早期补救卵胞浆内单精子注射妊娠结局及新生儿出生结局评估

目的:对常规体外受精(IVF)失败的周期行早期补救性卵胞浆内单精子注射(ICSI)后的妊娠结局及新生儿出生情况进行探讨和分析。方法:常规IVF后6小时未发现明确双极体者判断为完全受精失败,予以早期补救ICSI,纳入早期补救ICSI组(204个周期),随机选择与早期补救ICSI组患者同一日或前一日因男性因素而直接进行ICSI的204例患者纳入ICSI组(204个周期)。回顾性分析两组患者的累计临床妊娠率、流产率、异位妊娠率、累计活产率、分娩孕周及新生儿的单双胎比例、男女性别比例、出生体质量、出生缺陷等指标的差异性。结果:早期补救ICSI组与ICSI组的累计临床妊娠率、流产率、异位妊娠率、累计活产率、新生儿性别比例、新生儿出生体质量等指标的比较差异均无统计学意义(P0. 05)。早期补救ICSI组产妇的分娩孕周较ICSI组略长,双胎比率较ICSI组少,差异有统计学意义(P0. 05)。将分娩孕周分为单胎和双胎分别进行比较,则发现两组间差异无统计学意义(P0. 05)。早期补救ICSI组的活婴中出现1例先天性心脏病出生缺陷,ICSI组的活婴中未发现出生缺陷。结论:早期补救ICSI没有增加胎儿流产及新生儿出生缺陷的风险,双胎率明显下降,怀孕周期略长,可作为常规IVF失败时的一种安全有效的补救方法。     

1998-2007年上海市体外受精-胚胎移植子代出生缺陷情况分析

目的 对1998-2007年上海市体外受精-胚胎移植(IVF-ET)子代出生缺陷情况进行分析,了解影响出生缺陷发生的因素.方法 回顾性分析1998-2007年于上海市7个生殖医学中心(包括上海集爱遗传与不育诊疗中心、上海交通大学医学院附属仁济医院生殖医学中心、上海交通大学医学院附属瑞金医院生殖医学中心、国际和平妇幼保健院生殖医学中心、上海第一妇婴保健院生殖医学中心、上海市第九人民医院及上海长海医院生殖氏学中心)接受辅助生殖技术助孕并妊娠28周后分娩活产新生儿的产妇及其子代的随访资料.共收集产妇6551例及其子代8507例.了解子代的出生缺陷类型及发生率,并分析不同辅助生殖技术、子代性别、产妇年龄、妊娠胚胎数及精子获取方式对出生缺陷发生的影响.结果 8507例子代中,出生缺陷发生率为1.08%(92/8507),其中循环系统畸形的发生率最高,占所有出生缺陷的34%(31/92).IVF后移植新鲜胚胎、IVF后移植冻融胚胎、卵母细胞胞质内单精子注射(ICSI)后移植新鲜胚胎及ICSI后移植冻融胚胎者的出生缺陷率分别为1.21%(34/2799)、1.07%(20/1871)、1.04%(23/2212)和0.92%(15/1625),分别比较,差异均无统计学意义(P>0.05).男性和女性子代出生缺陷的发生率分别为1.12%(49/4371)和1.02%(42/4136),两者比较,差异无统计学意义(P>0.05);子代出生缺陷的发生率随母亲年龄的增加而增长,其中母亲年龄<30岁者为0.84%(41/4884),与>35岁者[1.77%(16/902)]比较,差异有统计学意义(P<0.05);单胎、双胎及三胎妊娠者的子代出生缺陷发生率分别为0.53%(25/4679)、1.59%(57/3576)和3.97%(10/252),分别比较,差异均有统计学意义(P<0.05);采用自然射精、附睾穿刺和他人供精方式出生的子代出生缺陷发生率分别为1.09%(81/7419)、1.21%(7/579)和0.79%(4/509),分别比较,差异均无统计学意义(P>0.05).结论 IVF-ET未增加子代出生缺陷的发生率,不同授精方式、胚胎处理方式及精子获取方式也与子代出生缺陷发生率无关,而高龄产妇和多胎妊娠则明显增加子代出生缺陷的发生率.     

