卵巢过度刺激高风险患者全胚冷冻后择期移植妊娠结局分析

目的于体外受精(IVF)超排卵周期取卵后及移植前,对根据血液指标和超声指标诊断为卵巢过度刺激综合征(OHSS)高风险患者,在充分知情同意下由患者自行选择新鲜胚胎移植或全胚冷冻后择期冻胚移植,观察比较两种情况下妊娠结局。方法回顾性分析我中心2012年1月1日至2013年6月30日期间进行IVF且有OHSS高风险的患者共374例,分为鲜胚胎移植组(A组)65例和全胚冷冻后择期冻胚移植组(B组)309例,比较两组妊娠结局的相关指标。结果 A组的妊娠率、种植率、流产率、异位妊娠率分别为41.5%(27/65)、30.0%(39/130)、7.4%(2/27)、3.7%(1/27),B组分别为69.6%(215/309)、50.2%(310/618)、7.0%(15/215)、3.7%(8/215),两组间妊娠率和种植率均有显著性差异(P0.05),而流产率、异位妊娠率则无显著性差异(P0.05)。OHSS发生率A组为10.8%,而B组仅为1.6%,两组间差异有统计学意义。结论对于有OHSS高风险的患者应该果断选择全胚冷冻并择期行冻胚移植,可减少甚至杜绝OHSS的发生,从而提高IVF安全性并可获得更为满意的妊娠结局,且可降低患者的治疗费用。     

赠卵体外受精-胚胎移植在卵巢早衰和非早衰受者中的应用

目的　探讨赠卵体外受精 胚胎移植 (IVF ET)中子宫内膜同步化激素治疗及比较卵巢早衰 (POF)和非POF受者的赠卵IVF ET效果。　方法　回顾性分析 5 0例赠卵IVF ET患者的 6 0个IVF周期和 73个ET周期。按赠卵指征分为POF组19例、2 3个周期和非POF组 31例、37个周期 ,进行t和 χ2 检验统计学分析。　结果　赠卵IVF ET的妊娠率为 4 8% (2 4 / 5 0 )和刺激周期为 4 3% (2 6 / 6 0 ) ;POF组妊娠率高于非POF组 ,但无显著性差异 (P >0 .0 5 )。子宫内膜同步化方法促性腺激素释放激素激动剂 /外源雌三醇 /黄体酮 (GEEP)方案组妊娠率明显高于后两者的 (EEP)组 (P <0 .0 5 )。　结论　卵巢早衰患者赠卵IVF ET妊娠率较高。子宫内膜同步化方法因人而异 ,有卵巢功能者GEEP方案优于EEP方案     

Analysis of the outcome of intracytoplasmic sperm injection using fresh or frozen sperm

Study Type – Diagnostic (retrospective cohort)
Level of Evidence 2b What’s known on the subject? and What does the study add? The results of ICSI using fresh or frozen sperm on the site of sperm retrieval remains controversial with respect to outcome. The results of this study showed no difference in outcome using ICSI either with respect to the site of retrieval or whether the sperm used was fresh or frozen. It also showed that the outcome of ICSI is not related to the underlying cause of the azoospermia.

OBJECTIVES

? To compare the outcome of first‐attempt intracytoplasmic sperm injection (ICSI) ICSI–embryo transfer (ET) cycles using frozen‐thawed testicular sperm (FTTS), fresh testicular sperm (FTS), frozen‐thawed epididymal sperm (FTES) and fresh epididymal sperm (FES) so as to determine which of these has the most successful ICSI outcome with respect to fertilization rate (FR), pregnancy rate (PR) and birth rate. ? To assess the outcomes according to the underlying aetiology of azoospermia.

PATIENTS AND METHODS

? The records of 493 patients undergoing first‐attempt ICSI between 1993 and 2008 were reviewed retrospectively. FTS was used in 112 cycles, FTTS in 43 cycles, FES in 279 cycles, and FTES in 59 cycles. ? Within each group, the aetiology of the azoospermia was recorded according to history, clinical examination and histological analysis (n= 316). ? The FR, clinical PR and delivery rate were calculated for each group with respect to the type of sperm retrieval used.

