体外受精联合未成熟卵母细胞体外培养技术在卵巢低反应者中的初步应用研究

目的:探讨体外受精(IVF)联合未成熟卵母细胞体外培养(IVM)对卵巢低反应者的治疗效果.方法:6例在控制性超促排卵中表现为低反应者,注射绒毛膜促性腺激素(hCG)后36h取卵,对不同期未成熟卵母细胞行体外培养及受精;对成熟卵母细胞进行常规体外受精,胚胎形成后行移植术,术后21d明确有无临床妊娠。结果:6例病人共获取卵子74只,其中未成熟卵母细胞58枚(GV期24枚,MI期34枚),经体外成熟培养后47枚成熟,受精后19枚继续发育成胚胎。同时获取的16枚成熟卵母细胞(MⅡ期),受精后12枚继续发育成胚胎形成。病人全部行胚胎移植术,临床妊娠2例。结论:IVF联合IVM技术为卵巢低反应性患者提供了一种有效的补救治疗措施,提高了妊娠机会。     

未成熟卵体外成熟技术在卵巢反应不良和卵泡发育迟缓周期中的应用

目的探讨利用未成熟卵体外成熟技术治疗卵巢反应不良和卵泡发育迟缓周期的可能性。方法2000年10月至2002年7月间,在南京医科大学第一附属医院生殖中心取在常规体外受精(IVF)刺激周期中卵巢反应不良和卵泡发育迟缓患者的生发泡期卵母细胞,体外成熟培养24~48h后,对排出第一极体的卵母细胞采用单精子卵浆内注射法(ICSI)受精,受精3d后移入患者子宫,移植后通过检查血清HCG含量和B超判断妊娠结局。结果8个周期共取生发泡期卵母细胞41枚,成熟培养后有33枚卵母细胞排出第一极体,体外成熟率为805%(33/41)。ICSI后,正常受精率为788%(26/33)。平均每周期移植胚胎25(20/8)枚,获得3例妊娠。结论未成熟卵体外成熟技术可以用来挽救常规IVF治疗中卵巢反应不良和卵泡发育迟缓的周期。     

培养液中添加不同促性腺激素对卵母细胞体外成熟的影响

目的:比较卵母细胞体外成熟培养液中添加不同促性腺激素对未成熟卵母细胞体外成熟结局的影响。方法:将行卵母细胞体外成熟(IVM)的35例患者共42个新鲜取卵周期,随机分成A组:22个取卵周期将重组人促卵泡激素(果纳芬,rFSH)和重组人绒毛膜促性腺激素(艾泽,hCG)按1∶1的比例混合添加,终浓度为75 mIU/ml;B组:20个取卵周期添加终浓度为75 mIU/ml的尿源性促性腺激素(hMG),进行未成熟卵母细胞体外成熟培养。35例患者中新鲜取卵周期未移植或移植后未孕者行解冻胚胎移植。比较组间患者的卵母细胞成熟率、受精率、卵裂率、优质胚胎率、累计临床妊娠率及胚胎着床率。结果:取卵均于月经周期第12日或最大卵泡发育至10￣12 mm时进行,故所获卵均为未成熟卵。A组获卵181枚,经培养后成熟84枚,行卵胞浆内单精子注射(ICSI)84枚,受精60枚,卵裂55枚,优质胚胎20枚;新鲜胚胎移植9例,获1例临床妊娠,解冻胚胎移植5例,获1例临床妊娠,累计临床妊娠率为14.29%,胚胎着床率为7.14%。B组获卵176枚,经培养后成熟120枚,行ICSI 120枚,受精97枚,卵裂90枚,优质胚胎41枚,新鲜胚胎移植6例,获4例临床妊娠,解冻胚胎移植9例,获3例临床妊娠,累计临床妊娠率为46.67%,胚胎着床率为33.33%。结论:卵母细胞体外成熟培养液中添加尿源性促性腺激素可获得较添加重组人促卵泡激素和重组人绒毛膜促性腺激素高的卵母细胞成熟率、临床妊娠率及胚胎着床率。     

