体外助孕治疗周期中分半进行IVF和ICSI的指征  

Indications of conventional IVF and ICSI split cycles in in vitro reproductive technology

作　　者：陆小溦[1] 冯云[1] 张爱军[1] 孙贻娟[1] 张慧琴[1] 牛志宏[1] 

机构地区：[1]上海交通大学医学院瑞金医院妇产科生殖医学中心,上海200025

出　　处：《上海交通大学学报（医学版）》2008年第3期256-259,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的对体外助孕治疗周期中存在不受精可能且上游有效精子数量不低于500万的夫妇分半进行常规体外受精（IVF）与卵胞浆内单精子显微注射（ICSI）治疗，探讨是否存在分半治疗的必要性以及指征选择的可行性。方法2002年3月～2007年6月接受体外助孕的夫妇中选取符合指征周期，采用常规超排卵方案，同一周期取得的卵子随机分半，分别进行常规IVF与ICSI治疗。卵裂球≥5个且卵裂球碎片〈50％的胚胎为可用胚胎。结果共有94周期进入分半治疗周期，其中常规IVF受精失败或低下（LFR）22周期（23．40％）；同期常规IVF治疗530周期，其中LFR36周期（6．79％）；两者有显著差异（P=5．26×10^-6）。94分半周期共获1596枚卵子，其中行常规IVF781枚，受精率55．19％；行ICSI815枚，MⅡ616枚，受精率72．02％；两者有显著差异（P=2．59×10^-12）。94周期卵裂983枚，可用胚胎554枚，临床妊娠率为35．7l％。结论存在同一治疗周期分半进行常规IVF与ICSI的指征和必要性，可明显减少不受精情况的出现；对常规IVF与ICSI均受精的周期，可选择移植常规IVF胚胎，减少子代遗传和先天缺陷风险。Objective The couples with the possibility of no fertilization and upstream effective sperm quantity no less than 5 million in assisted reproduction technology cycles were treated by conventional in vitro fertilization （IVF） and intracytoplast single sperm injection （ICSI） in one cycle （half-ICSI cycles） through spliting the oocytes into two parts, and the necessity and indications of the treatment were determined. Methods From March 2002 to June 2007, oocytes chosen randomly from the cycles in accordance with the indications were performed conventional IVF and ICSI separately in one cycle. The embryos with blastomere number I〉 5 and blastomere fragment 〈 50% were the available ones. Results A total of 94 cycles were performed half-ICSI treatment, among which 22 （ 23.40% ） experienced fertilization failure or low fertilization rate （LFR） in conventional IVF. During the same period, 530 cycles were performed conventional IVF, and 36 （6.79%） experienced LFR. There were significant differences between the above findings （P =5.26×10-6）. A total of 1 596 oocytes were gained from the 94 half-ICSI cycles, among which 781 oocytes were perfomed conventional IVF with the fertilization rate of 55.19% and the other 815 were performed ICSI with 616 in M Ⅱ period and the fertilization rate of 72.02%. There was also significant difference between the above two findings （P = 2.59×10^-12）. There were a total of 983 cleavage embryos in the 94 cycles, of which 554 were available ones, and the clinical pregnancy rate was 35. 71%. Conclusion There are indications and necessity of spliting oocytes to perform conventional IVF and ICSI in one cycle in order to minimize the risk of fertilization failure. For the cycles with fertilization both in conventional IVF and ICSI, the option of conventional IVF embryos transplantation may reduce the risks of genetic and congenital defect of the offspring.

关 键 词：分半周期 体外受精 卵胞浆内单精子显微注射 受精失败或低下发生率 

分 类 号：R714.8[医药卫生—妇产科学]