辅助生殖技术出生儿近期安全性评价

目的:比较辅助生殖技术(体外受精-胚胎移植和卵泡浆内单精子注射)单胎出生儿与自然妊娠单胎出生儿的出生情况,评价辅助生殖技术出生儿的近期安全性。方法:将2004年1月～2007年12月在广州医学院第三附属医院经体外受精(IVF)妊娠单胎出生儿列为IVF组,共415例;经卵泡浆内单精子注射(ICSI)妊娠单胎出生儿列为ICSI组,共152例;将同期自然妊娠单胎出生儿列为对照组,共8240例。比较3组间低出生体重、早产及出生缺陷的发生率。结果:IVF组低出生体重率、早产率及出生缺陷率分别为6.0%、11.8%、2.2%;ICSI组分别为6.6%、14.5%、2.0%;对照组则分别为5.9%、10.3%、2.4%。3组间低出生体重率、早产率及出生缺陷率的差异均无统计学意义(P0.05)。结论:辅助生殖技术单胎出生儿与自然妊娠单胎出生儿的出生情况无明显差异,不同助孕方式间出生儿的出生结局也无明显差异,近期评估辅助生殖技术是安全的。     

无精子症和严重少/弱精子症ICSI子代与其他精子ICSI/IVF子代出生缺陷的比较研究

目的:观察无精子症和严重少/弱精子症患者借助卵胞质内单精子注射(ICSI)技术出生的子代与其他精子ICSI/体外受精(IVF)子代的出生缺陷情况。方法:将接受ICSI/IVF治疗的237对夫妇生育的300例子代按ICSI/IVF当日精液情况和受精方式分为附睾/睾丸精子ICSI组(A组,患者92例,子代118例)、严重少/弱精子ICSI组(B组,患者84例,子代106例)、非严重少/弱/畸形精子ICSI组(C组,患者35例,子代42例)、正常精子IVF组(D组,患者26例,子代34例)。对召回现场随访的子代进行出生缺陷病史询问、超声检查和无精子症因子(AZF)基因检测。结果:受访子代平均年龄为33.1±20.3(4~84)个月,新生儿出生缺陷率为1.7%(5/300),总出生缺陷率为4.7%(14/300),4组的出生缺陷率分别为5.1%(6/118)、3.8%(4/106)、2.4%(1/42)和8.8%(3/34),组间无统计学差异(P0.05)。112个家庭AZF基因检测显示B组有3对父子存在同样位点的AZF基因微缺失。结论:无精子症和严重少/弱精子症等严重男性不育症患者ICSI子代的出生缺陷发生率与其他较好精子或正常精子IVF子代相比无明显增加,AZF基因检测没有新增缺失位点和新增缺失病例。     

代谢组学预测卵子质量与胚胎发育潜能研究进展

辅助生殖技术(ART)为不孕不育症患者带来了诞生新生命体的希望,然而在体外受精(IVF)中,超过80%的胚胎着床失败,为提高成功率,各生殖中心进行多胚胎移植,由此多胎妊娠随之增加,而多胎妊娠出生的新生儿早产、死产、低出生体重、出生缺陷及母亲高血压等并发症均较自然     

未成熟卵体外培养成熟技术治疗后妊娠情况及结局分析

目的通过比较接受人类未成熟卵体外培养成熟（IVM）技术、常规体外受精技术（IVF）及单精子卵胞浆内注射技术（ICSI）治疗后妊娠的病例，分析妊娠和产科结局，从而评估IVM技术的安全性。方法回顾性分析安徽医科大学第一附属医院生殖医学中心2004年1月～2007年12月接受IVM35例、IVF369例和ICSI298例治疗后妊娠的702例患者的临床资料。结果3组的多胎妊娠发生率、流产率、异位妊娠率比较，差异无显著性（P〉0.05）。除外流产和继续妊娠外，IVM、IVF和ICSI治疗后出生婴儿数分别为34、321和243例，比较3组单胎妊娠和双胎妊娠的妊娠结局，差异无显著性（P〉0．05）。结论与常规IVF、ICSI比较。IVM并不增加妊娠风险、产科并发症和新生儿异常的比例。     