多囊卵巢综合征患者未成熟卵母细胞体外成熟培养后生长分化因子-9的表达

目的:探讨生长分化因子-9(GDF-9)与多囊卵巢综合征(PCOS)患者卵母细胞体外成熟及胚胎发育的关系。方法:采集PCOS患者自然周期月经未成熟卵母细胞,经体外成熟培养(IVM)后,免疫组化比较不同成熟度的卵母细胞及其周围颗粒细胞中GDF-9的表达差异;同时收集行IVM后受精的胚胎以及同期因输卵管因素行常规体外受精-胚胎移植(IVF-ET)的胚胎及未受精的卵子,免疫组化比较这些胚胎中GDF-9表达的差异。结果:①IVM后共获弃卵70个,其中MII期21个、MI期26个、GV期23个,染色结果显示GDF-9的表达在培养后成熟的卵母细胞MII期中表达较MI期、GV期增强,差异有显著性;而MI期、GV期两组间表达无差异;②共对343个卵子的颗粒细胞进行了免疫组化染色,MII期、MI期、GV期、退变卵周围颗粒细胞中GDF-9表达的阳性率随着卵母细胞成熟度的降低,逐渐降低,退变卵中最低。③共获IVF弃胚胎75个,GDF-9在各期胚胎中的表达均为阳性,且各期胚胎间的表达水平无差异。④对62个IVF中未受精的弃卵进行了染色,结果显示GDF-9的表达水平较IVF胚胎降低,差异有显著性。⑤共获IVM弃胚胎57个,各期胚胎间GDF-9的表达也无显著性差异,但IVF组胚胎中GDF-9的表达水平较IVM组高,差异有显著性。结论:GDF-9可能与人类卵母细胞的体外成熟及胚胎发育有关。     

食蟹猴体内自然成熟和体外培养成熟的卵母细胞对卵胞质内单精子显微注射(ICSI)结局的影响

目的:探讨食蟹猴体内自然成熟和体外培养成熟(IVM)的卵母细胞对卵胞质内单精子显微注射(ICSI)结局的影响。方法:选取有正常月经周期和生育功能的13只健康成熟的雌性食蟹猴,使用优化的促排卵方案进行促排卵后,B超下观察用药后的卵巢情况,手术取卵后对已成熟的MⅡ期卵母细胞进行ICSI,未成熟的GV及MⅠ期卵母细胞在IVM 16~38 h后发育为MⅡ期卵母细胞,再进行ICSI,观察IVM及体内自然成熟的卵母细胞的受精情况和胚胎发育情况。结果:IVM为76.1%±14.9%,受精率为56.79%,卵裂率为73.91%,优质胚胎率为44.12%;体内自然成熟的卵母细胞受精率为68.52%,卵裂率为94.59%,优质胚胎率为58.57%。在受精率和卵裂率方面,两者间均有统计学差异(P0.05和P0.01),而优质胚胎率无统计学差异(P0.05)。结论:食蟹猴体外培养成熟的卵母细胞对ICSI结局有较大影响。     

超排卵周期未成熟卵体外培养的研究

目的:研究来源于超排卵周期中的未成熟卵在拆除卵丘细胞后进行体外成熟培养(IVM)的成熟、受精及胚胎发育能力,探讨IVM技术的临床应用。方法:选取46名体外受精/卵胞浆内单精子显微注射-胚胎移植(IVF/ICSI-ET)患者为研究对象,比较MI和GV期不成熟卵的体外成熟情况,并比较体内成熟卵和体外成熟卵进行ICSI后的正常受精、异常受精、卵裂和优质胚胎形成情况。结果:体外培养中69.8%的MI期卵和77.2%的GV期卵均在24小时内达到成熟,其24小时和48小时的成熟率、总成熟率均无明显差异(P>0.05)。体外成熟卵与体内成熟卵相比较,正常受精率、异常受精率和卵裂率均无明显差异(P>0.05),优质胚胎形成率较低,差异有显著性(P<0.05)。结论:常规超排卵周期中的未成熟卵在拆除卵丘细胞后能够继续体外发育成熟,具有与体内成熟卵相似的ICSI受精、卵裂能力。虽然优质胚胎的形成率低于体内成熟卵,但增加了可移植胚胎和冷冻胚胎数量,提高了助孕成功率。     

