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目的探讨常规体外受精(IVF)完全失败后行补救卵胞浆内单精子注射(补救ICSI)在冻融胚胎移植(FET)中的临床应用价值。方法选择2013年11月-2015年11月在解放军第455医院生殖医学中心常规接受ICSI治疗的359个周期为常规ICSI组(对照组),62例行补救ICSI者纳入补救ICSI组(在常规IVF完全失败后于受精后16~20 h行补救ICSI)。采取回顾性分析方法,比较两组受精率、卵裂率、胚胎质量及临床结局。结果 (1)该中心2013年11月-2015年11月,共行常规IVF为1 109个周期,受精完全失败62个周期,失败率为5.6%;共行half-ICSI 5个周期,其中1个周期IVF部分受精完全失败,失败率为20.0%。(2)补救ICSI组异常受精率显著高于常规ICSI组、优质胚胎率及可利用胚胎率均显著低于常规ICSI组,差异有统计学意义(χ~2=27.132、118.077、16.914,P<0.01),而两组间MII卵的比例、正常受精率及卵裂率比较,差异均无统计学意义(χ~2=0.622、0.581、1.647,P>0.05)。(3)补救ICSI组新鲜胚胎移植(ET)有1个周期未孕,移植的2个胚胎为八细胞二级和五细胞二级。(4)补救ICSI组行FET的胚胎临床妊娠率(32.1%)及种植率(16.8%)显著低于常规ICSI组(47.2%和26.1%),差异均有统计学意义(χ~2=4.519、7.155,P<0.05)。结论对不孕患者在常规IVF完全失败后,于受精后16~20 h行补救ICSI FET周期可降低周期取消率,可相对改善胚胎发育速度与患者子宫内膜发育的同步性,获得相对较好的临床妊娠率。受精后16~20 h补救ICSI可作为常规IVF完全失败周期的补救措施。
Objective To investigate the clinical value of intracytoplasmic sperm injection (ICSI) rescue in frozen-thawed embryo transfer (FET) after complete failure of conventional in vitro fertilization (IVF). METHODS: From November 2013 to November 2015, 359 cycles routinely receiving ICSI in the Reproductive Medicine Center of the 455 Hospital of People’s Liberation Army were routine ICSI group (control group) and 62 cases of ICSI were included in the ICSI group (routine IVF Complete failure after fertilization 16 ~ 20 h line ICSI). Retrospective analysis was used to compare fertilization rate, cleavage rate, embryo quality and clinical outcome. Results (1) From November 2013 to November 2015, the routine IVF of this center was 1 109 cycles, the failure of fertilization completely failed 62 cycles and the failure rate was 5.6%. Half-ICSI had 5 cycles, of which 1 Part IVF partial fertilization failed completely, the failure rate was 20.0%. (2) The rate of abnormal fertilization in ICSI group was significantly higher than that in routine ICSI group, the rate of high-quality embryos and available embryos were significantly lower than that of routine ICSI group (χ ~ 2 = 27.132,118.077,16.914, P < 0.01). There was no significant difference in MII egg ratio, normal fertilization rate and cleavage rate between the two groups (χ ~ 2 = 0.622,0.581,1.647, P> 0.05). (3) Recovery ICSI group fresh embryo transfer (ET) a period of non-pregnancy, transplanted 2 embryos for the eight cells of two and five cells two. (4) The clinical pregnancy rate (32.1%) and the implantation rate (16.8%) in the ICSI group were significantly lower than those in the ICSI group (47.2% and 26.1%), the differences were statistically significant (χ ~ 2 = 4.519 , 7.155, P <0.05). Conclusions After sterilized IVF completely failed, infertile patients underwent ICSI FET cycle recuperation at 16-20 h after fertilization to reduce the cycle cancellation rate, which could improve the synchrony of embryo development rate and endometrium development relatively well The clinical pregnancy rate. Remedial ICSI 16-20 h after fertilization can be used as a remedy for a complete IVF failure cycle.