不同精子来源及受精方式对胚胎冻融结局的影响

目的探讨常规体外受精(IVF)、精液精子与穿刺后精子卵胞浆内单精子注射(ICSI)对胚胎冻融结局的影响。方法分析我中心2013年1月至2013年12月间行胚胎冻融移植周期的临床妊娠结局,其中IVF周期1479,ICSI周期258,早期补救52例;来源于精液精子组105个周期,行穿刺后精子组33个周期。结果 IVF组、ICSI组与早期补救ICSI组间的复苏胚胎存活率相比无差异(96.5%、95.0%vs 99.0,P0.05);三组之间种植率、妊娠率相比也无统计学差异(27.7%、25.3%vs 35.1%;41.0%、39.5%vs 46.2%,P0.05)。精液精子组与穿刺精子组的复苏胚胎存活率、种植率和妊娠率之间差异不显著(P0.05)。结论 ICSI及穿刺后精子行ICSI胚胎其冻融后的存活率和妊娠率与常规IVF之间无显著差异。     

精子DNA碎片对IVF/ICSI结局的影响

目的探讨精子DNA碎片对体外受精/卵胞浆内单精子注射(IVF/ICSI)结局的影响。方法回顾性的分析了行IVF/ICSI治疗的725例不孕夫妇(IVF 502例、ICSI 223例)的临床资料。根据精子DNA碎片指数(DFI)分为正常组(DFI10%)、轻度DFI组(10%≤DFI20%)和重度DFI组(DFI≥20%),分别比较了IVF和ICSI中三组的受精率、卵裂率、可用胚胎率、优质胚胎率和临床妊娠率。结果在IVF周期中,DFI对受精率、卵裂率、可用胚胎率、优质胚胎率和临床妊娠率均无影响(P0.05);在ICSI周期中,DFI对受精率和卵裂率无影响(P0.05),但可用胚胎率和优质胚胎率三组之间有显著性差异(P0.05),临床妊娠率虽然随着DFI的增高而下降,却无显著相关性(P0.05)。结论精子DNA碎片对IVF结局基本无影响,但与ICSI结局中的可用胚胎率和优质胚胎率呈负相关,这可能与受精过程中IVF周期中卵子对精子有自然选择的过程,而ICSI周期中则是人为的选择精子有关。     

序贯培养和连续培养对IVF/ICSI-ET移植前胚胎发育和临床妊娠结局的影响

目的比较研究序贯培养和连续培养对体外受精/卵胞浆内单精子注射(IVF/ICSI)后移植前胚胎发育情况和移植后临床妊娠结局的影响,进一步优化培养条件,提高移植前胚胎的发育质量,改善IVF/ICSI-ET的临床妊娠结局。方法1将接受IVF或ICSI的患者随机分成序贯培养组(A组,IVF患者150例,ICSI患者100例)和连续培养组(B组,IVF患者150例,ICSI患者100例),比较相对应的两组胚胎在受精后第3天卵裂期胚胎的发育情况和移植后的临床妊娠情况;2将接受IVF或ICSI的患者随机分组成序贯培养组(A组,IVF患者50例,ICSI患者50例)和连续培养组(B组,IVF患者50例,ICSI患者50例),比较相对应的两组胚胎在受精后第5天囊胚的发育情况和移植后的临床妊娠情况;3将培养第三天冷冻复苏后的胚胎随机分成序贯培养组(A组,50例)和连续培养组(B组,50例),比较相对应的两组胚胎在培养后囊胚的发育情况和移植后的临床妊娠情况。结果 1在两组患者年龄、不孕年限无统计学差异的基础之上,与A组相比,B组的胚胎在IVF或ICSI后的受精率、卵裂率以及第3天形成的优质胚胎率和移植后的临床妊娠结局无统计学差异,但B组的优质胚胎率略高于A组;2在年龄、不孕年限,卵裂率和优质胚胎率无统计学差异的基础上,与A组相比,B组胚胎在IVF或ICSI后形成的囊胚没有统计学差异,移植后的临床妊娠率亦无统计学差异。3在优质胚胎率无差异的基础上,A组和B组胚胎的囊胚形成率和临床妊娠率没统计学差异。结论与序贯培养条件相比,连续培养并没有降低IVF/ICSI后胚胎发育潜能,也没有改变临床妊娠结局,序贯培养是胚胎培养的重要方法,但不是必要方法。     

