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。

Analysis of 112 cycle were treated by conventional in vitro fertilization and intracytoplast single sperm injection in one cycle

Objective：The couples were treated by conventional in vitro fertilization（IVF） and intracytoplast single sperm injection（ICSI） in one cycle（half-ICSI cycles） through spliting the oocytes into two parts,and the necessity and indications of the treatment were explored.Methods：The outcomes of the patients from Jan.2004 to Dec.2008,oocytes chosen randomly from the cycles in accordance with the indication were performed conventional IVF and ICSI separately in one cycle.According to the treatment they were divided into three group：group A（Oligoasthenoteratozoospermia on male）,group B（the patients who experienced fertilization failure after IVF）,group C（the couples with unexplained in fertility underging）,which experienced fertilization failure or low fertilization rate（LFR） in conventional IVF.Results：A total of 112 cycles were performed half-ICSI treatment among with 38（33.9%） experienced fertilization failure or low fertilization rate（LFR） in conventional IVF.During the same period,1377cycles were performed conventional IVF and 96（7.0%） experienced LFR.There were significant differences between the above findings（P 0.05）.A total of 1633 oocytes were gained from the 112 half-ICSI cycles,among which 766 oocyters were performed conventional IVF with the fertilization rate of 54.7% and the other 867 were performed ICSI 765 in MⅡ period and the fertilization rate of 84.3%.They were also significant difference between the above two findings（P 0.05）.The clinical pregnancy rate was 32.0%.Conclusion：There are indications and necessity of splitting oocytes to perform conventional IVF and ICSI in one cycle in order to minimize the risk of fertilization failure.For the cycles with fertilization both in conventional IVF and ICSI,the option of conventional IVF embryos transplantation may reduce the risks of genetic and congenital defect of the offspring.