RESULTS

? Analysis of the data showed no significant differences between any of the four groups in the FR, PR or delivery rate (P > 0.05). ? There were no significant differences seen between fresh sperm (FTS and FES) and frozen sperm (FTTS and FTES) or between epididymal sperm (FES and FTES) and testicular sperm (FTS and FTTS) in any of the outcomes measured (P > 0.05). However, sub‐set analysis showed a statistically higher FR and PR for FTTS over fresh sperm. ? When comparing aetiologies, there was no significant difference in the FR, clinical PR and delivery rate between obstructive azoospermia (OA) and non‐obstructive azoospermia (NOA) groups. However, sub‐set analysis showed a higher PR and birth rate for FTTS over fresh sperm in both OA and NOA groups.

CONCLUSIONS

? The results of the present study suggest that using frozen sperm in ICSI cycles is a reliable and favourable method with the same outcome as fresh sperm. ? Testicular and epididymal sperm have similar ICSI outcomes for both fresh and frozen samples. However, results suggest a tendency for higher PRs and birth rates for frozen than for fresh testicular sperm in both OA and NOA aetiologies. ? The aetiology of azoospermia does not significantly affect the outcome of first‐attempt ICSI. The higher rates in the frozen groups suggest that these patients have had better quality semen when they were initially harvested and frozen.     

获单卵或双卵周期体外受精方式对治疗结局的影响

目的比较常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)两种授精方式对周期获卵数仅为1～2个患者的治疗结局的影响。方法回顾性分析胚胎移植(ET)168个周期获卵数仅为1～2个的卵巢低反应患者的资料,比较常规IVF组和ICSI组的受精率、卵裂率、优质胚胎率和临床妊娠率等情况。结果ICSI组受精率高于IVF组(分别为83.7%和63.8%,P0.05);IVF组有24.5%周期的卵子全部不受精,高于ICSI组的9.7%(P0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率两组间差异无统计学意义(P0.05)。≥35岁、精液参数不正常时,ICSI组受精率高于IVF组(分别为83.9%和55.6%,P0.05);IVF组有34.8%周期的卵子全部不受精,高于ICSI组的14.3%(P0.05);而卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间差异无统计学意义(P0.05)。≥35岁、精液参数正常时及35岁、精液参数正常或不正常时受精率、卵裂率、优质胚胎率、取消移植周期率和临床妊娠率,两组间的差异均无统计学意义(P0.05)。结论鉴于获卵数为1～2个的周期采用ICSI治疗并不能提高其优质胚胎率、临床妊娠率。因此我们不建议全部行ICSI治疗,男方精液参数正常或处于临界状态建议行IVF治疗。     

补救卵母细胞浆内单精子注射治疗的临床结局分析

体内精卵受精是一个复杂的过程,包括卵母细胞成熟、精子成熟、精子获能、精子透明带结合、配子融合、卵子激活和精子解聚等一系列过程,其中任何过程发生障碍都可能造成受精失败。在常规体外受精-胚胎移植（IVF—ET）周期中,常有一些周期存在受精完全失败的情况,具体原因在每一个受精失败周期中各不同。卵胞浆内单精子注射（ICSI）技术是直接将单一精子注射人卵细胞浆内,跨越了常规IVF时精卵结合等过程,     

Sperm extracted and cryopreserved from testes several hours after death results in pregnancy following frozen embryo transfer: case report

A 38-year-old male died suddenly on his honeymoon. Sperm was extracted from his testes 3 h following his death and cryopreserved. His wife had in vitro fertilization (IVF) and the eggs were inseminated by intracytoplasmic sperm injection (ICSI). None of the sperm were motile. Selection was based on softness and pliability. There were 4 embryos formed that cleaved, but only 2 were transferred on the retrieval cycle. The wife failed to conceive, but then had a second transfer of the 2 cryopreserved embryos. She achieved a chemical pregnancy with the beta-human chorionic gonadotropin level attaining a maximum level of 107 mIU/mL (rising from 19 mIU/mL). Though this retrieval cycle did not result in a successful pregnancy the achievement of a clinical pregnancy following frozen embryo transfer at least provides cautious optimism for other cases with similar conditions.     

