常规体外受精失败卵母细胞行早期补救卵胞浆内显微注射的临床应用价值

目的探讨常规体外受精-胚胎移植（IVF—ET）中受精障碍患者行早期补救卵胞浆内单精子注射（ICSI）的可行性。方法回顾性分析我院生殖中心2007年1月至2009年7月常规IVF—ET治疗877周期，其中2008年3月至2009年7月期间开展短时受精并对受精障碍周期行早期补救ICSI的546周期作为研究组，2007年1月至2008年2月期间未开展短时受精、早期补救ICSI的331周期作为对照组。研究组通过IVF后6h观察卵母细胞是否排出第2极体评估受精，对完全未受精和低受精周期中未见第二极体排出的成熟卵母细胞立即行早期补救ICSI，比较两组临床及实验室指标。研究组中行早期补救ICSI的70周期实验室指标和临床指标与同期179个常规ICSI周期相比较。结果研究组通过早期补救ICSI，受精率、周期冷冻率、优质胚胎率均比对照组显著提高（P〈O．01），因受精失败取消移植率显著降低（P〈O．01）。早期补救ICSI周期受精率、可移植胚胎率、临床妊娠率及胚胎种植率与常规ICSI相似，正常受精率、卵裂率和优质胚胎率显著低于常规ICSI，≥3原核（PN）异常受精的比率较常规ICSI略有升高，但无显著性差异。结论IVF后6h行早期补救ICSI能提高常规IVF卵的利用率，并获得与常规ICSI相似的临床妊娠结局。

Application of rescue intracytoplasmic sperm injection in the cases of fertilization failure of conventional in vitro fertilization

Objective： To analyze the outcomes of rescue intracytoplasmic sperm injection （ICSI） of unfertilized oocytes 6 hours after conventional in vitro fertilization （IVF）. Methods： A total of 877 IVF cycles in our center between January 2007 and July 2009 were retrospec- tively studied. Of which 546 cycles of rescue ICSl 6 hours after insemination were as study group and the other 331 conventional IVF cycles as control. Another 179 conventional ICSI cycles at the same period were as method control. The rates of fertilization, cleavage, good-quality embryo, transferrable embryo, embryo cryopreservation, cycle cancellation, implantation and clinical pregnancy were compared between groups. Results： With rescue ICSI, the fertilization rate, good-quality embryo rate and cryopreservation rate were significantly higher while cycle cancellation rate was significantly lower in study group than those in control group （P〈0. 01）. Compared with those of conventional ICSI group, the rates of fertilization, transferrable embryo, implantation and clinical pregnancy in study group were comparable （P〉0.05）, but the rates of normal fertilization, cleavage and good-quality embryo were significantly lower （P〈0.01, P〈0.05 and P〈0.01, respectively）. Conclusions： Rescue ICSI 6 hours after insemination could improve the utility of oocytes and achieve a clinical pregnancy rate comparable to that of conventional ICSI.