不明原因不孕患者不同受精方式妊娠结局比较  

Comparison of pregnancy outcomes of different fertilization methods in patients with unexplained infertility

作　　者：范莹露 黄月娇 田海清[1] 万晓慧[1] 祁静[1] 艾海权[1] 腊晓琳[1] FAN Yinglu;HUANG Yuejiao;TIAN Haiqing;WAN Xiaohui;QI Jing;Al Haiquan;LA Xiaolin(Department of Reproductive Deparlmenl,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830054,China;Chengduxinan Gynecologic Hospital,ChengDu,Sichuan 610000,China)

机构地区：[1]新疆医科大学第一附属医院生殖医学中心,乌鲁木齐830000 [2]成都西囡妇科医院,成都610000

出　　处：《新疆医学》2019年第2期123-126,130,共5页Xinjiang Medical Journal

基　　金：新疆维吾尔自治区自然科学基金(项目编号:2017D01C318)

摘　　要：目的比较不明原因不孕患者采用常规IVF与ICSI两种受精方式的临床结局。方法回顾性分析本中心采用half-ICSI方案的87例不明原因不孕患者。将每位患者超促排获取的成熟的同胞卵分为2组,分别行常规IVF与ICSI。并根据年龄不同分别分为三组,即:1组:(26~30)岁,2组:(31~35)岁,3组:(36~40)岁。比较两种受精方式在正常受精率、2PN卵裂率、可移植胚胎率、优胚率、生化妊娠率、着床率、临床妊娠率、抱婴率间的差异。结果 ICSI组正常受精率(72.6%)明显高于常规IVF组(52.5%),差异有统计学意义(P <0.001)。ICSI组的完全受精失败率(5.4%)明显低于常规IVF组(23.0%),差异有统计学意义(P=0.001)。两组在2PN卵裂率,可移植胚胎率,优质胚胎率、生化妊娠率、着床率、临床妊娠率、抱婴率方面均无统计学差异。在3个年龄组中,常规IVF组正常受精率均比ICSI组低,差异均有统计学意义;在(36~40)岁年龄组中,优胚率、可移植胚胎率常规IVF组均比ICSI组高,差异均有统计学意义。。结论获卵数目较多的不明原因不孕的第一周期患者,选用half-ICSI可避免发生完全受精失败。如获卵数目较少,可以根据患者意愿及经济情况适当放宽ICSI指征,但ICSI在大多情况下并不优于常规IVF。Objective To compare the clinical outcomes of conventional IVF and ICSI fertilization in patients with unexplained infertility. Methods 87 cases of unexplained infertility treated with half-ICSI in our center were retrospectively analyzed. Mature sibling eggs obtained by superovulation were divided into two groups, routine IVF and ICSI. According to age, they were divided into three groups:group 1: 26-30 years old, group 2: 31-35 years old, and group 3: 36-40 years old. The differences of normal fertilization rate, 2 PN cleavage rate, transplantable embryo rate, good embryo rate, biochemical pregnancy rate, implantation rate, clinical pregnancy rate and baby-holding rate between the two fertilization methods were compared. Results The normal fertilization rate(72.6%)in ICSI group was significantly higher than that of the conventional IVF group(52.5%), and the difference was statistically significant(P < 0.001). The failure rate of complete fertilization in ICSI group(5.4%)was significantly lower than that of the conventional IVF group(23.0%)and the difference was statistically significant(P = 0.001). There were no significant differences in cleavage rate, transplantable embryo rate, high quality embryo rate, biochemical pregnancy rate, implantation rate, clinical pregnancy rate and baby-holding rate between the two groups.Among the three age groups, the normal fertilization rate of the conventional IVF group was lower than that of the ICSI group, and the difference was statistically significant. In the 36-40 age group, the excellent embryo rate and the transplantable embryo rate of the conventional IVF group were higher than those of the ICSI group, and the difference was statistically significant. Conclusion Half-ICSI can avoid complete fertilization failure in the first cycle of unexplained infertility with a large number of eggs. If the number of eggs is small,ICSI indications can be relaxed according to patients’ wishes and economic conditions, but ICSI is not superior to conventional IVF in most cases.

关 键 词：不明原因不孕 体外受精-胚胎移植 卵胞浆内单精子注射 受精率 妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]