人黄体期卵母细胞的体外成熟及玻璃化冷冻的实验研究

目的:探讨未成熟卵母细胞体外成熟(IVM)技术联合玻璃化冷冻保存黄体期卵母细胞对某些女性肿瘤患者的生育能力的保存情况。方法:采集因妇科肿瘤等行卵巢切除手术过程中穿刺获取的256枚未成熟卵母细胞,按取卵时患者的月经周期分为卵泡期组(143枚)与黄体期组(113枚),每组再随即分为新鲜对照组及玻璃化冷冻组。分别进行IVM后行新鲜卵胞质内单精子注射(ICSI)授精和玻璃化冻融卵ICSI授精,比较各组间IVM后MII卵率、受精率、卵裂率、优质胚胎率。结果:①卵泡期与黄体期卵母细胞的IVM率差异无统计学意义;而组间复苏存活率(68.0%vs 48.1%)有统计学差异(P<0.05);卵泡期与黄体期卵母细胞新鲜组间受精率、卵裂率、优质胚胎率无统计学差异,冷冻组间差异亦无统计学意义。②与新鲜组相比,玻璃化冷冻使卵泡期与黄体期卵母细胞的受精率均降低(P<0.01)。结论:黄体期未成熟卵母细胞可以体外成熟并有继续发育为优质胚胎的能力;玻璃化冷冻使卵母细胞受精率、卵裂率下降。IVM和冻融后体外授精是某些女性肿瘤患者保存生育能力的一种有临床应用前景的方式。     

人未成熟卵母细胞体外培养成熟、受精及胚胎移植

目的 应用卵母细胞体外成熟(IVM)技术帮助卵泡成熟障碍的不孕症患者获得妊娠及分娩。方法 接受未成熟卵IVM技术治疗者30例35个周期,其中多囊卵巢综合征14例,有卵巢过度刺激综合征病史6例,体外受精和胚胎移植(IVF-ET)周期中卵巢反应不良患者10例。设计卵巢刺激方案,采用含人成熟卵泡液的IVM培养液,建立未成熟卵母细胞的体外培养方法。结果 35个周期共取得未成熟卵母细胞203个,平均每个周期5．8个。培养后有156个卵母细胞排出第一极体,IVM率76．8％(156／203);在卵胞浆单精子显微注射(ICSI)12～18h后观察原核,正常受精率为76．9％(120／156);共有移植周期33个,获8例临床妊娠,妊娠率24％(8／33);有5例共7个婴儿出生。结论 IVM对一些卵泡发育和成熟障碍,特别是顽固性多囊卵巢综合征患者,是一种有效的辅助生育措施。人成熟卵泡液含有理想的自然促卵母细胞成熟的成分。     

未经促排卵的未成熟卵母细胞行体外成熟治疗不孕症的临床研究

目的探讨未经任何药物刺激的未成熟卵母细胞行体外成熟（IVM）治疗不孕症的临床价值。方法40例不孕患者接受54个IVM周期,其中多囊卵巢综合征（PCOS）不孕患者26例,经其他辅助生育技术失败14例。在未采用任何药物刺激的前提下,于月经周期的第9—12天,在超声引导下经阴道对两侧卵巢内直径≤10mm的卵泡进行穿刺取卵。对取出卵母细胞于体外培养24～48h,待第一极体出现后,进行卵母细胞质内单精于注射（ICSI）,18h后观察受精情况,继续培养24—48h,直至胚胎移植,移植前行激光辅助胚胎孵化。结果54个IVM周期中,有7个周期取消,取消率为13％;共移植周期47个,共获得未成熟卵母细胞857个,平均每周期18．2个。体外培养48h后,卵母细胞成熟率为73．7％（632／857）,正常受精率为75．3％（476／632）,卵裂率为91．2％（434／476）。移植日子宫内膜厚度平均为8．9mm,平均移植胚胎4．3个（2—6个）;1例生化妊娠,19例临床妊娠,每取卵周期的临床妊娠率为35％（19／54）,每移植周期的临床妊娠率为40％（19／47）。26例PCOS不孕患者共移植周期34个,1例生化妊娠,15例临床妊娠,每移植周期的临床妊娠率为44％（15／34）。结论未经促排卵药物刺激的卵母细胞行IVM用于治疗各种原因的不孕症,尤其是PCOS不孕患者,是一种有效的治疗方法。     