不明原因不孕患者体外受精方式的探讨

目的探讨不明原因不孕患者行首次体外受精(IVF)治疗时受精方式的选择。方法对2004年6月至2005年12月在北京大学第三医院行IVF治疗的35例不明原因不孕患者,将其卵母细胞分为2组,同时行常规受精和卵胞浆内单精子注射受精(ICSI),比较2组的受精结局、妊娠率及着床率。结果常规受精组受精率(51.2%)低于ICSI组(61.3%),差异有统计学意义(P<0.05);而完全受精失败率(20.0%)明显高于ICSI组(2.8%),差异有统计学意义(P<0.05);2组的优质胚胎率、临床妊娠率、着床率差异无统计学意义。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。     

辅助生殖技术单卵双胎相关因素分析及含单绒毛膜双胎三胎妊娠减除单绒毛膜双胎之一的临床结局比较

目的探讨辅助生殖技术(ART)治疗后行多胎妊娠减胎术中单卵双胎(MZT)的发生和三胎妊娠行单绒毛膜双胎中一胎减胎术保留双胎者的临床结局。方法回顾性分析ART治疗后行经阴道多胎妊娠减胎术的196例患者的临床资料,分析比较MZT在不同分组中的发生情况,同时比较其中伴单绒毛膜双胎的三胎妊娠减单绒毛膜双胎之一者(A组)与不伴单绒毛膜双胎的三胎妊娠减胎后保留双胎者(B组)的临床结局。结果 (1)196例患者中MZT所占比率为44.39%(87/196)。MZT占比率在体外受精(IVF)组(0.85%)、卵胞质内单精子显微注射(ICSI)组(0.66%)、冻融胚胎移植(FET)组(0.78%)和人工授精(AIH/AID)组(0.16%)间比较差异有统计学意义(P=0.001);在辅助孵化(AH)组(1.48%)和无AH组(0.44%)间比较差异亦有统计学意义(P=0.000)。MZT占比率在高龄(≥35岁)和非高龄患者中(P=0.330)及卵裂期胚胎移植组和囊胚期胚胎移植组组间(P=0.950)比较差异无统计学意义。(2)A组和B组患者的平均年龄、平均孕周、新生儿的平均胎龄、平均胎儿出生体质量、流产率、早期流产率、晚期流产率、早产率、足月产率、活产率、低出生体质量儿发生率、新生儿出生缺陷率和妊娠并发症率比较,差异均无统计学意义(P0.05)。结论 ART行多胎妊娠减胎术的患者中MZT所占几率很高,为减少MZT的发生,尽量选择单胚胎移植;A组和B组患者临床结局无统计学差异,单绒毛膜双胎中一胎减胎术可能是安全而可行的。     

多胎减胎后单胎分娩与单胎妊娠分娩比较分析

目的探讨体外受精-胚胎移植(IVF-ET)助孕单胎分娩者中,孕早期多胎妊娠自然减胎及手术减胎对围产期母儿结局的影响。方法回顾性分析3 376例行IVF助孕治疗,新鲜或冷冻胚胎移植后单胎分娩者的临床资料,根据孕早期宫内孕囊数分组:A组(多胎妊娠,455例),其中A1组(手术减胎,34例),A2组(自然减胎,421例);B组(单胎妊娠,2 921例);分年龄进行组间临床基本资料,出生低体质量儿率、新生儿畸形率、妊娠期并发症等围产期母婴结局的比较。结果 (1)35岁的患者中,A组比B组不孕时间短、移植胚胎数多和优质胚胎数多;(2)囊胚移植比例、冷冻胚胎移植比例A、B组间均无统计学差异;(3)A1组和A2组出生低体质量儿率、出生极低体质量儿率、胎儿畸形率均显著高于B组(P0.05),但A1、A2组间无统计学差异(P0.05),A2组早产率明显增加,与B组有统计学差异(P0.01)。结论多胎妊娠即使减胎后单胎分娩,其新生儿低体质量及畸形风险仍高于单胎妊娠分娩者,35岁、不孕时间短者,建议选择性单优质胚胎移植,以降低多胎妊娠。     