取卵日连续2次取精在辅助生殖技术中的应用效果

目的:评价取卵日连续2次取精而减少ICSI特别是经皮附睾穿刺抽吸术(PESA)/睾丸细针抽吸术(TESE)周期数在辅助生殖技术中的应用效果。方法:收集取卵日连续2次射精的精液样本(34例68份)。比较前后2次取出的精液分析参数,总结2次精液处理后混合用于授精的实验室结果和临床妊娠结局。结果:34例男性均在4 h内连续手淫取出2次精液。第1和第2次射精时间间隔[94.9±39.8(26~183)]m in。第1次射出精液的量[(2.0±1.4)m l]显著高于第2次射出的量[(1.5±0.9)m l](P=0.007),而第1次射出精液的精子活动率和a+b级精子百分率[(40.8±25.3)%、(30.9±22.4)%]显著低于第2次的[(52.2±21.1)%、(39.9±17.5)%](P<0.05);但是2次取出精液的精子浓度和精子总计数比较差异无统计学意义(P>0.05)。34例男性的精液处理后行IVF、ICSI和IVF+ICSI周期分别为28、3、3。其中IVF、ICSI、IVF+ICSI周期的平均获卵数、正常受精率、优质胚胎率、冷冻周期数/新鲜移植周期数分别为15.5±8.7、57.0%(247/433)、58.7%(145/247)、20/24;21.7±8.3、61.5%(40/65)、67.5%(27/40)、3/2;10.0±2.6、72.4%(21/29)、66.7%(14/21)、3/3。新鲜胚胎移植临床妊娠率和冷冻胚胎冻融移植(FET)临床妊娠率分别为34.5%、30.7%。在妊娠例数中14例活产6男9女的健康小孩。结论:取卵日连续2次取精以收集更多数量和/或活动力更好的精子用于辅助生殖技术中可以获得30%以上的临床妊娠率,也可以避免微创取精术和其他不必要的显微受精方式。     

Comparison of sibling oocyte outcomes after intracytoplasmic sperm injection and in vitro fertilization in severe teratozoospermic patients in the first cycle

To follow up the outcome of sibling oocytes subjected to both conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in the first cycles of severe teratozoospermic patients with normal sperm morphology (NSM)or=6 cell embryos on day 3 and blastocyst formation on days 5 and 6, did not differ significantly between the two groups. There was a trend towards a high pregnancy rate cycle in mixed ICSI/IVF embryo transfer (ET) (49.1%). In conclusion, this study showed that in couples with only severe teratozoospermia, there was a benefit in subjecting sibling oocytes to both IVF and ICSI in the first cycle because 24 (28.2%) cycles of total fertilization failure were avoided. Furthermore, despite initially significant higher fertilization rates in ICSI than IVF oocytes, subsequent rates of development from >or=6 cells up to blastocyst stage were the same suggesting that ICSI should be used with caution, as after day 3, ICSI-derived embryo development was compromised compared with IVF.     

Spermatozoa retrieved by electroejaculation: Should we prefer fresh or cryopreserved spermatozoa for intracytoplasmic sperm injection?

We aim to evaluate our experience, comparing intracytoplasmic sperm injection (ICSI) outcomes of cycle using fresh versus thawed electroejaculated spermatozoa. All consecutive couples undergoing ICSI cycles using electroejaculated spermatozoa, during a 16-year period, were evaluated. Embryological/laboratory variables of the ICSI cycles were assessed and compared between those utilising fresh (fresh group) versus thawed (thawed group) electroejaculated spermatozoa. Fifty-seven couples were evaluated, 30 used a fresh electroejaculated spermatozoa in 55 ICSI cycles, while 27 used a thawed sperm sample in 41 ICSI cycles. There were no in-between group differences in the mean numbers of oocytes retrieved per oocyte retrieval nor the percentage of MII oocytes. The fresh group demonstrated significantly higher fertilisation (71.5% vs. 64.1%, respectively, p < .05), top-quality embryos (66.5% vs. 54.9%, respectively, p < .02), clinical pregnancy per transfer (41.3% and 21.2%, respectively, p < .05) and cumulative clinical pregnancy (58.2% vs. 26.8%, respectively, p < .001) rates, as compared to the thawed group. Independent of the source of spermatozoa used, no pregnancy was achieved following ICSI utilising immotile spermatozoa. In conclusion, ICSI cycles using ejaculated spermatozoa of patients suffering from neurologic or psychogenic anejaculation are reassuring. The use of fresh ejaculated spermatozoa retrieved on the day of the female spouse oocyte retrieval might improve outcome. Whenever a thawed electroejaculated spermatozoa yield no motile spermatozoa, emergency electroejaculation is mandatory.     