体外受精失败后补行卵胞浆内单精子注射的临床价值探讨

目的:探讨卵胞浆内单精子注射(ICSI)在体外受精完全失败或受精率低于25%的常规IVF周期中的临床价值。方法:回顾分析2001.01-2004.12在我院生殖医学中心接受常规IVF治疗的35例非男性因素不育患者,取卵后体外受精培养16-18h,发现卵母细胞完全未受精或受精率低于25%,立即行ICSI再授精。结果:在24个常规IVF低于25%的周期中,共有197个未受精卵,其中159个MⅡ期卵,显微注射159个,受精123个,最终形成胚胎96个,受精率为77.4%,卵裂率为78.1%,在22个新鲜移植周期(每周期的移植胚胎由来源于常规体外受精卵和补救ICSI后受精卵的胚胎组成),共有4例临床妊娠;在8个冷冻移植周期中(每周期的移植胚胎完全来源于补救ICSI后的受精卵),有1例临床妊娠。在11个常规IVF完全失败周期中,共有89个未受精卵,其中78个MⅡ期卵,显微注射78个,受精63个,卵裂51个,受精率为80.7%,卵裂率为80.9%,在10个新鲜移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中共有2例临床妊娠;在2个冷冻移植周期(每周期的移植胚胎完全来源于补救ICSI后的受精卵)中有1例单胎妊娠,妊娠早期流产。胚胎来源于常规体外受精卵和补救ICSI后受精卵的移植周期临床妊娠率为18%;胚胎完全来源于补行ICSI后受精卵的移植周期临床妊娠率为20%。结论:ICSI可作为常规IVF失败后的有效补救措施。     

PCOS患者未成熟卵体外成熟培养后妊娠结局分析

目的:探讨PCOS患者未成熟卵母细胞体外成熟(in vitro maturation,IVM)治疗的有效性和安全性。方法:分析比较PCOS合并不孕症自愿要求行IVM或IVF治疗的患者临床结局。结果:IVF组的平均优质胚胎数明显高于IVM组(P<0.05),两者的临床妊娠率(39.22%vs 40.32%)和着床率(24.37%vs 23.89%)无差异(P>0.05)。IVM组的妊娠丢失率为38.0%,高于IVF患者(21.1%,P<0.05),出生婴儿(单胎)的平均体质量组间无统计学差异(P>0.05)。结论:对于PCOS患者进行IVM治疗可以获得与IVF周期相类似的临床妊娠率和着床率;但是IVM治疗后流产率明显增加。     

脱氢表雄酮(DHEA)预治疗在体外受精-胚胎移植周期中的应用

目的:探讨脱氢表雄酮(DHEA)预治疗在卵巢储备低下妇女的体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)周期治疗中的作用。方法:对173例卵巢储备功能低下进行IVF/ICSI-ET的患者进行随机对照研究。DHEA预治疗组(n=81)患者口服DHEA,连用3个月,对照组为未服用DHEA预治疗者(n=92)。观察患者的一般情况、超促排卵情况及胚胎发育和妊娠结局。结果:患者一般情况、hCG注射日子宫内膜厚度及E2水平、Gn使用量和Gn使用天数组间均无统计学差异(P>0.05)。DHEA组IVF受精率、优质胚胎率及临床妊娠率均高于对照组(P<0.05)。但在胚胎种植率、早期流产率、周期取消率组间差异无统计学意义(P>0.05)。结论:DHEA预治疗可以改善卵巢储备功能低下妇女的IVF结局。     

