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目的探讨早期补救卵泡浆内单精子注射(ICSI)在常规体外受精(IVF)中完全不受精或低受精的临床应用价值。方法回顾性分析2013年3月~2015年5月在本院生殖中心常规IVF治疗受精6h后判断为完全不受精或低受精而行早期补救ICSI的52周期患者,统计其实验室培养指标及临床结局,并与同期因男方因素而直接进行ICSI的127周期进行比较。结果早补救ICSI组的受精率、卵裂率、临床妊娠率及种植率和直接ICSI组比较差异无统计学意义(P>0.05),而优胚率、胚胎利用率及囊胚形成率显著低于直接ICSI组,两组差异有统计学意义(P<0.05)。结论早补救ICSI可作为常规IVF受精失败的补救措施具有较高的临床应用价值,但由于卵母细胞在体外的培养时间延长导致卵子老化,甚至会影响胚胎的发育潜能。建议对高度怀疑受精障碍尤其高龄(≥37岁)、获卵数≥8患者采用Half-ICSI以提高胚胎利用率和累积妊娠率。
Objective To investigate the clinical value of early recovery of intracytoplasmic sperm injection (ICSI) in complete in vitro fertilization (IVF) without fertilization or low fertilization. Methods A retrospective analysis was performed on 52 cycles of ICSI patients who were judged to be completely unfertilized or underwent fertilization 6 hours after routine IVF treatment in our reproductive center from March 2013 to May 2015. The laboratory culture parameters and clinical Outcome and compared with 127 cycles of direct ICSI for male factors over the same period. Results There was no significant difference in fertilization rate, cleavage rate, clinical pregnancy rate and implantation rate between ICSI group and ICSI group (P> 0.05), while the rate of excellent embryo, embryo utilization and blastocyst formation were significantly lower In the direct ICSI group, the difference between the two groups was statistically significant (P <0.05). Conclusion Early recovery of ICSI can be used as a remedy for conventional IVF fertilization failure with high clinical value, but due to prolonged incubation of oocytes in vitro lead to egg aging, and even affect the embryonic development potential. It is recommended that Half-ICSI be used to increase embryo utilization and cumulative pregnancy rates for highly suspected obstructive disorders, especially those aged> 37 years and those with oocytes> 8.