冻融胚胎移植临床结局的回顾性分析

目的探讨影响冻融胚胎移植(frozen-thawed embryo transfer,FET)妊娠结局的相关因素。方法回顾性分析本中心132例冻融胚胎移植周期,其中1例取消移植外,将另外131例移植周期按照妊娠结局分为妊娠组和未妊娠组进行研究。结果 132周期共解冻胚胎290枚,存活280枚(96.55%),移植131周期,临床妊娠率为48.85%(64/131),胚胎着床率为30.00%。患者的基本资料之间无显著性差异,FET周期临床资料中,妊娠组患者的胚胎复苏率、完全存活率、冷冻前和复苏后的优胚率、继续发育胚胎比例及移植胚胎中含有致密化以上胚胎比例均显著高于未妊娠组(99.26%vs94.77%;92.65%vs 77.78%;94.12%vs 84.31%;91.11%vs 77.93%;68.89%vs 39.31%;40.74%vs 18.62%)。FET周期患者在新鲜取卵周期中,两组的Gn用量与天数、获卵数、受精率及新鲜周期胚胎移植失败率之间无显著性差异,但妊娠组的优胚率和冷冻胚胎数均显著高于未妊娠组(65.80%vs 55.72%;7.69 vs 5.03)。结论在冻融胚胎移植中,患者新鲜周期的胚胎质量、胚胎冻融过程以及解冻后的胚胎发育情况共同决定其妊娠结局     

多核受精对体外受精胚胎移植结局的影响

目的探讨发生多核受精周期和无多核受精周期的临床结局。方法将2014年1月至2014年12月进行IVF-ET/ICSI治疗的患者,排除早期补救ICSI受精周期和无可移植胚胎的周期,共1461个治疗周期纳入研究,其中IVF受精1259个周期,ICSI受精202个周期,分别比较各受精组中发生多核受精和无多核受精的临床结局。结果 (1)在IVF多核受精组平均年龄和卵子利用率显著低于非多核组,两组有统计学差异(P0.05)。但两组的受精率、D3优胚率、囊胚形成率、临床妊娠率、胚胎种植率无显著性差异(P0.05)。(2)ICSI非多核受精组与多核受精组的平均年龄受精率、D3优胚率、囊胚形成率、临床妊娠率、胚胎种植率无显著性差异(P0.05),ICSI多核受精组卵子利用率显著低于非多核组(P0.05)。结论多精受精对临床结局的影响主要是减少了可利用胚胎的比例,有多核受精发生的周期,不影响胚胎优质率,囊胚形成率,可以得到较好的临床妊娠率和胚胎种植率,多核受精与患者年龄增加无关,而与卵子质量相关。     

冷冻复苏的睾丸精子对ICSI助孕结局的影响

目的探讨冷冻复苏的睾丸精子对ICSI助孕结局的影响。方法回顾性分析2014年3月至2017年5月因男方梗阻性无精子症(OA)或非梗阻性无精子症(NOA)在我院采用细针睾丸穿刺抽吸精子行ICSI助孕的209个周期的临床资料,新鲜睾丸精子(新鲜睾丸精子组)用于174个周期,冷冻复苏的睾丸精子(冻精组)用于35个周期。比较两组的一般资料、受精率、卵裂率、优质胚胎率、临床妊娠率以及种植率。结果两组的一般资料比较无统计学差异(P0.05)。冻精组与新鲜睾丸精子组行ICSI助孕后的受精率、卵裂率、优质胚胎率、临床妊娠率及种植率比较均无统计学差异(P0.05)。结论冷冻复苏的睾丸精子对ICSI助孕结局并无显著影响。     

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。     

提前复苏分裂速率较慢胚胎对妊娠率的影响

目的探讨冻融胚胎移植(FET)周期中,提前一日复苏冷冻前分裂速率较慢的胚胎对妊娠结局的影响。方法回顾性分析哈尔滨医科大学附属第一医院生殖中心2006年3月至2009年9月561例FET周期中,移植冷冻前分裂速率较慢胚胎的周期共88个。其中,33个周期为移植当日复苏胚胎,培养1-4h后移植。55个周期为移植前一日复苏胚胎,培养18-24h移植。比较两组胚胎移植后的妊娠率和种植率。结果移植当日复苏组与移植前一日复苏组妊娠率(9.1%,32.7%)与种植率(4.2%,15.5%)均有显著性差异(P﹤0.05);而患者平均年龄、移植前平均内膜厚度、胚胎复苏存活率及100%卵裂球存活率均无显著性差异(P﹥0.05)。结论对冷冻前分裂速率较慢胚胎提前一日复苏,可提高临床妊娠率和种植率。     

