体外受精后6h应对受精失败的补救措施探讨

目的比较分析体外受精(IVF)后6 h补救卵胞浆内单精子注射(ICSI)和half ICSI应对受精失败的优劣。方法16例IVF完全受精失败周期采卵当日选取4个卵母细胞行ICSI,其余卵行常规IVF(half ICSI组);39例IVF完全受精失败周期在常规IVF后6 h补救ICSI(6 h补救ICSI组),比较两组的实验室指标。结果6 h补救ICSI组的受精率和冷冻胚胎比率显著高于half ICSI组,(分别为P0.01、P0.05);两组的卵裂率和优质胚胎比率无显著差异,妊娠率、种植率和累积妊娠率也无显著差异。结论IVF后6 h补救ICSI可应用在所有IVF周期,ICSI指征明确;half ICSI只能应用于不明原因不孕患者。工作中经患者知情同意后,在优先选择IVF后6 h补救ICSI的前提下,结合应用half ICSI,可提高受精失败患者的临床结局。

Analysis of rescue ICSI and half ICSI 6 hours after IVF in prevention of fertilization failure

Objective： To analyze the advantages and disadvantages of rescue intracytoplasmic sperm injection （ICSI） after in vitro fertilization （IVF） and half ICSI in the treatment of fertilization failure. Methods： Sixteen IVF fertilization failure cycles were treated by conventional IVF and ICSI in one cycle （half-ICSI）. In another 39 IVF fertilization failure cycles, rescue ICSI of unfertilized oocytes were performed 6 hours after IVF （rescue ICSI）. Laboratory parameters were compared in two groups. Results： Fertilization rate and freezing embryo rate in rescue ICSI group were significantly higher than those in half ICSI group. The rates of cleavage and good-quality embryo showed no significant difference between two groups. No significant difference was found in the rates of pregnancy, implantation or accumulated implantation either. Conclusions： Rescue ICSI could be applied in all IVF cycles, with clear indications, while half ICSI can only be applied in the unexplained infertility patients. To improve the clinical outcome of the patient with total fertilization failure, rescue ICSI could be the first choice.