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

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%,P0.05);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。

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

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.