补救ICSI的妊娠结局分析(附补救后冷冻胚胎复苏妊娠一例)

目的对体外受精(IVF)完全失败的周期及时补行卵细胞浆内单精子显微注射(rescue ICSI)后的临床妊娠结局的探讨和分析。方法IVF受精失败后及时将MⅡ卵母细胞进行补救ICSI。结果补行ICSI后10周期中移植9个周期19个胚胎,妊娠1例双胎,种植为10.5%;有2个周期有冷冻胚胎并行复苏胚胎移植,单胎妊娠1例。补救ICSI累计移植胚胎25个,种植3个累计种植率为12.0%,但2例均以流产告终。结论补救ICSI妊娠率低、流产率高与卵子过度老化有关,冷冻复苏补救ICSI的胚胎,可以消除胚胎发育与子宫内膜发育不同步的因素。在IVF受精率低的周期中可以将未受精的卵母细胞补行ICSI后行胚胎冷冻-复苏移植,可以增加取卵周期的妊娠率。     

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.     

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     

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。     

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。     

常规体外受精失败后行补救性卵胞质内单精子注射的临床总结

目的回顾分析常规IVF受精完全失败在临床中的发生情况及受精失败后应用补救性卵母细胞内单精子注射（ICSI）的临床结局。方法总结1999年5月-2009年5月,在我中心行常规IVF患者中,受精完全失败的发生情况。回顾性分析了2004年1月-2009年5月,因受精完全失败行补救性ICSI后的临床结局。结果1999年至2009年5月,我中心共行常规IVF8359个周期,其中,受精完全失败232个周期,发生率为2．78％。2004年1月至2009年5月,共184个周期受精完全失败,资料完整,对其中115个周期共838个MII期卵子行补救性ICSI,其受精率、卵裂率与优质胚胎率分别为71.0％、93．78％和51．79％;临床妊娠率为11％,获得活产儿5个。结论补救性ICSI能获得较高的受精率和卵裂率,降低周期取消率,但并没有明显增加活产儿出生数,改善妊娠结局。     

短时受精结合早期补救卵胞浆内单精子注射在IVF-ET治疗中的应用

目的观察短时受精结合早期补救卵胞浆内单精子注射（ICSI）能否改善辅助生殖治疗的结局。方法对常规体外受精-胚胎移植（IVF-ET）治疗周期,精卵共培养4h后脱颗粒观察,如排出第二极体的卵母细胞数目少于总MⅡ期卵母细胞数目的 30%以下或全部未见第二极体者,再继续观察2个小时,如果仍然没有改变,实施早期补救ICSI。结果 226个IVF周期中有17个周期实施了早期补救ICSI,补救率为7.52%（17/226）,早期补救ICSI新鲜胚胎移植周期临床妊娠率为46.15%（6/13）;同时进行的85个常规ICSI周期的新鲜胚胎移植临床妊娠率为44.0%（33/75）。结论短时受精结合早期补救ICSI可避免完全受精失败和低受精率,临床妊娠率同常规ICSI没有差别,可有效减少周期取消率,改善辅助生殖治疗的结局,是值得采用的方法。     

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。     

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。     

分析短时受精及早补救ICSI的应用价值

目的分析短时受精后观察第二极体及受精失败后早补救ICSI在体外受精-胚胎移植中的应用价值。方法回顾分析本中心2013年1月—2015年5月第一次行常规IVF-ET治疗周期的患者资料,根据受精后3h是否剥除颗粒细胞观察第二极体分为第二极体观察组(605例),非第二极体观察组(217例),分析两组的数据;并对比受精失败组与同期ICSI周期的数据进行分析。结果 1)短时受精后第二极体观察对正常受精率、多精受精率、优质胚胎率及临床妊娠率无明显影响(P0.05),2)受精失败组的基础LH水平、成熟卵率明显低于正常受精组(P0.05),3)对比低受精组、完全受精失败组与常规ICSI周期,分析后发现完全受精失败组的成熟卵率及优质胚胎率均明显低于低受精失败组和常规ICSI组(P0.05),正常受精率和临床妊娠率无统计学差异。结论短时受精后剥除颗粒细胞观察第二极体联合补救ICSI能有效的避免受精失败并减少ICSI率,患者的基础LH水平及获卵的成熟度可能会影响受精及胚胎的发育。     

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。     

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.     

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。     

Efficacy of Intracytoplasmic Sperm Injection (ICSI) Treatment in the Immunological Infertile Patients

PROBLEM: To evaluate the efficacy of intracytoplasmic sperm injection (ICSI) treatment in the immunological infertile patients. METHODS: The subjects were 60 cycles of 44 immunological infertile patients and these clinical data were analysed, retrospectively. They were classified into female and male immunological infertility group and were treated with conventional IVF, ICSI, and half-ICSI. RESULTS: The fertilization rate of ICSI (60.3%) and half-ICSI (60.7%) cycles were significantly (P<0.01) higher than conventional IVF (42.6%) cycles. In the male immunological infertility group, fertilization rate was significantly (P<0.01) higher in ICSI (60.7%) and half-ICSI (66.7%) cycles than in conventional IVF (27.4%) cycles and clinical pregnancy rate was higher in ICSI (54.5%) and half ICSI (33.3%) than in conventional IVF (25.0%) cycles. CONCLUSIONS: We suggest that ICSI treatment is highly effective method to improve fertilization and pregnancy rate in IVF-ET program of male immunological infertility.     

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.     

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.     

影响不明原因不孕患者IVF受精率的因素分析

目的探讨不明原因不孕患者首次IVF治疗影响其受精率的因素。方法将44个首次行IVF方案的不明原因不孕患者的,根据受精率高低划分为受精率高组（A组28例,受精率〉50%）和受精率低组（B组16例,受精率≤50%）,比较2组之间年龄、不孕年限、促排卵方案、成熟卵母细胞数、优质胚胎数、妊娠率及种植率有无差异。结果 44例患者在年龄、基础FSH、启动Gn数、用药时间、总Gn用量、获得卵细胞均无明显统计学差异,但A组不孕时间短于B组,且获得成熟卵母细胞的比率较B组高,获得的优质胚胎率也显著高于B组,有统计学差异（P=0.002,P〈0.05）;A组临床妊娠率为32%,高于B组的14.28%。结论不明原因不孕患者行首次IVF治疗时,应综合分析年龄、不孕时间及获卵数来判断受精方式,不要盲目扩大ICSI指征。     

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.     

体外受精后异常受精的影响因素分析

目的探讨体外受精后单原核和多原核孕卵生成的影响因素，为降低异常受精率探寻可行的方法。方法应用卡方检验分析927个体外受精周期（608个IVF周期和319个ICSI周期），共计9718个卵细胞资料，研究多原核和单原核孕卵生成率与体外受精方式，女方年龄，超促排卵方案，HCG日血清E2水平和获卵数的关系；结果（1）体外受精中单原核孕卵生成率与体外受精方式、女方年龄、获卵数、HCG日血清E2水平、超促排卵方案均无显著性关系；（2）常规IVF周期中多原核孕卵生成率显著高于ICSI组，但．6-的受精率显著低于后者；当获卵数〉15个和HCG日血清E2〉4000pg／ml时，体外受精周期中多原核孕卵生成率显著升高；（3）ICSI组，随着女方年龄的增高，多原核孕卵生成率显著增高。结论体外受精中异常受精生成的机理和影响因素不尽相同，针对不同不孕人群选择合适的体外受精方式有助于提高正常受精率，降低异常受精率。