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目的:探讨短时受精联合早期补救ICSI在不明原因性不孕治疗中的应用价值。方法:对118例不明原因不孕患者(A组)行短时受精,于IVF受精后4~6 h去颗粒细胞,观察第二极体(Pb2)排出情况;若所有成熟卵细胞均未排出Pb2或大部分成熟卵细胞(>70%)无Pb2则及时行补救ICSI(A2组),未行补救ICSI的则归为A1组。同时选择85例行常规IVF的不明原因不孕患者作为对照组(B组),比较2种受精方法的结局。结果:A组118个周期中有72个周期(A1组)未行补救ICSI;46个周期(A2组)行早期补救ICSI。A1组共763个成熟卵中490个卵受精后6~8 h观察到Pb2,24 h过夜后观察到2原核(2PN)。A组未发生受精完全失败,但其中2例(A2组)因受精卵有多个明显的PN而放弃胚胎移植。B组85个周期中有17个周期因完全受精失败无可移植胚胎放弃移植,完全受精失败率为20.0%,明显高于A组(0%)(P<0.01)。A组总受精率明显高于B组(74.6%vs 56.2%)(P<0.05);卵裂率、可用胚胎率、胚胎种植率、移植周期妊娠率、流产率、多胎率A、B组间均无统计学差异(P>0.05)。A2组的多精受精率较其它各组(A1组、B组)未见明显增高(P>0.05)。A组的起始周期妊娠率(32.2%)略高于B组(25.0%),但无统计学差异(P>0.05)。结论:短时受精联合早期补救ICSI作为预防不明原因性不孕患者中可能发生受精失败的策略,可以获得较高的受精率、胚胎种植率以及临床妊娠率。
Objective: To investigate the value of short-term fertilization combined with early rescue ICSI in the treatment of unexplained infertility. Methods: A total of 118 patients with unexplained infertility (group A) underwent short-term fertilization. The granulocytes were removed 4 to 6 h after IVF fertilization and the discharge of the second polar body (Pb2) was observed. If all mature oocytes did not excrete Pb2 Or most of the mature oocytes (> 70%) without Pb2 in a timely manner to remedy ICSI (A2 group), without remedial ICSI are classified as A1 group. At the same time, 85 patients with unexplained infertility who underwent conventional IVF were selected as the control group (group B), and the outcomes of the two fertilization methods were compared. Results: 72 cycles (group A1) of 118 cycles in group A did not recover ICSI, and 46 cycles (group A2) received ICSI in early stage. Pb2 was observed 6-8 h after fertilization of 490 eggs of 763 mature eggs in group A1, and 2 prokaryotic (2PN) was observed after 24 h. A group of patients failed to complete fertilization failure, but two of them (A2 group) because of fertilized eggs have a number of obvious PN and give up embryo transfer. In group B, 17 cycles of 85 cycles failed to be completely transplanted due to incomplete fertilization. The rate of complete fertilization failure was 20.0%, which was significantly higher than that of group A (0%) (P <0.01). The total fertilization rate in group A was significantly higher than that in group B (74.6% vs 56.2%, P <0.05). The cleavage rate, available embryo rate, embryo implantation rate, pregnancy rate in transplantation, abortion rate, No statistical difference (P> 0.05). The fertilization rate of A2 group was not significantly higher than that of other groups (Group A1 and Group B) (P> 0.05). The initial cycle pregnancy rate (32.2%) in group A was slightly higher than that in group B (25.0%), but there was no significant difference (P> 0.05). Conclusion: Short-term fertilization combined with early rescue ICSI can prevent fertilization failure in patients with unexplained infertility, and can achieve higher fertilization rate, embryo implantation rate and clinical pregnancy rate.