体外受精与胚胎移植后发生多胎妊娠230例临床分析

随着体外受精(IVF)与胚胎移植(ET)和卵母细胞浆内单精子显微注射(ICSI)受精与胚胎移植技术(ICSI-ET)的广泛应用，人们越来越关注其术后患者妊娠的围产情况。多胎妊娠的发生是影响其围产情况的主要因素。本研究回顾分析1995年1月至1999年12月在我生殖中心接受IVF、ICSI-ET治疗后发生多胎妊娠的病例，并与同期IVF、ICSI-ET后单胎妊娠比较，以了解多胎妊娠的发生率及其高危因素。     

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。     

Comparison of clinical outcomes between conventional in vitro fertilization and intracytoplasmic sperm injection in poor responders with only single oocyte retrieved

ObjectiveTo compare the clinical outcomes between conventional insemination (IVF) and intracytoplasmic sperm injection (ICSI) in poor responders with only a single oocyte retrieved.Materials and methodsThis is a retrospective case–control study. Couples who were treated with assisted reproductive technology (ART) with a single oocyte retrieved in Mackay Memorial Hospital from 1996 to 2016 were recruited. All data were categorized into three groups, according to their fertilization method and semen quality: group A, conventional insemination with non-male factor (IVF-NMF, n = 115), group B, ICSI with male factor (ICSI-MF, n = 30), and group C, ICSI with non-male factor (ICSI-NMF, n = 49).ResultsNo statistically significant difference was observed between IVF and ICSI groups in pregnancy outcomes, including the chemical or clinical pregnancy rate, miscarriage rate, and live birth rate. Similar fertilization rates per oocyte obtained were observed in IVF and ICSI patients, but significantly lower per mature oocyte in the ICSI group (IVF: 91.5%, ICSI-MF: 75.0%, ICSI-NMF: 77.8%). Although there is no statistical significance, the lower live birth rate is observed in group C than others (A:11.5%, B:25%, C:5%, p = 0.187).ConclusionIn this study, pregnancy outcomes of conventional in vitro fertilization and ICSI in poor responders with only a single oocyte retrieved were similar. However, the fertilization rate of matured oocytes in ICSI groups is significantly lower than that in the IVF group, indicating that ICSI procedures might cause oocyte damage. Therefore, the choice of fertilization method should be based on semen quality. A randomized controlled trial should be performed to confirm our findings.     

A prospective randomized trial of conventional in vitro fertilization versus intracytoplasmic sperm injection in unexplained infertility

PURPOSE: To compare outcomes in patients with unexplained infertility undergoing conventional in vitro fertilization (IVF) versus intracytoplasmic sperm injection (ICSI). METHODS: Sixty women with unexplained infertility in a Canadian tertiary-level clinic were randomized to IVF or ICSI. Subjects underwent downregulation with gonadotropin-releasing hormone agonist prior to initiation of recombinant human follicle-stimulating hormone. The primary outcome measure was fertilization rate. Secondary outcomes included implantation rate, embryo quality, clinical pregnancy rate, and live birth rate. RESULTS: There was no statistically significant difference in fertilization rate (77.2% IVF vs. 82.4% ICSI), implantation rate (38.2% IVF vs. 44.4% ICSI), clinical pregnancy rate (50% in each group), or live birth rate (46.7% IVF vs. 50% ICSI). There were two cases of failed fertilization in the IVF group. There was no significant difference in embryo quality between groups. CONCLUSIONS: There were no differences in clinical outcomes associated with IVF versus ICSI in the treatment of unexplained infertility.     

