【摘要】 目的: 比较补救ICSI和同期实施的ICSI结果并评估补救ICSI的预后. 方法: 自2000 04 /2003 05我中心613个体外受精胚胎移植(IVF ET)周期中,有24个精液指标正常的常规IVF治疗周期为完全受精失败或(和)几乎完全受精失败,共有215个未受精的卵于常规IVF授精后20 ~22h实施ICSI再授精(补救ICSI),为补救ICSI组;同时期实施的178个周期的ICSI为对照组,将两组的结果相比较. 结果: 补救ICSI组受精率为48. 4%, 低于对照组受精率为56. 4%, 具有统计学意义(P<0. 05); 对照组的临床妊娠率和植入率分别为28. 1%和9. 8%, 而补救ICSI组获得3例妊娠,妊娠率为12. 5% 和植入率为4. 3%, 虽然无统计学意义(P>0. 05),但对照组的两项指标明显高于补救ICSI组. 遗憾的是补救ICSI组3例妊娠中有2例流产, 1例胎死腹中行引产. 结论: 尽管补救ICSI的预后非常差,但为了避免周期取消并为不孕夫妇争取一次受孕的机会,可以考虑实施补救ICSI. 关键是实施补救ICSI的时间选择,使卵处于最适宜的受精窗口内,获得有活力的胚胎并提高临床妊娠率.更多还原

【Abstract】 AIM: To compare the results of reinsemination by rescue ICSI of unfertilization oocytes in conventional IVF and those by ICSI during the same period and to evaluate the outcome of rescue ICSI. METHODS: In the total of 613 IVF-ET cycles from April 2000 to May 2003, there were 215 unfertilized oocytes from 24 conventional IVF cycles with total or near total fertilization failure. In cases where the semen seemed to be normal, reinseminated by ICSI was performed 20-22 h after conventional IVF insemination, and named rescue ICSI group. A matched control group with a total of 178 cycles undergoing ICSI during the same period was named ICSI group. RESULTS: A fertilization rate of 48.4% was achieved in rescue ICSI group, being lower than 56.4% in the control group ( P <0.05). All of the 24 cycles with total or near total fertilization failure had fresh transfers with rescue ICSI embryos (16 cycles with total fertilization failure and 8 patients with near total fertilization failure). The clinical pregnant rate and implantation rate in the control group were 28.1% and 9.8% respectively, whereas in rescue ICSI group the pregnant rate and implantation rate were 12.5% and of 4.3% ( P >0.05). Unfortunately, all of the 3 pregnancies in the rescue ICSI had abortion. CONCLUSION: Although the outcome after rescue ICSI is very poor, it should be considered in case of total or near total fertilization failure in conventional IVF so as to avoid cycle cancellation and obtain an additional chance of pregnancy for infertile couple. What counts is the time selection of rescue ICSI to establish fertilization within an optimal window and produce viable embryos and pregnancies.更多还原