【摘要】 目的 评估短时受精联合早期补救性卵胞浆内单精子注射(ICSI)术在重度畸形精子症患者中的临床应用。方法 235例重度畸形精子症患者(1%≤精子正常形态率<5%)行体外受精-胚胎移植(IVF-ET)周期随机分组,101例直接实施ICSI为A组,134例实施短时受精联合早期补救性ICSI为B组,短时受精后4~5h行极体观察,其中109例大于30%可见双极体列为B1组,25例早期判断未见双极体或小于30%未见双极体行早期补救性ICSI术列为B2组。比较不同组受精率、卵裂率、优质胚胎率、胚胎种植率及临床结局。结果 3组的卵子成熟率分别为83.93%,87.03%和90.48%,正常受精率分别为78.76%,72.49%和75.61%,异常受精率分别为6.11%,14.88%和9.76%,卵裂率分别为83.93%,85.89%和84.96%,优质胚胎率分别为49.45%,50.49%和53.23%,胚胎植入率分别为28.10%,26.67%和32.00%,临床妊娠率分别为43.66%,43.04%和47.62%,流产率分别为6.45%,8.82%和10.00%。3组的卵子成熟率、正常受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率、流产率差异均无统计学意义(P>0.05),异常受精率在B1组有增高趋势,与其它组比较差异无统计学意义(P>0.05)。结论 短时受精联合早期补救性ICSI在重度畸形精子症患者有应用价值,可以最大限度的减少ICSI比率,获得好的临床结局。更多还原

【Abstract】 Objective To evaluate clinical application of short-period fertilization combined with early rescue intracytoplasmic sperm injection(ICSI) technique in fertilization of severe abnormal sperm.Methods Total 235 patients with severe teratozoospermia(1%≤Normal sperm morphology rate<5%) for in vitro fertilization-embryo transfer(IVF-ET) cycles for egg were randomly divided into two groups.101 cases of direct implementation of the ICSI as group A,134 cases for short-period fertilization combined with early rescue ICSI as group B.Among group B,cumulus cells were removed after fertilization 4~5h,second polar body of oocytes was observed,in which 109 cases more than 30%visible bipolar body as B1 group,25 cases of early judgment no less than 30%of bipolar body performed early remedial ICSI surgery as a group B2.The fertilization rate,cleavage rate,high-quality embryo rate,implantation rate and clinical outcome were comparatively analyzed among different groups.Results Egg maturation rates of three groups were 83.93%,87.03%and 90.48%respectively,normal fertilization rates were 78.76%,72.49%and 75.61%,abnormal fertilization rates were 6.11%,14.88%and 9.76%,cleavage rates were 83.93%,85.89%and 84.96%,high-quality embryos were 49.45%,50.49%and 53.23%,implantation rates were 28.10%,26.67%and 32.00%,clinical pregnancy rates were 43.66%,43.04%and 47.62%,miscarriage rates were 6.45%,8.82%and 10.00%.there were no significant difference in egg maturation rate,normal fertilization rate,cleavage rate,high-quality embryo rate,implantation rate,clinical pregnancy,miscarriage rates among three groups different(P>0.05).Abnormal fertilization rate in group B had an increasing trend,but the difference was not statistically significant(P>0.05).Conclusion Short-period fertilization combined with early rescue Intracytoplasmic sperm injection(ICSI) show great value for fertilization of patients with severe abnormal sperm.A good clinical outcome can be obtained if minimizing the ICSI.更多还原