常规IVF完全/部分受精失败后行早期补救ICSI的应用

目的探讨常规短时受精联合早期补救卵胞浆内单精子注射(R-ICSI)在常规体外受精(IVF)失败和低受精率周期中的临床应用效果。方法回顾性分析2012年1月至2017年12月在河北省生殖医学中心接受IVF/ICSI-ET助孕治疗的2811个周期的临床资料,根据受精方式不同分为3组:R-ICSI组(210个周期):实施早期R-ICSI;IVF组(2062个周期):行常规IVF助孕;ICSI组(539个周期):直接行ICSI助孕。比较3组患者的一般情况、实验室指标和妊娠结局。结果R-ICSI组的原发不育比例显著高于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。3组患者的平均获卵数、移植胚胎数及MⅡ率比较均无显著性差异(P>0.05);R-ICSI组患者的受精率显著高于IVF组和ICSI组(P<0.05);R-ICSI组患者的2PN率显著低于ICSI组(P<0.05),但与IVF组比较无显著性差异(P>0.05);R-ICSI组的多PN率显著高于ICSI组,但显著低于IVF组(P<0.05);R-ICSI组患者的优胚率、可利用胚胎率及临床妊娠率均显著低于IVF组和ICSI组(P<0.05);R-ICSI组患者的着床率显著低于IVF组(P<0.05),但与ICSI组比较无显著性差异(P>0.05)。结论常规IVF受精失败及低受精的患者行早期R-ICSI可有效克服受精障碍,提高受精率,获得较好的妊娠结局。

Application of early rescue ICSI in complete or partial fertilization failure in conventional IVF cycles

Objective:To investigate the application value of short time fertilization combined with early rescue intracytoplasmic sperm injection(R-ICSI)in patients of complete or partial fertilization failure in conventional in IVF cycles.Methods:The data of 2811 IVF-ET cycles in department of reproductive center of our hospital from January 2012 to December 2017 were retrospectively analyzed.According to fertilization condition,the patients were divided into three groups:R-ICSI group(implement early rescue ICSI,n=210),IVF group(implement conventional IVF,n=2062),ICSI group(implement ICSI directly,n=539).The general information and pregnancy outcome were compared among the three groups.Results:The primary infertility rate in R-ICSI group was significantly higher than that in IVF group(P<0.05),but was not significantly different with ICSI group(P>0.05).There were no significant differences in the average number of oocytes retrieved,average number of embryos transferred and the MⅡrate among the three groups(P>0.05).The fertilization rate in R-ICSI group was significantly higher than that of IVF group and ICSI group(P<0.05).The 2PN embryo rate in group R-ICSI was significantly lower than that in ICSI group(P<0.05),but which was not significantly different with IVF group(P>0.05).The multi PN rate of R-ICSI group was significantly higher than that of ICSI group,but which was significantly lower than that of IVF group(P<0.05).The high quality embryo rate,available embryo rate and clinical pregnancy rate in R-ICSI group were significantly lower than those in IVF and ICSI group(P<0.05).The implantation rate in R-ICSI group was significantly lower than IVF group(P<0.05),but which was not significantly different with ICSI group(P>0.05).Conclusions:Early R-ICSI in patients with failed IVF fertilization or low fertilization rate can effectively overcome fertility disorders,improve fertilization rate,and obtain better pregnancy outcomes.