常规IVF中受精失败相关因素及后续处理结果分析

目的:分析常规IVF受精失败原因,以进一步提高IVF受精率。方法:回顾性分析常规IVF中受精率低下或受精失败患者的各种因素及后续处理结果。结果:438个常规IVF取卵周期中,受精率≤25%的周期30个(A组)(6.85%)。其中12个周期第1日行补救性ICSI或重复IVF,最终共20个周期进行了胚胎移植,但均未获得临床妊娠。与受精率正常的周期(B组)相比,A组精子密度、活率、a级精子比例、前向运动精子比例(PMS)及分离后的精子活率、PMS比例、精子密度等均显著降低(P均<0.05)。组间的获卵数无明显差别,但A组MI期及GV期卵的数量明显高于B组(P<0.01)。其他受精失败因素包括对精子因素导致受精失败的7例在随后的周期进行ICSI,5例获得临床妊娠。结论:受精失败的原因是多方面的,但精液各参数下降及卵子发育不成熟是其主要原因;第1日行补救性ICSI或重复IVF的妊娠结局差;对于精子因素造成的受精失败,在以后的周期中行ICSI能获得理想的结果。     

Cryptic sperm defects may be the cause for total fertilization failure in oocyte donor cycles

In conventional IVF cycles with total fertilization failure, rescue intracytoplasmic sperm injection (ICSI) performed 24h after insemination has yielded poor results. However, when ICSI is used, total fertilization failure is a rare event. The aim of the present study is to investigate the degree of sperm contribution to fertilization failures using the egg-sharing model in oocyte donor cycles. The study included only the oocyte donor cycles of sibling oocytes with total fertilization failure in at least one of the matched recipients. Oocytes from 49 oocyte donor cycles were equally shared among 98 recipients undergoing conventional IVF. Due to total fertilization failure in half of the recipients, rescue ICSI was carried out. Compared with the conventional IVF only group, the rescue ICSI group had a lower pregnancy rate (30.61% versus 71.43%), clinical pregnancy rate (28.57% versus 67.35%) and ongoing pregnancy rate (28.57% versus 63.27%) (all P<0.01). Cryptic sperm defects in apparently normal spermatozoa may be the cause of total fertilization failure, indicating the need for simple routine tests to detect them.     

A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries

OBJECTIVE: To establish the relative success of treatment by unstimulated in vitro maturation (IVM) of oocytes or stimulated in vitro fertilization (IVF) in women with polycystic ovaries undergoing assisted conception treatment. METHODS: The case-control study included 107 IVM and 107 IVF cycles matched for age and cause of infertility. In vitro maturation patients underwent transvaginal recovery of immature oocytes during an unstimulated cycle, in vitro oocyte maturation, and fertilization. Those in the IVF group underwent ovarian stimulation after pituitary suppression. Embryos were transferred in the same cycle in both groups. Main outcome measures included numbers of mature oocytes and embryos produced, and rates of implantation, pregnancy, live birth, and complications. RESULTS: In the IVM group after in vitro culture, 7.8 mature oocytes and 6.1 embryos were obtained per retrieval. With IVF, 12.0 mature oocytes (P <.01) and 9.3 embryos (P <.01) were obtained. The IVM pregnancy and live birth rates per retrieval were 26.2% and 15.9% compared with 38.3% and 26.2% for IVF (nonsignificant). The implantation rate of IVF-derived embryos was higher (17.1% versus 9.5%) than that for IVM (P <.01). There were 12 cases (11.2%) of moderate or severe ovarian hyperstimulation syndrome in IVF patients, compared with none in the IVM group (P <.01). CONCLUSION: Our results suggest that for women with polycystic ovaries who require assisted conception, IVM is a promising alternative to conventional IVF treatment.     