早补救ICSI新鲜周期与复苏周期卵裂期胚胎移植临床结局分析

目的探讨行早补救ICSI助孕治疗患者新鲜周期与复苏周期卵裂期胚胎移植的临床妊娠结局。方法回顾性分析2014年01月至2017年06月期间在我院生殖中心接受治疗的患者,在短时受精失败行早补救ICSI助孕、并行冷冻卵裂期胚胎移植的患者共29个周期,为复苏周期组;与同期行早补救ICSI助孕而移植新鲜卵裂期胚胎的患者共16个周期,为新鲜周期组,比较两组的临床妊娠结局。结果复苏周期的临床妊娠率为41.38%(12/29),胚胎种植率为33.33%(18/54),流产率为16.67%(2/12);新鲜周期的临床妊娠率为43.75%(7/16),胚胎种植率为34.48%(10/29),流产率为14.28%(1/7),两组之间临床妊娠率、种植率及流产率差异均无统计学意义(P0.05)。结论早补救ICSI助孕治疗患者行新鲜周期与复苏周期的卵裂期胚胎均可获得较好的临床妊娠结局,早补救ICSI不失为一种有效的辅助生殖补救措施,改善了部分患者临床治疗结局。     

非优质卵裂胚胎继续培养至囊胚的临床应用研究

目的探讨新鲜IVF/ICSI周期中移植或冷冻后剩余的非优质卵裂期胚胎在体外继续培养至囊胚的临床应用价值。方法将第3天移植或冷冻后剩余的非优质卵裂期胚胎在体外继续培养至第5、6天,选择优质的囊胚进行玻璃化冷冻。冷冻3个月后,当需要时将其解冻后进行胚胎移植,观察统计第5、6天囊胚移植后的妊娠结局。结果 67个解冻周期中共解冻102枚囊胚,复苏率、妊娠率及种植率为99.02%、22.39%和15.84%;其中第5、6天囊胚复苏率、妊娠率和种植率分别为(100%vs98.36%)、(32%vs16.67%)和(21.95%vs11.67%),两者间无统计学差异。结论部分第3天非优质卵裂期胚胎可在体外继续培养至囊胚,从中选择优质囊胚进行冻融胚胎移植,从而提高胚胎的利用率。     

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.     

Dizygotic twin pregnancy after intracytoplasmic sperm injection of 1 day old unfertilized oocytes

We report on a case where late intracytoplasmic sperm injection (ICSI) on unfertilized oocytes after standard in-vitro fertilization (IVF) cycles resulted in a dizygotic twin pregnancy. Fifteen oocytes were harvested from a patient with a history of salpingotomy. After a single cycle of IVF, only one oocyte showed two pronuclei. Subsequently ICSI was performed on six unfertilized metaphase II oocytes, and three of these oocytes showed two pronuclei. Three fertilized embryos were transferred (two derived from ICSI and one from IVF). A normal twin pregnancy resulted, and after delivery of two healthy boys the twins were confirmed to be dizygotic by DNA analysis of several loci. We conclude that at least one of the embryos was derived from the reinsemination by 'second day ICSI'.      

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.     

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.     

Cryo-thawed embryos obtained from conception cycles have double the implantation and pregnancy potential of those from unsuccessful cycles

BACKGROUND: The purpose of this study was to evaluate the influence of fresh IVF/ICSI cycle outcome on the prognosis of the related frozen embryo replacement (FER) cycle. METHODS: 459 FER cycles, involving 2049 cleavage stage embryos with no or up to 10% fragmentation, were performed for which the outcome of the fresh cycle was recorded. The cycles were divided into two groups; group A included cycles in which cryopreserved embryos were obtained from fresh cycles in which conception occurred. Group B were cycles in which cryopreserved embryos originated from unsuccessful fresh cycles. RESULTS: Groups A and B were comparable with respect to mean (+/- SD) age at cryopreservation (33 +/- 3.9 versus 33.2 +/- 4 years, P = not significant), mean number of oocytes retrieved and fertilized normally in the fresh cycle (11 +/- 5.2 versus 11.2 +/- 4.8, P = not significant) and mean age at the cryo-thawed transfer (34.5 +/- 4.2 versus 33.9 +/- 4 years, P = not significant). No significant difference was found between the two groups with regard to mean number of embryos cryopreserved (6.5 +/- 3.9 versus 6.2 +/- 3.6) and subsequently thawed (4.5 +/- 2.5 versus 4.5 +/- 1.8) per cycle and number of cryo-thawed embryos transferred per cycle (2.0 +/- 0.7 versus 2.1 +/- 0.8). However, the implantation rate per transferred embryo in group A was double that in group B (23 versus 11.2%, P < 0.0001). Moreover, the clinical pregnancy and ongoing pregnancy rates per cycle were significantly higher in group A compared with group B (34.8 and 27.3% versus 15.6 and 13.1%, P < 0.0001 and P = 0.0003 respectively). The difference in FER cycle outcome could not be explained by confounding variables. CONCLUSIONS: After thawing, cryopreserved embryos originating from conception IVF/ICSI cycles achieve double the implantation and pregnancy rates of those obtained from unsuccessful cycles.     

