不同时间行早期补救ICSI在IVF完全受精失败周期中的临床结局

目的探讨短时授精后判定为完全受精失败患者于不同时间行补救ICSI的临床结局。方法回顾性分析2010年1月至2019年4月在南京医科大学第一附属医院临床生殖医学中心行短时授精后完全受精失败的补救ICSI周期。符合纳入标准的病例共607个周期,根据IVF授精后行补救ICSI时间的不同分为4组:授精后4~5 h(A组,n=55);B组:授精后5~6 h(B组,n=219);C组:授精后6~7 h(C组,n=117);授精后>7 h(D组,n=216)。统计分析各组患者的一般临床资料、实验室数据和临床结局指标。结果4组的正常受精率、多精受精率、卵裂率和流产率比较均无统计学差异(P>0.05);D组的优质胚胎率显著低于其他3组(50.91%vs.59.14%、63.14%、56.80%)(P<0.05);D组的临床妊娠率、胚胎着床率和每移植周期活产率均低于其他3组,且与B组和C组有统计学差异(P<0.05)。结论对于短时授精发生完全受精失败的周期,授精后4~7 h行补救ICSI可获得理想的临床结局,其中授精后5~6 h行补救ICSI的临床结局最好,应尽量避免授精后7 h行补救ICSI。

Clinical outcomes of early rescue ICSI at different time in complete fertilization failure cycles

Objective:To investigate the clinical outcomes of rescue ICSI at different time in patients with complete fertilization failure after short-term insemination.Methods:A retrospective analysis was conducted on the rescue ICSI cycle of complete fertilization failure after short-term insemination in the Clinical Reproductive Medicine Center of the First Affiliated Hospital of Nanjing Medical University from January 2010 to April 2019.A total of 607 IVF cycles met the inclusion criteria were divided to four groups according to the different time of rescue ICSI after insemination:group A:4-5 hours(n=55);group B:5-6 hours(n=219);group C:6-7 hours(n=117)and group D:>7 hours(n=216).The general clinical data,laboratory data and clinical outcome indexes were analyzed.Results:There were no differences of normal fertilization rate,polyspermy fertilization rate,cleavage rate and abortion rate among the four groups(P>0.05).The high-quality embryo rate in group D was significantly lower than that in the other three groups(50.91%vs.59.14%,63.14%,56.80%,P<0.05).The clinical pregnancy rate,embryo implantation rate and live birth rate per transfer cycle of group D were significantly lower than those of group B and C(P<0.05).Conclusions:For the cycle of complete fertilization failure after short-term insemination,rescue ICSI at 4-7 hours after insemination can obtain ideal clinical outcome.Among them,rescue ICSI at 5-6 hours after insemination has the best clinical outcome.Rescue ICSI at 7 hours after insemination should be avoided as far as possible.