甲状腺自身抗体阳性对体外受精-胚胎移植结局的影响

目的：探讨抗甲状腺自身抗体（antithyroid autoantibodies,ATA）阳性对体外受精．胚胎移植泐vitro fertilization and embryo transfer,ⅣF—ET）结局的影响。方法：回顾性分析行IVF／ICSI治疗不孕的患者资料。选取甲状腺抗体阳性但甲状腺功能正常者65例（共71个周期）作为研究组（ATA＋组）,492例甲状腺抗体阴性患者（共512个周期）作为对照组（ATA组）。结果：ATA＋组与ATA-患者的一般情况、促排卵天数、促性腺激素使用总量（Gn总量）、hCG注射日E2水平、获卵数、ICSI受精率、可移植胚胎数和妊娠率,组间比较均无统计学差异（P〉0．05）。ATA＋组IVF受精率（59．73％）、优质胚胎率（26．94％）明显低于ATA-组（70．86％和36．31％）;ATA＋组的流产率（37．50％）明显高于ATA组（17．79％）,差异有统计学意义（P〈0．05）。结论：ATA＋对IvF—ET妊娠结局有不利的影响,因此,对于ATⅣ患者在接受IVF—ET治疗前调节甲状腺自身免疫功能可对妊娠结局有利。     

Embryo transfer and luteal support in natural cycles

Embryo transfer policy and luteal supplementation was reviewed, comparing literature data and the results from the Maribor IVF Centre. A retrospective analysis of 1024 cycles in patients undergoing IVF, intracytoplasmic sperm injection (ICSI) or testicular sperm aspiration in unstimulated cycles was carried out using four different approaches for cycle monitoring. This showed that the most successful protocol for monitoring was administration of human chorionic gonadotrophin (HCG) when serum oestradiol was >0.49 nmol/l and follicle diameter was at least 15 mm. The implantation rate per transferred embryo was higher when a blastocyst was transferred (42.8%) rather than a day-2 embryo (23.5%) in the same monitoring protocol. Analysis of the influence of patient age on the success of oocyte retrieval, oocyte fertilization, embryo transfer rate and delivery rate demonstrates that patient age does not influence the rate of positive oocyte retrieval or fertilization rate as much as it influences pregnancy rate per embryo transfer. The delivery rate per cycle was dramatically influenced by age in patients over 38 years. There is no clear evidence in the literature as to whether luteal phase support is necessary in natural cycles for IVF/ICSI. Comparing the data, a higher pregnancy rate was observed if HCG was administered after embryo transfer.     

Pronuclear stage cryopreservation after intracytoplasmic sperm injection and conventional IVF: implications for timing of the freeze

Objective: To compare clinical outcomes of frozen embryo transfers using cryopreserved pronuclear stage oocytes that had undergone either intracytoplasmic sperm injection (ICSI) or conventional IVF.

Design: Observational.

Setting: A tertiary referral reproductive medicine unit.

Patient(s): Couples undergoing either ICSI or conventional IVF from January 1, 1995 to December 31, 1997.

Intervention(s): Patients underwent a standard controlled ovarian hyperstimulation protocol and transvaginal ultrasound-guided oocyte retrieval. All normally fertilized (2PN) oocytes exceeding a specified embryo number designated for fresh transfer were immediately cryopreserved at the pronuclear stage. Our cryopreservation method included timing of the freeze according to pronuclear morphology. Subsequent frozen embryo thaw-transfer cycles were usually performed by thawing only the intended number of embryos for transfer.

Main Outcome Measure(s): Thaw survival rate, implantation rate, clinical pregnancy rate, delivery rate.

Result(s): Ninety-six thaw-transfer cycles (n = 72) and 93 thaw-transfer cycles (n = 67) were undertaken in patients who had previously undergone conventional IVF or ICSI, respectively. Embryo thaw survival rates (IVF, 90.4%; ICSI, 91.1%) were similar. Clinical pregnancy (IVF, 40.6%; ICSI, 44.1%) and delivery (IVF, 36.4%; ICSI, 39.8%) rates per transfer, as well as implantation (IVF, 19.1%; ICSI, 19.9%) rates, were also similar. There were only four clinical pregnancy losses in both groups.

Conclusion(s): Embryo thaw survival is similar for cryopreserved pronuclear stage oocytes derived from ICSI and conventional IVF. Clinical pregnancy, implantation and delivery rates were also similar for the two groups. In addition, there was no increase in the rate of pregnancy loss in ICSI patients after frozen embryo transfers.     

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。