常规IVF中受精失败相关因素及后续处理结果分析

目的:分析常规IVF受精失败原因,以进一步提高IVF受精率。方法:回顾性分析常规IVF中受精率低下或受精失败患者的各种因素及后续处理结果。结果:438个常规IVF取卵周期中,受精率≤25%的周期30个(A组)(6.85%)。其中12个周期第1日行补救性ICSI或重复IVF,最终共20个周期进行了胚胎移植,但均未获得临床妊娠。与受精率正常的周期(B组)相比,A组精子密度、活率、a级精子比例、前向运动精子比例(PMS)及分离后的精子活率、PMS比例、精子密度等均显著降低(P均<0.05)。组间的获卵数无明显差别,但A组MI期及GV期卵的数量明显高于B组(P<0.01)。其他受精失败因素包括对精子因素导致受精失败的7例在随后的周期进行ICSI,5例获得临床妊娠。结论:受精失败的原因是多方面的,但精液各参数下降及卵子发育不成熟是其主要原因;第1日行补救性ICSI或重复IVF的妊娠结局差;对于精子因素造成的受精失败,在以后的周期中行ICSI能获得理想的结果。

Factors Relating with Fertilization Failure and Subsequent Treatment Outcomes in Conventional IVF-ET Cycles

Objective: To analyze the factors relating with fertilization failure in conventional IVF cycles so as to increase the fertilization rate for further clinical treatment. Methods: Relating factors of patients with fertilization failure or low fertilization rate in conventional IVF cycles and the further treatment outcomes were retrospectively analyzed. Results: In 438 conventional IVF cycles, there were 30 cycles (6.85%) with fertilization rate <25% (group A). Among these 30 cycles, rescue ICSI or repeated IVF was carried out at d 1 in 12 cycles, and finally there were 20 cycles with embryo transfer, but no clinical pregnancy was obtained. The sperm density, motility, grade a motility, percentage of progressive motile sperm (PMS), total progressive motile sperm count (TPMSC) and the separated sperm motility, percentage of PMS, concentration in group A were significantly lower than those in normal fertilization rate group (group B) (all P<0.05). The number of retrieved oocytes had no significant difference between group A and group B, but the oocyte number at M_I and GV stage in group A was significantly more as compared with those in group B (all P<0.01). The other factors relating with fertilization failure included sever teratospermia, bacterial contaminant semen, oocyte development block and so on. Among patients with fertilized-failure result of sperm factors, 7 patients were fertilized with ICSI in the next cycles, and there were 5 patients with clinical pregnancy. Conclusion: Many factors are related with fertilization failure. However, low semen parameters or poor sperm quality and immature oocytes are main factors. Outcome of recuse ICSI at d 1 or repeated IVF is poor. ICSI selected in the next cycle may give satisfactory outcomes for fertilization failure patient relating with sperm factors.