A strategy for treatment of couples with unexplained infertility who failed to conceive after intrauterine insemination

Couples with unexplained infertility treated unsuccessfully with intrauterine insemination often receive further treatment with IVF or intracytoplasmic sperm injection (ICSI). The aim of this study was to evaluate the frequency of fertilization and fertilization failure with respect to the method of fertilization used, when half of the sibling oocytes were fertilized by conventional IVF and insemination and the remainder by ICSI. Included was the first IVF/ICSI treatment of 248 unexplained infertile couples who had failed to conceive after three IUI cycles. An overall pregnancy rate per embryo transfer of 57% was observed. A significantly better fertilization rate was obtained after ICSI as compared with IVF (68 versus 46%) (P < 0.005), and total fertilization failure following ICSI and IVF treatment was seen in 4.4 and 25% of the cycles respectively. The group who experienced total fertilization failure after IVF had normal semen parameters, although significantly lower sperm concentration and motility as compared with the entire study group. Transfer of their ICSI-fertilized oocytes subsequently resulted in a pregnancy rate of 49.2% per transfer. The policy of splitting the sibling oocytes can effectively minimize complete fertilization failure while maintaining high chances of achieving a pregnancy. At the same time, the optimal fertilization method for subsequent treatment cycles can be determined.     

Intracytoplasmic sperm injection could minimize the incidence of prematurely condensed human sperm chromosomes

Objective: To compare the fertilization and prematurely condensed human sperm chromosomes (PCCs) rates between two intracytoplasmic sperm injection (ICSI) techniques.

Design: A retrospective study.

Setting: The data were obtained from the University of British Columbia in vitro fertilization (IVF) laboratory.

Patient(s): ICSI cycles (n = 105) were performed for couples suffering from severe male-factor infertility and dysfunction of fertilization.

Intervention(s): Two types of ICSI techniques were used for ICSI procedures.

Main Outcome Measure(s): Fertilization and pregnancy rates in group B using the improved ICSI technique were compared with those of group A using the standard ICSI technique. Unfertilized oocytes from the two groups were studied with cytogenetic methods.

Result(s): Oocyte damage dropped from 14.8% in group A to 5.3% in group B. Normal fertilization for each group was 57.3% and 88.4%, respectively (P<.05). Pregnancy rate per egg retrieval was 15.6% in group A and 27.4% in group B (P<.05). PCCs occurred in 19.4% of unfertilized oocytes in group A and did not occur in group B.

Conclusion(s): This study indicates that ICSI not only yields high fertilization rates, but also minimizes the incidence of PCCs. It may be directly related to two crucial steps (immobilization of sperm and aspiration of oocyte cytoplasm) used in ICSI procedures. This study also suggests that it is possible to overcome one cause of IVF failure resulting from the formation of PCCs by using the improved ICSI technique.     

Late Fertilization of Unfertilized Human Oocytes in In Vitro Fertilization and Intracytoplasmic Sperm Injection Cycles: Conventional Insemination versus ICSI

Purpose: The aim of this study was to evaluate the efficacyof intracytoplasmic sperm injection (ICSI) in comparisonwith conventional reinsemination using fertilization failedoocytes by conventional in vitro fertilization (IVF). Methods: Oocytes were collected from patients of IVF orICSI cycles. Patients were grouped by fertilizationtechniques: group 1: conventional IVF; group 2: reinseminationafter conventional IVF failure; group 3: regular ICSI; group4: 1-day-old ICSI after conventional IVF failure; group 5:2-day-old ICSI after conventional IVF failure; group 6:re-ICSI after regular ICSI failure. Results: In different insemination groups, normalfertilization rate was higher (P < 0.001) in 1-day-old ICSI (47.1%)and 2-day-old ICSI groups (40.0%) than in reinsemination(14.7%). Abnormal fertilization rate was higher (P < 0.05)in re-ICSI group (21.7%) than any other groups (range:0–8%). Cleavage rate was higher in 1-day-old (36.7%)and 2-day-old ICSI groups (36.0%) than in reinsemination(5.3%, P < 0.001) or re-ICSI groups (17.4%, P < 0.05).Pregnancy rate was 27.6% and 20.0% in conventional IVFand regular ICSI groups, respectively. However, 1-day-oldICSI (group 4) and 2-day-old ICSI (group 5) were attemptedonce embryo transfer (ET) but failed pregnancy occurredin each group. Conclusions: In fertilization failure cycles, late ICSIincreases the rate of fertilization and embryonic developmentand may rescue the completely failed attempt of pregnancy.     