Comparison of clinical outcome after cryopreservation of embryos obtained from intracytoplasmic sperm injection and in-vitro fertilization

The impact of intracytoplasmic sperm injection (ICSI) on cryopreservedzygotes and embryos was evaluated by comparing embryo survivaland implantation between embryos derived from ICSI and thosederived from standard insemination procedures. The study includedpatients whose excess zygotes and embryos were cryopreservedbetween September 1993 and December 1994 and who subsequentlyunderwent a frozen embryo transfer. Embryo survival, clinicalpregnancy rates per transfer and pregnancy outcome were compared.Three hundred and thirty eight cryopreservation cycles, duringwhich 1471 embryos were cryopreserved, were included in thisstudy. Of those, 961 were derived from oocytes fertilized byinsemination in vitro and 510 were derived from oocytes fertilizedby ICSI. A total of 690 of the embryos (451 in the inseminationgroup and 239 in the ICSI group) have since undergone a thawcycle. The embryo survival rates were similar between the twogroups (70.5 and 73.2%, insemination and ICSI respectively)and were not significantly affected by the stage at cryopreservation.There was no significant difference in pregnancy rates per transfer(31.8 and 32.3%), the preclinical pregnancy loss rate (16.7and 23.8%), or the clinical miscarriage rate (16.7 and 23.8%)between the insemination and the ICSI groups respectively. Itis concluded that ICSI does not have an adverse impact on thesurvival and successful implantation of cryopreserved and thawedembryos.     

体外成熟卵母细胞受精方式及发育能力的影响因素

目的 探讨体外成熟卵母细胞的受精方式及影响其胚胎发育的因素.方法 收集本院2008年7月至12月因男性因素需进行卵母细胞胞浆内单精子注射术(ICSI)助孕的135对夫妇未成熟的卵母细胞(DO)354枚,置入P1培养体系中观察培养20～24、26～30、36～40 h后的成熟情况.去除了退化的成熟卵母细胞,随机分为常规体外受精(IVF)和ICSI组,比较2组的正常受精率、卵裂率、第3天优质胚胎率及各组优质胚胎和非优质胚胎的患者年龄、不孕年限、促排时间及卵母细胞体外成熟时间.结果 卵母细胞体外成熟率为82.5%(292/354),IVF组正常受精率56.5%(70/124)低于ICSI组69.9%(107/153)(P<0.05).两组卵裂率和优质胚胎率差异无统计学意义(P>0.05).2组组内优质胚胎的患者年龄、体外成熟时间均小于非优质胚胎(P<0.05);不孕年限及促排时间差异无统计学意义(P>0.05).结论 ICSI能够提高体外成熟卵母细胞的受精率.体外成熟卵母细胞具有常规受精的能力,第3天胚胎质量与ICSI相似.患者年龄和卵母细胞体外成熟时间是体外成熟卵母细胞发育能力的主要影响因素.     

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。     

A comparison of ICSI outcomes with fresh and cryopreserved epididymal spermatozoa from the same couples

The published experience with frozen-thawed epididymal spermatozoa and intracytoplasmic sperm injection (ICSI) suggests that fertilization and pregnancy success rates are comparable to those achieved with freshly retrieved spermatozoa. However, no study has exactly compared clinical outcomes between the two IVF/ICSI cycles in the same couples. To formally address this issue, we assessed ICSI outcomes in couples each of whom had had two IVF/ICSI cycles: one using fresh and the second using frozen-thawed epididymal spermatozoa obtained from a single aspiration procedure. From a pool of 101 consecutive patients undergoing IVF/ICSI with epididymal spermatozoa, 19 couples initially used fresh epididymal spermatozoa and subsequently underwent a second IVF/ICSI procedure with frozen-thawed spermatozoa from the same aspiration. Normal (2PN) oocyte fertilization rates, embryo quality and pregnancy rates were compared between the two IVF/ICSI cycles for each couple. In the fresh epididymal sperm group, 58.4% of the injected oocytes fertilized normally compared with 62.0% of the injected oocytes in the frozen-thawed epididymal sperm group, revealing no statistically significant difference. Graded embryo quality also did not differ significantly between the paired IVF/ICSI cycles. The clinical pregnancy rates were 31.6% (6/19) and 36.8% (7/19) in the first and second cycles respectively. All but one pregnancy were singletons. In summary, this study provides strong evidence to support the notion that motile, cryopreserved and thawed epididymal spermatozoa are equal to freshly retrieved spermatozoa for ICSI in couples with obstructive azoospermia.     

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。