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| 短时IVF联合早期补救ICSI与half-ICSI预防初次助孕周期受精低下的比较 |
| 刘苡萱,印惠荣,颜宏利,孙方臻,施敏凤,冯书改,松迪,许亚军,洪毅,蔡艳萍,朱旻*,张慧琴* |
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(第二军医大学长海医院生殖医学中心, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 对比分析短时体外受精（IVF）或短时IVF联合早期补救卵胞浆内单精子显微注射（ICSI）与部分卵胞浆内单精子显微注射（half-ICSI）两种授精方式在首次助孕周期对预防IVF受精率低下的疗效。方法 回顾性分析2015年5月1日-2016年12月31日初次助孕周期中因存在精卵结合障碍高危因素而接受短时IVF（或短时IVF联合联合早期补救ICSI）或half-ICSI预防IVF受精率低下患者的病例资料。根据授精方式分为短时IVF助孕组（A组，n=192）和half-ICSI助孕组（B组，n=85），比较两组患者的一般情况、受精情况、胚胎发育以及接受新鲜胚胎移植后的妊娠结局。为进一步分析受精情况，筛选A、B两组中IVF受精率低下周期（受精率≤ 30%）的患者，分别设为A1组（n=20）和B1组（n=9），比较A1、B1两组的卵子受精情况。结果 与B组相比，A组不存在过度ICSI（0.0% vs 89.8%，χ2=479.888，P<0.01）。A组正常受精率低于B组（73.3% vs 79.6%，χ2=14.780，P<0.01），但两组可用胚胎率、优质胚胎率、囊胚形成率以及接受新鲜胚胎移植后临床妊娠率、胚胎着床率、流产率差异均无统计学意义（P均>0.05）。IVF受精率低下周期中，短时IVF联合早期补救ICSI可提高正常受精率（A1组77.9%，B1组49.4%，χ2=28.833，P<0.01）。结论 相比half-ICSI，短时IVF联合早期补救ICSI可避免过度ICSI、提高IVF受精率低下周期的正常受精率，预防IVF受精率低下更加精确、有效。 |
| 关键词: 受精率低下 部分卵胞浆内单精子显微注射 体外受精 早期补救卵胞浆内单精子显微注射 |
| DOI：10.16781/j.0258-879x.2017.11.1418 |
| 投稿时间：2017-04-19修订日期：2017-09-06 |
| 基金项目: |
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| Comparative analysis of short-term in vitro fertilization (IVF) combined with early rescue ICSI and half-ICSI in prevention of low fertilization in initial IVF cycles |
| LIU Yi-xuan,YIN Hui-rong,YAN Hong-li,SUN Fang-zhen,SHI Min-feng,FENG Shu-gai,SONG Di,XU Ya-jun,HONG Yi,CAI Yan-ping,ZHU Min*,ZHANG Hui-qin* |
(Department of Reproductive Medicine Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To compare the efficacy of short-term in vitro fertilization (IVF) combined with early rescue intracytoplasmic sperm injection (ICSI) and half-ICSI in preventing low IVF fertilization in initial IVF cycles. Methods Data of patients with high-risk factors of sperm-egg binding disorders during initial IVF cycles, who received short-term IVF combined with early rescue ICSI (Group A, n=192) or half-ICSI (Group B, n=85) to prevent low IVF fertilization from May. 1, 2015, to Dec. 31, 2016, were retrospectivey analyzed. The general characteristics, fertilization, embryo formation, and pregnancy outcome after receiving fresh embryo transfer of patients were compared between the two groups. Patients with low IVF fertilization (fertilization rate ≤ 30%) in the two groups were selected as Group A1 (n=20) and Group B1(n=9), respectively, and then the fertilization outcomes in the two groups were compared. Results There were no significant differences in general characteristics between the two groups. Compared with Group B, there was no excessive ICSI in Group A (0.0% vs 89.8%, χ2=479.888, P<0.01). The normal fertilization rate in the Group A was significantly lower than that in the Group B (73.3% vs 79.6%, χ2=14.780, P<0.01), while there were no significant differences in available embryo rate, good-quality embryo rate, blastocyst formation rate, clinical pregnancy rate, embryo implantation rate or abortion rate between the two groups(all P>0.05). In the cycles with low IVF fertilization, the normal fertilization rate in the Group A1 was significantly increased versus the Group B1 (77.9% vs 49.4%, χ2=28.823, P<0.01). Conclusion Compared with half-ICSI, short-term IVF combined with early rescue ICSI can avoid excessive ICSI and increase the normal fertilization rate in low IVF fertilization cycles, indicating that it is more accurate and effective in prevention of low IVF fertilization. |
| Key words: low fertilization rate half-intracytoplasmic sperm injection short-term in vitro fertilization early rescue intracytoplasmic sperm injection |
