ICSI对高龄非男性因素不孕患者生育结局的影响

目的回顾性分析高龄非男性因素不孕患者ICSI或IVF受精后的临床结局,探讨ICSI在这类患者中的应用。方法回顾性分析2016~2018年期间在重庆妇幼保健院因非男性因素不孕接受微刺激促排卵方案治疗的高龄女性患者(≥38岁)的临床资料,根据受精方式分为ICSI组(n=189,共334个周期)和IVF组(n=189,共325个周期)。比较两组之间周期取消率、2PN受精率、优胚率、流产率及活产率的差异。结果两组之间患者年龄和获卵数均无显著性差异(P>0.05);ICSI组MⅡ卵率(85.92%vs. 92.27%)显著低于IVF组,2PN受精率(77.87%vs. 71.77%)和卵裂率(98.53%vs. 96.27%)显著高于IVF组(P均<0.05);两组之间的周期取消率、优胚率、胚胎冷冻率、流产率及活产率均无显著性差异(P>0.05)。结论 ICSI不能改善高龄非男性因素不孕患者胚胎质量和临床结局,此类患者首次助孕应选择IVF授精方式,而前次无2PN胚胎取消周期史的患者ICSI虽不能规避再次取消周期的风险但可有效改善其妊娠结局。

Influence of ICSI on pregnancy outcomes in patients with advanced maternal age and non-male factor infertility

Objective:To retrospectively analyze the clinical outcomes of ICSI or IVF insemination in advanced-age patients with non-male factor infertility,and to explore the application of ICSI for these patients.Methods:The clinical data of the patients aged≥38 with non-male factor infertility who received mild stimulation for ovulation induction in Chongqing Reproductive and Genetics Institute from 2016 to 2018 were collected and analyzed.According to the mode of fertilization,the patients were divided to ICSI group(189 patients/334 cycles)and IVF group(189 patients/325 cycles).The cancellation cycle rate,2PN fertilization rate,high quality embryos rate,clinical miscarriage rate and live birth rate were compared between the two groups.Results:There were no significant difference in age and number of oocytes retrieved between the two groups(P>0.05).The MⅡoocytes rate in ICSI group was significantly lower than that in IVF group(85.92%vs.92.27%,P<0.05).The 2PN fertilization rate(77.87%vs.71.77%)and cleavage rate(98.53%vs.96.27%)in ICSI group were significantly higher than those in IVF group(P<0.05).There were no significant differences in cancellation cycle rate,high quality embryos rate,freezing embryo rate,abortion rate and live rate between the two groups(P>0.05).Conclusions:ICSI cannot improve embryo quality and clinical outcomes in advanced-age patients with non-male factor infertility.IVF should be used for them in the first time of ART.While ICSI can effectively improve the pregnancy outcomes for the patients who cancelled cycles because of no 2PN embryo.