature oocytes (13.8% vs 5.8%; respectively). The fertilization rate was lower in PCOS patients (52% vs 61% in the controls). The cleavage rates, embryo morphology and pregnancy rates were similar in both groups. DISCUSSION AND CONCLUSIONS: Although more oocytes were recovered from PCOS patients, the number of good quality embryos, suitable for transfer or freezing was similar in the two groups as less of the oocytes were mature and the fertilization rate was lower in the PCOS group. IVF or ICSI (according to the indication) are therefore efficient in PCOS patients.     

Impact of oocyte pre-incubation time on fertilization, embryo quality and pregnancy rate after intracytoplasmic sperm injection

Although, it is well known that pre-incubation of oocytes prior to conventional IVF improves fertilization and pregnancy rates, there are conflicting results regarding the effect of pre-incubation time in ICSI. This study evaluated the role of pre-incubation of oocytes on outcome in intracytoplasmic sperm injection (ICSI) cycles. A total of 1260 patients undergoing their first ICSI cycles were evaluated retrospectively. In patients undergoing ICSI during the year 2000 (Group I, n = 670), oocytes were injected immediately after retrieval, whereas in patients undergoing ICSI during 2001 (Group II, n = 590), oocytes were incubated for 2-4 h prior to injection. The mean age of patients was 33.9 +/- 5.04 years and 34.1 +/- 5.06 years in groups I and II, respectively. The number of oocytes with a first polar body (MII) and fertilization and cleavage rates were higher, and embryo quality was significantly better in group II. In contrast, the total numbers of oocytes without a first polar body (MI), those where germinal vesicle breakdown had not occurred (GV), and empty zona oocytes were higher in group I. No difference was found in the number of embryos transferred or implantation or clinical pregnancy rates. This study demonstrated that pre-incubation of oocytes prior to ICSI is associated with improved maturation of oocytes, fertilization and embryo quality.