单卵患者体外受精与卵胞浆内单精子注射授精方式的比较

目的探讨仅获得一枚卵子的患者行体外受精（IVF）或卵胞浆内单精子注射（ICSI）治疗后受精率及妊娠率的差别。方法通过对本中心133个仅获得一枚卵的IVF治疗周期临床指标的分析,调查IVF与ICSI不同授精方式处理后受精率和妊娠率的差别。结果76个获得一枚卵IVF周期与57个获得一枚卵ICSI周期受精率和妊娠率均无统计学差异（73．7％vs82．5％,P〉0．05;10．5％vs14．0％,P〉0．05）;其中〈38岁组受精率和妊娠率分别为（73．9％vs83．3％,13．0%vs23．3％）,〉38岁组受精率和妊娠率分别为（73．3％vs81．5％,6．7％vs3．7％）,均无统计学差异（P〉0．05）。结论对于仅获得一枚卵子进行IVF或ICSI授精方式,其受精率及妊娠率没有统计学差异。     

低评分胚胎体外继续培养的临床价值

目的探讨对形态学评分较低的胚胎进行体外继续培养的临床价值。方法对低评分胚胎体外继续培养的104个IVF-ET／ICSI周期患者的临床资料进行回顾性分析,观察继续培养后获得冷冻胚胎的个数及这些冷冻胚胎冻融后移植的临床妊娠率。结果104个IVF—ET／ICSI周期取卵后第三天（D3）低评分胚胎经体外继续培养有32个周期获得冷冻胚胎,冷冻胚胎拥有率30．76％,共培养了606枚低评分胚胎,获87枚冷冻胚胎,冷冻胚胎获得率14．36％（87／606）。23个冻融胚胎移植周期中有3例临床妊娠;103例累计妊娠24例,累计妊娠率23．3％。结论继续培养能有效筛选出具有继续发育潜能的低评分胚胎,提高了胚胎的利用率和累计妊娠率,具有一定的临床价值。     

Factors influencing success rate of IVF/ET:analysis of 770 treatment cycles

<正> Objective:To evaluate the factors influencing success rate of in vitro fertilization /embryo transfer (IVF/ET).Methods:A retrospective study of 770 consecutive cycles undergone IVF/ET or in-tracytoplasmic sperm injection (ICSI) from March 1999 to June 2001.Estradiol and pro-gesterone concentrations on the day of hCG administration were measured.Factors ef-{ecting embryo transfer on the effects of clinical pregnancy rate were evaluated.Results:The overall clinical pregnancy rate in 770 cycles was 40.8%.Take homebaby rate was 31%.No significantly differences rate were observed between groupswith different estradiol levels.If the progesterone concentration on the day of hCG ad-ministration was>6.36 nmol/L,the implantation and clinical pregnancy rate was lower(P<0.003).The lowest clinical pregnancy rate was observed when the duration of in-fertility was≥10 years.The average number of embryos transferred was 2.23±0.83.Conclusion:This study demonstrated that the most important factor on clinicalpregnancy rate was low progesterone concentration on the day of hCG administration.The other two important variables influencing success rate of IVF/ET were the durationof infertility,the number of high-grade embryos transferred.     

Effect on clinical outcome of the interval between collection of epididymal and testicular spermatozoa and intracytoplasmic sperm injection in obstructive azoospermia

