无明确原因原发性不孕患者行体外受精-胚胎移植治疗中受精方式的选择  

Fertilization method for primary infertility patients without definite cause undergoing in vitro fertilization and embryo transfer

作　　者：郭新宇[1,2] 张金玉[2] 林德伟[2] 于妍[2] 姚元庆[1] 

机构地区：[1]中国人民解放军总医院妇产科,北京100853 [2]广州军区总医院妇产科,广东广州510010

出　　处：《南方医科大学学报》2012年第2期218-220,共3页Journal of Southern Medical University

基　　金：国家973课题(2007CB948102)~~

摘　　要：目的探讨无明确原因原发不孕患者体外受精-胚胎移植(IVF-ET)周期如何选择合适的受精方式。方法回顾性分析无明确原因原发不孕患者行IVF-ET 321周期,按不孕年限分为A组≥5年共165周期,B组不孕年限<5年共156周期,各组中又按受精方式分为体外受精(IVF)、单精子卵细胞胞浆内注射(ICSI),部分ICSI组,以同时期输卵管因素行常规IVF受精周期和男性因素ICSI受精周期作为对照。分析比较各组间受精率、受精低下发生率和临床妊娠率。结果 A组1VF受精率低于ICSI与部分ICSI受精率(分别为67.5%,82.0%和77.7%,P<0.05),且低于同期IVF对照组(76.3%);A组IVF受精低下发生率明显高于ICSI与部分ICSI(33.3%,8.3%与15.8%,P<O.05),B组IVF受精低下发生率为12.3%,低于A组IVF受精方式,但与同组ICSI与halfICSI间受精低下发生率无统计学差异(P>0.05);A组IVF临床妊娠率21.1%,低于同期1VF对照组与同组ICSI与部分ICSI受精方式的临床妊娠率(分别为48%,43.3%与40.0%,P<0.05),且低于B组1VF妊娠率(50.0%,P<0.05)。结论无明确病因原发不孕患者行ICSI可改善受精率,对于不孕年限长患者,存在受精障碍的可能性高,行halfICSI或全部ICSI可以改善临床妊娠率。Objective To determine the optimal fertilization method for primary infertility patients without definite causes undergoing in vitro fertilization and embryos transfer（IVF-ET）.Methods A total of 321 IVF-ET cycles for primary infertility without definite causes were divided into two groups,namely group A with infertility period≥5 years（165 cycles） and group B with infertility period 5 years（156 cycles）.Each group was further divided into IVF,ICSI,and partial ICSI subgroups.The fertilization rate,incidence of low fertilization rate and clinical pregnancy rate were analyzed.Results The fertilization rate of IVF in group A was 67.5%,significantly lower than that of ICSI and partial ICSI in the same group（82.0%and 77.7% respectively） and that in IVF control group（76.3%,P〈0.05）.The incidence of low fertilization rate of IVF in group A was 33.3%, significantly lower than that of ICSI and partial ICSI（8.3%and 15.8%,P〈0.05）;in group B,the incidence of low fertilization rate of IVF was 12.3%,significantly lower than that of IVF in group A but showed no significant differences from that of ICSI and partial ICSI in group B（P〉0.05）.In group A,IVF resulted in a significantly lower clinical pregnancy rate（21.1%） than ICSI （43.3%,P〈0.05）,half ICSI（40.0%,P〈0.05）,IVF in the control group（48%,P〈0.05）,and IVF in group B（50.0%,P〈0.05）. Conclusion ICSI treatment can increase the fertilization rate in IVF-ET cycles in patients with primary infertility for unknown causes,and may improve the clinical outcome of patients with long infertility period.

关 键 词：原发性不孕症 体外受精-胚胎移植 单精子卵细胞胞浆内注射 受精方式 

分 类 号：R714.8[医药卫生—妇产科学]