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【目的】探讨常规体外受精胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)不受精时,应用卵母细胞单精子显微注射(intracytoplasmic sperm injection,ICSI)技术进行补救授精的临床意义。【方法】2001年8月～2005年8月,在499个常规IVF-ET周期中有25个周期完全不受精,进行补救ICSI,并与同期实施的179个正常ICSI周期进行比较。【结果】补救ICSI组与正常ICSI组比较,HCG日平均血清雌二醇水平、每个成熟卵泡平均血清雌二醇量、每个周期的获卵数无明显差别,补救ICSI受精率为57.7%,低于正常ICSI组(67.8%),补救ICSI组平均每个周期获得胚胎数(7.8±3.9)比正常ICSI(10.0±4.9)组少,且有统计学意义(P<0.01)。补救ICSI组≥4细胞的胚胎占总胚胎数的54.5%,低于正常ICSI组(87.5%),有统计学意义(P<0.01)。正常ICSI组妊娠率为38.5%,补救ICSI组无一例妊娠。补救ICSI组中有8例在下一周期行ICSI,有2例妊娠并分娩2个健康女婴。【结论】补救ICSI虽可以避免取消IVF周期,但其受精率和妊娠率低,其临床应用价值还有待于进一步探讨。对于常规IVF不受精的患者,再次治疗时可考虑行ICSI助孕。
【Objective】 To investigate the clinical significance of using oocyte scytoplasmic sperm injection (ICSI) technique to rescue and fertilize when in vitro fertilization and embryo transfer (IVF-ET) is not fertilized. 【Methods】 From August 2001 to August 2005, 25 cycles of 499 routine IVF-ET cycles were completely unfertilized, ICSI was remedied and compared with 179 normal ICSI cycles performed in the same period. 【Results】 Compared with normal ICSI group, the average serum estradiol level of HCG and the average serum estradiol level of each mature follicle in ICSI group were no significant difference. The ICSI fertilization rate was 57.7% , Which was lower than that of the normal ICSI group (67.8%). The mean number of embryos retrieved in each ICSI group (7.8 ± 3.9) was significantly lower than that in the normal ICSI group (10.0 ± 4.9) (P <0.01). The number of embryos in ICSI group (≥4 cells) was 54.5% of that in ICSI group (87.5%), which was statistically significant (P <0.01). Pregnancy rate was 38.5% in the normal ICSI group and none in the ICSI group. Eight patients in the Remedy ICSI group had ICSIs in the next cycle, with two pregnancies and two healthy baby births delivered. 【Conclusion】 Salvage ICSI can avoid the abolition of IVF cycle, but the fertilization rate and pregnancy rate are low, its clinical value remains to be further explored. For patients with conventional IVF insemination, ICSI can be considered for re-treatment.