We wished to determine whether the interval between surgical retrieval of epididymal and testicular spermatozoa in obstructive azoospermia and their subsequent use in intracytoplasmic sperm injection (ICSI) has an effect on their fertilizing capacity and pregnancy rates in patients undergoing ICSI. This was a retrospective review of 164 consecutive cycles of ICSI in partners of men undergoing surgical sperm retrieval for obstructive azoospermia. Seventy-three cycles used fresh testicular spermatozoa; in 35 cycles ICSI was performed within 4 hours of sperm retrieval, and in 38 cycles spermatozoa were incubated overnight before ICSI. Epididymal spermatozoa were used in 29 cycles; 22 cases within 4 hours of retrieval and 7 cases following overnight culture. Cyropreserved testicular and epididymal spermatozoa were used in 42 and 20 ICSI cycles, respectively. Fertilization and clinical pregnancy rates were calculated for each treatment group. Fertilization rates for epididymal spermatozoa were 67% at 4 hours, 56% at 24 hours, and 63% for cryopreserved spermatozoa (P =.52). Fertilization rates for testicular spermatozoa were 63% at 4 hours, 71% at 24 hours, and 60% for cryopreserved spermatozoa (P =.16). Unlike testicular spermatozoa, cryopreserved epididymal spermatozoa showed a significant increase in clinical pregnancy rates with cryopreservation, with rates of 4 of 22, 1 of 7, and 10 of 20 at 4 hours, 24 hours, and cryopreservation, respectively (P =.049). This study confirms that fertilization and pregnancy rates following ICSI with motile spermatozoa are unaffected by the duration between surgical retrieval of spermatozoa and their injection into oocytes. It also demonstrates that of all treatment modalities, the use of frozen epididymal spermatozoa was associated with the greatest pregnancy rates.     

Sperm DNA fragmentation measured by Halosperm does not impact on embryo quality and ongoing pregnancy rates in IVF/ICSI treatments

Sperm DNA fragmentation (SDF) has been proposed to be one of the main markers regarding male infertility. A prospective study was performed to assess primarily whether sperm DNA damage has any impact on embryological data and secondarily on pregnancy rates. This prospective study evaluated the sperm DNA damage in fresh ejaculated sperm samples from couples undergoing IVF/ICSI treatments, using the improved SCD method, known as Halosperm^®. The results were evaluated by performing statistical analysis with the statistical package of SPSS v17. A total of 156 fresh semen samples derived from 156 couples undergoing 156 IVF/ICSI cycles. From the 156 couples, 139 finally reached the embryo transfer (ET) procedure. Overall, SDF did not correlate with embryological data, while ongoing pregnancy rate/ET was 21.6%. SDF only correlated with sperm characteristics. After the categorisation of SDF (≤35% and >35%), according to the specific references of the method used, embryological data were comparable as also ongoing pregnancy rates. Using the SCD method, sperm DNA damage is associated neither with embryological data nor to pregnancy rates. However, we should not rule out the fact that extremely high DNA damages are associated with total pregnancy failure.     

口服避孕药预处理时间对预期卵巢低反应患者临床结局的影响

目的探讨短效口服避孕药(OCP)预处理时间对POSEIDON标准的预期卵巢低反应(POR)患者IVF结局的影响。方法回顾性分析2016年1月至2018年6月就诊于北医三院生殖医学中心接受IVF-ET、符合POSEIDON标准预期POR患者的167个IVF周期的临床资料。所有患者均采用OCP预处理(7~30 d)后超短GnRH激动剂联合拮抗剂方案,按照OCP预处理时间不同分为A组(OCP预处理时间≤16 d,n=107)、B组(OCP预处理时间>16 d,n=60),比较两组患者的一般资料、促排卵周期指标及临床妊娠率等。结果两组患者年龄、不孕年限、不孕类型、BMI、基础FSH、AMH、IVF周期数及排卵障碍比例比较均无统计学差异(P>0.05)。A组窦卵泡数(AFC)显著低于B组[(2.2±1.8)vs.(2.9±2.3),P=0.028];相对于B组,A组Gn起始剂量[(273.8±46.5)U vs.(290.4±59.3)U]、促排卵时间[(9.5±2.6)d vs.(10.4±2.6)d]及Gn总量[(2648.4±858.8)U vs.(3036.6±1009.0)U]均显著降低(P<0.05),而两组间HCG日血清激素水平(E 2、LH、P)、子宫内膜厚度、获卵数、ICSI率、受精率、卵裂率、可移植胚胎数、优胚率、移植胚胎数及周期取消率均无统计学差异(P>0.05)。A组鲜胚移植周期着床率和临床妊娠率均显著高于B组(32.2%vs.12.7%;42.4%vs.17.6%)(P<0.05),而A、B两组冻融胚胎移植周期的着床率(32.1%vs.40.0%)和临床妊娠率(45.0%vs.40.0%)比较均无统计学差异(P>0.05),且两组间早期流产率在鲜胚移植周期和冻融胚胎移植周期均无统计学差异(P>0.05)。结论POSEIDON预期POR患者超短GnRH激动剂联合拮抗剂方案前OCP预处理>16 d,鲜胚移植周期的妊娠率明显下降,且增加卵巢刺激时间及Gn用量,增加患者经济负担,但并不影响冻融胚胎移植周期的妊娠率。建议OCP预处理不超过16 d。     