Rescue intracytoplasmic sperm injection (ICSI)-salvaging in vitro fertilization (IVF) cycles after total or near-total fertilization failure

Objective: To evaluate the effectiveness of delayed oocyte reinsemination by ICSI (rescue ICSI) after total or near-total fertilization failure (≤25%) in IVF.

Design: A retrospective clinical study.

Setting: Non–hospital-based IVF program.

Patient(s): Thirty IVF cycles with total fertilization failure and two cycles with ≤25% initial fertilization.

Main Outcome Measure(s): Fertilization and pregnancy rates after rescue ICSI.

Intervention(s): Rescue ICSI 19–22 hours after initial oocyte insemination.

Result(s): A fertilization rate of 60.2% was achieved with rescue ICSI (141 of 234 oocytes, 29 of 32 patients). Of 30 patients with total fertilization failure, 27 had fresh transfers with rescue ICSI embryos. Two additional patients with ≤25% initial fertilization had subsequent replacement of frozen-thawed rescue ICSI embryos. Six pregnancies resulted, including three singleton, one twin, one missed abortion, and one ectopic pregnancy (20.7%). One of the singleton pregnancies resulted from replacement of four frozen-thawed embryos and is the first known pregnancy achieved from cryopreserved rescue ICSI embryos.

Conclusion(s): Rescue ICSI should be considered in the presence of total or near-total fertilization failure in IVF. Early application of rescue ICSI (19–22 hours after insemination) may be critical for establishing fertilization within an optimal window and producing viable embryos and pregnancies.     

Optimization of IVF pregnancy outcomes with donor spermatozoa

Purpose

To identify risk factors for suboptimal IVF outcomes using insemination with donor spermatozoa and to define a lower threshold that may signal a conversion to fertilization by ICSI rather than insemination.

Method

Retrospective, age-matched, case-control study of women undergoing non-donor oocyte IVF cycles using either freshly ejaculated (N?=?138) or cryopreserved donor spermatozoa (N?=?69). Associations between method of fertilization, semen sample parameters, and pregnancy rates were analyzed.

Results

In vitro fertilization of oocytes with donor spermatozoa by insemination results in equivalent fertilization and pregnancy rates compared to those of freshly ejaculated spermatozoa from men with normal semen analyses when the post-processing motility is greater than or equal to 88%. IVF by insemination with donor spermatozoa when the post-processing motility is less than 88% is associated with a 5-fold reduction in pregnancy rates when compared to those of donor spermatozoa above this motility threshold. When the post-processing donor spermatozoa motility is low, fertilization by ICSI is associated with significantly higher pregnancy rates compared to those of insemination.

Conclusion

While ICSI does not need to be categorically instituted when using donor spermatozoa in IVF, patients should be counseled that conversion from insemination to ICSI may be recommended based on low post-processing motility.     

Intracytoplasmic sperm injection overcomes previous fertilization failure with conventional in vitro fertilization

Objective: To evaluate the outcome of intracytoplasmic sperm injection (ICSI) in patients with previous idiopathic fertilization failure (≤20% fertilization rate) after conventional IVF.

Design: Retrospective analysis.

Setting: IVF program at a university medical center.

Patient(s): Twenty-five patients who underwent 38 ICSI cycles after experiencing unexplained fertilization failure with conventional IVF (group A) and 87 patients who underwent 118 ICSI cycles for male factor indications during the same period (group B).

Intervention(s): Intracytoplasmic sperm injection was performed in a subsequent cycle after fertilization failure with conventional IVF.

Main Outcome Measure(s): Outcomes of IVF were compared between groups A and B.

Result(s): Fertilization was achieved with ICSI in all patients with previous fertilization failure. The mean (±SD) fertilization rate (68% ± 21% vs. 64% ± 22%), implantation rate per embryo (22.6% vs. 20%), and delivery rate per cycle (47.3% vs. 49.1%) did not differ significantly between groups A and B. Overall, 72% of patients with previous unexplained fertilization failure had a successful pregnancy after ICSI.

Conclusion(s): Intracytoplasmic sperm injection can overcome unexplained fertilization failure caused by a potentially occult gamete abnormality, with the same fertilization, implantation, and pregnancy rates as are seen in patients with abnormal sperm parameters.