胞浆内单精子注射并不能改善临床结局，尽管它对胚胎结果有积极影响：1130 半 ICSI 治疗的回顾性分析。
Intracytoplasmic Sperm Injection May Not Improve Clinical Outcomes Despite Its Positive Effect on Embryo Results: A Retrospective Analysis of 1130 Half-ICSI Treatments.
机构信息
Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China.
Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 15;13:877471. doi: 10.3389/fendo.2022.877471. eCollection 2022.
OBJECTIVE
To explore the clinical application value of half-ICSI treatment for infertility in assisted reproductive technology.
METHOD
A retrospective analysis of 1130 half-ICSI treatments was conducted at the Affiliated Reproductive Hospital of Shandong University from January 2011 to December 2015. Patients with low fertilization rates in previous cycles, primary infertility for >5 years with unexplained reason, or secondary infertility for >5 years without fallopian tube factor were involved in this study. The 2PN rate, high-quality embryo rate, oocyte utilization rate, and clinical outcomes were compared between IVF insemination group (IVF group) and ICSI insemination group (ICSI group). The clinical outcome of half-ICSI insemination treatment, grouped according primary and secondary infertility, was also analyzed.
RESULTS
Compared with IVF, ICSI resulted in a significantly higher 2PN rate (74.8% vs. 62.9%), high-quality embryo rate (54.6% vs. 51.7%), and oocyte utilization rate (35.9% vs. 32.8%; P<0.05). Among the 884 fresh-embryo transfer cycles, there were no notable differences in clinical pregnancy rate, live birth rate, or neonatal abnormality rate between the IVF and ICSI groups. Among the 792 primary infertility cycles, ICSI resulted in a significantly higher 2PN rate, high-quality embryo rate, and oocyte utilization rate compared with IVF (75.3% vs. 62.4%, 54.3% vs. 50.8%, 36.4% vs. 32.6%, P<0.05). For the 338 secondary infertility cycles, ICSI resulted in a significantly higher 2PN rate (73.6% vs. 63.9%, P<0.05) compared with IVF, but there were no notable differences in other laboratory results. Moreover, the biochemical pregnancy rate of the ICSI group was significantly lower than for IVF in secondary infertility cycles (49.3% vs. 65.6%; P<0.05). A total of 89 cycles (7.9%) with complete IVF fertilization failure showed a low second polar body (2PB) rate (33.6%) after a 5-h short-time fertilization period, including 34 cycles (3.0%) with no 2PB oocytes observed in the IVF group.
CONCLUSION
ICSI insemination improved laboratory results compared with IVF insemination, however, fresh-embryo transfer of ICSI originated embryos did not improve clinical pregnancy and live birth rates. Rescue ICSI has been successfully applied in clinical IVF insemination to avoid fertilization failure. Therefore, as an extra intervention, it is suggested that ICSI be used judiciously.
目的
探讨在辅助生殖技术中采用半单精子注射（ICSI）治疗不孕的临床应用价值。
方法
回顾性分析 2011 年 1 月至 2015 年 12 月在山东大学附属生殖医院接受半 ICSI 治疗的 1130 个周期。本研究纳入的患者为既往周期受精率低、不明原因原发性不孕>5 年或无输卵管因素的继发性不孕>5 年。比较体外受精（IVF）组和 ICSI 组的 2 原核（2PN）率、优质胚胎率、卵母细胞利用率和临床结局。还根据原发性和继发性不孕对接受半 ICSI 治疗的患者进行分组，分析其临床结局。
结果
与 IVF 相比，ICSI 可显著提高 2PN 率（74.8% vs. 62.9%）、优质胚胎率（54.6% vs. 51.7%）和卵母细胞利用率（35.9% vs. 32.8%；P<0.05）。在 884 个新鲜胚胎移植周期中，IVF 组和 ICSI 组的临床妊娠率、活产率和新生儿异常率无显著差异。在 792 个原发性不孕周期中，ICSI 组的 2PN 率、优质胚胎率和卵母细胞利用率均显著高于 IVF 组（75.3% vs. 62.4%、54.3% vs. 50.8%、36.4% vs. 32.6%；P<0.05）。对于 338 个继发性不孕周期，ICSI 组的 2PN 率显著高于 IVF 组（73.6% vs. 63.9%；P<0.05），但其他实验室结果无显著差异。此外，ICSI 组的生化妊娠率明显低于 IVF 组（49.3% vs. 65.6%；P<0.05）。89 个周期（7.9%）完全受精失败，在 5 小时短时间受精后，第二极体（2PB）率较低（33.6%），其中 34 个周期（3.0%）观察到 IVF 组无 2PB 卵母细胞。
结论
与 IVF 相比，ICSI 可改善实验室结果，但 ICSI 胚胎的新鲜胚胎移植并未提高临床妊娠率和活产率。ICSI 已成功应用于临床 IVF 受精失败的挽救，因此作为一种额外的干预措施，建议谨慎使用 ICSI。
Zotero 插件