常规IVF失败后补救ICSI治疗

目的 :探讨常规IVF周期中受精完全失败或受精率低于 2 5 %时 ,应用卵母细胞单精子显微注射 (ICSI)技术进行再受精的临床意义。　方法 :回顾分析 1999年 1月～ 2 0 0 0年 8月 ,在我院生殖医学研究中心接受IVF ET治疗5 4 6个周期中 ,精子参数正常者行常规IVF ,受精失败或受精率低于 2 5 %行补救性ICSI 17个周期。采用常规超排卵方案治疗 ,取卵后 4～ 6h受精 ,16～ 18h后观察 ,发现未受精或受精率低于 2 5 % ,立即行补救ICSI,16～ 2 0h后观察受精情况。　结果 :10个周期受精率低于 2 5 % ,共有未受精卵 112个 ,其中MⅡ 期 89个 ;显微注射 89个 ,受精 5 0个 ,受精率 5 6.2 % ;共有 5例妊娠 ,3例单胎 ,1例双胎 ,1例流产 ,其移植胚胎包括来源于第 1d受精卵和补救性ICSI后受精卵 ;2个周期有冷冻胚胎 ,1例妊娠。 7个周期受精完全失败 ,共有未受精卵 79个 ,其中MⅡ 期 4 7个 ;显微注射 4 7个 ,受精 2 9个 ,受精率 61.7% ,5个周期有胚胎移植 ,1例妊娠。　结论 :补救性ICSI是常规IVF周期受精失败后的可行治疗方法。     

Schedule to inject in vitro matured oocytes may increase pregnancy after intracytoplasmic sperm injection

To ascertain the value of using immature oocytes in an intracytoplasmic sperm injection (ICSI) program, the authors designed a schedule, at 5 p.m. on day 1 (the day of oocyte retrieval) and at 8 a.m. and 2 p.m. on day 2, to recognize and inject the in vitro matured (IVM) oocytes. For the 1,166 oocytes retrieved in 107 ICSI cycles, 128 (11.0%) were at the stage of metaphase I (MI) and 113 (9.7%) at germinal vesicle. Routine ICSI for metaphase 11 oocytes was performed at 2 p.m. on day 1 (initial ICSI). In culture medium of human tubal fluid with 15% maternal serum, 85.1% (205/241) immature oocytes progressed to maturation in which 16.4% (21/128) of MI oocytes matured at 5 p.m. of day 1. The rate of normal fertilization for IVM oocytes (58.5%) was not significantly different from that of initial ICSI (64.0%). One patient received a transfer of two fertilized IVM oocytes alone that were injected at 5 p.m. of day 1, maturing from the MI stage, and achieved a normal pregnancy. The fertilized IVM oocytes were replaced along with the embryos from initial ICSI for 40 cycles that led to 14 (35%) clinical pregnancies. In 43 fertilized IVM oocytes donated for research, we observed that cleavage (95.3%) to the 2- to 4-cell stage was not distinct from that of initial ICSI (94.6%); however, the percentage of embryos of grade I and II morphology was significantly smaller (24.4% vs. 62.5%). Only five (11.6%) developed to blastocysts in vitro. Twenty-one fertilized IVM oocytes were frozen for future transfer. A schedule to inject IVM oocytes in ICSI cycles may generate more accessible embryos for fresh transfer or cryopreservation to increase the chance of pregnancy, although the embryo quality was relatively poor.     

