常规体外受精完全失败后补行卵胞浆内单精子注射的应用价值

目的：探讨IVF-ET周期中,对常规IVF完全受精失败的卵子补行卵胞浆内单精子注射精子（Rescue ICSI）的临床应用价值。方法：在常规IVF后18-22 h,对体外受精完全失败的12个周期、85个未受精MⅡ期卵行补行ICSI。以同时期进行ICSI的34个周期、226个MⅡ期卵为对照,比较ICSI结局。结果：补救ICSI组与对照组比较,基础内分泌指标,HCG日平均血清雌二醇和孕激素水平、子宫内膜厚度,获MⅡ期卵个数以及平均移植胚胎个数,无显著性差异。补救ICSI组受精率和卵裂率分别为78.82%、91.04%,与对照组（受精率为80.09%,卵裂率为95.58%）比较,差异无统计学意义。取卵后第3天,补救ICSI组卵裂球数≥5的优质胚胎比例占13.11%,低于对照ICSI组（73.99%）,差异有显著性（P〈0.05）。对照ICSI组妊娠率为38.24%,补救ICSI组无一例妊娠。结论：补行ICSI虽然可使常规IVF中未受精卵受精并获得胚胎,但是所得胚胎的发育潜能差,妊娠率极低,临床应用价值有限。

The Application Value of Rescue ICSI after Complete Fertilization Failure in Conventional IVF

Objective： To assess the value of intracytoplasmic sperm injection （ICSI） for ＂rescue＂ of completely failed conventional in vitro fertilization （IVF） cycles. Methods： Rescue ICSI was performed on 85 metaphase Ⅱ （M Ⅱ） oocytes in 12 conventional IVF cycles with complete fertilization failure. Thirty-four ICSI cycles （226 M Ⅱ oocytes） during the same period were included as control. Results： Patients＇ characteristics such as the hormone levels, the thickness of endometrium on the HCG administration day, the number of M Ⅱ occytes for ICSI and the average number of embryo transferred, were comparable in the two groups. The fertilization and cleavage rates in rescue ICSI group were 78.82%, 91.04% respectively, which did not differ significantly compared to the control group （80.09% and 95.58%, respectively） （P〉0.05）. Rescue ICSI showed a significantly lower proportion of good- quality embryos with ≥5 blastomeres on day 3 after oocytes retrieval than that of the control （13.11% vs 73.99 %） （P〈0.05）. The pregnancy rate in control group was 38. 24% while no pregnancy was obtained in rescue ICSI group. Conclusion： The potential of the embryos ensuing from rescue ICSI to achieve pregnancy is extremely poor. Therefore, the application value of rescue ICSI after complete failure of fertilization is rather trivial.