卵胞浆内单精子注射和常规体外受精-胚胎移植的胚胎形态及临床结果比较

目的 :比较卵胞浆内单精子注射 (ICSI)和常规体外受精 -胚胎移植 (IVF-ET)两种助孕技术处理后的胚胎形态和临床结果。方法 :90对夫妇进行 93个 ICSI/ IVF治疗周期 (ICSI 45周期 ,IVF 48周期 ) ,比较两组周期平均获卵数 ,正常受精数 ,A、B级胚胎数和生化妊娠率 ,临床妊娠率。结果 :ICSI组周期平均获卵数及正常受精数 (分别为 1 1 .2 5 ,6 .6 0 )与 IVF组 (分别为 1 0 .6 7,6 .90 )相类似 (P>0 .0 5 ) ;周期 A、B级胚胎数 ICSI组3.31 ,IVF组 3.1 9,两组比较无显著差异 (P>0 .0 5 )。周期临床妊娠率 ICSI组 42 % ,IVF组 44 % ,两组比较无显著差异 (P>0 .0 5 )。周期“抱婴回家”率 ICSI组 36 % ,IVF组 31 % ,两组比较无显著差异 (P>0 .0 5 )。结论 :ICSI技术治疗严重男性因素引起的不育症可取得与常规 IVF治疗主要由女方不育因素引起的不育症相似的临床效果     

卵胞浆内单精子注射在常规体外受精失败病例中的应用

目的评价卵胞浆内单精子注射(ICSI)对常规体外受精(IVF)失败病例的应用效果。方法对于常规IVF受精失败的病人在第2天进行补救ICSI(A组)21个周期,或在下一个周期直接应用ICSI技术治疗(B组)18个周期。分别与因严重少、弱精子症而行ICSI的243周期(对照组)的受精率、优质胚胎率和妊娠率等进行比较。结果A组的受精率、卵裂率、优质胚胎率分别为61.53%、81.73%、72.94%,均比B组的83.87%、97.69%、84.25%显著降低(P<0.05),而两组的多原核率差异无显著性(3.55%vs1.29%,P>0.05)。比较临床妊娠率、种植率和冷冻周期率,B组与对照组均无显著差异,而A组与对照组均有显著差异。结论常规IVF受精失败者可通过第2天补救ICSI或下一周期直接行ICSI而提高受精率和种植率,而后者比前者能获得更好的妊娠结局。     

Analysis of outcomes of cryopreserved surgically retrieved sperm for IVF/ICSI

We evaluated our experience to date with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) after either cryopreserved sperm or sperm produced on the date of IVF/ICSI was used. We performed a retrospective statistical analysis of data derived from 188 women undergoing IVF/ICSI cycles using surgically retrieved sperm. A total of 318 IVF/ICSI treatment cycles with 3280 ova were performed using testicular sperm extraction (TESE, 304 cycles) or microsurgical epididymal sperm aspiration (MESA, 14 cycles). Sperm obtained at time of IVF/ICSI (fresh) or thawed cryopreserved sperm samples were used in 38 and 280 of the ICSI cycles, respectively. For IVF/ICSI cycles using both TESE and MESA sperm, the fertilization rate was 59.9% for cryopreserved sperm, and 53.6% when fresh sperm was used (chi2 P-alpha < .02, Cramer's 0.04). The fertilization rate for the TESE group alone was 60.0% for cryopreserved sperm and 55.1% for fresh sperm (chi2P-alpha = .075). Cohen effect size was computed at 0.03; yielding for P-beta = .8, 6597 ova would be required to demonstrate similarity between fresh and cryopreserved sperm in the TESE group. To demonstrate superiority of cryopreserved sperm in this group at a P-alpha significance level of .05, 7524 ova would be necessary. The pregnancy rate for the TESE group was 27.3% for cryopreserved sperm and 27% for fresh sperm. Further analysis of the pregnancy data in this group, using the methods described, yielded a chi2 P-alpha and power of 0.971 (effect size calculated at 0.002). While our fertilization rates for cryopreserved sperm are greater in analyses of surgically derived sperm, based on the 7 years required to obtain data on 3280 ova, full numerical resolution of the issue of whether cryopreserved sperm is superior or similar will not be available until approximately 2010. However, we believe these results, along with the similarity shown in pregnancy rates achieved with both types of sperm, clearly indicate that cryopreserved sperm is not inferior to fresh sperm.