单精子卵胞浆内注射治疗周期受精情况、临床结局及出生缺陷的研究
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摘要
第一部分不同参数不同来源精子行ICSI治疗受精情况、临床结局及出生缺陷的分析
研究目的
回顾性分析因非男性因素及男性因素不孕而采用行卵胞浆内单精子注射-胚胎移植(ICSI-ET)治疗时的受精情况、临床结局以及子代出生缺陷的发生有无差异,非男性因素精子来源于射精液,其精液常规参数正常或轻度异常,男性因素精子来源于射精液(严重少弱精子症)、附睾和睾丸,探索不同参数、不同来源精子采用ICSI治疗对临床结局和出生缺陷的影响。
资料与方法
分析2003年1月-2008年12月在南方医院生殖医学中心接受ICSI-ET治疗的不孕患者,其中资料完整并列入统计分析的共980周期。根据男方精液参数与精子来源不同,共分为以下四组:
A组:精子密度和活率正常:精子密度≥20.0x10~6/ml且精子活动率＞50%,或轻度异常:精子密度10～20x10~6和(或)活动率＜50%,共168周期;
B组:重度少弱精子症:精液密度＜5x10~6/ml和(或)活动率＜10%,共610周期;
C组:附睾精子组:男方梗阻性无精子症,共156周期;
D组:睾丸精子组:分为以下三种情况:a.男方精液常规正常,但取卵当日取精困难,共16周期;b.梗阻性无精子症附睾取精失败,共46周期;c.非梗阻性无精子症,共6周期。
女方采用本中心常规超促排卵方案,并在B超引导下取卵,男方于取卵当日手淫取精或附睾穿刺取精(PESA)或睾丸穿刺取精(TESA)取精,选取形态正常的活动精子对每个成熟卵母细胞行ICSI操作,培养观察患者所有的卵子受精、卵裂及形成胚胎情况,选择优质胚胎于取卵后第三天或第五天移植,并继续随访患者妊娠及分娩情况,分析患者的基本特征、受精和胚胎情况以及临床结局。
结果
四组的正常受精率、异常受精率、正常卵裂率及优质胚胎率无显著性差异(P＞0.05);C组的胚胎着床率、临床妊娠率高于A组与B组(P＜0.05);A组(正常或轻度异常精液)的出生缺陷率为2.3%,B组(严重少弱精子症)为5.3%,C组(附睾精子)为6.9%,无显著性差异(P＞0.05),D组(睾丸精子)未发生出生缺陷。
结论1.不同参数、不同来源精子行ICSI治疗均能获得相似的令人满意的受精率、卵裂率、优质胚胎率和分娩率。
2.附睾精子组获得的胚胎着床率与临床妊娠率较高,可能与本组患者年龄较轻、获卵数较多有关。
3.ICSI子代出生缺陷发生的机率随着精子数量的减少、活力的降低以及成熟度的降低有升高的趋势,尚不能认为ICSI子代出生缺陷的发生与ICSI操作技术本身直接相关。
第二部分同一取卵周期采用IVF结合ICSI治疗的受精情况、临床结局和出生缺陷的分析
研究目的
分析和比较由于因单项或多项不孕因素的原发性及继发性不孕症患者于同一取卵周期实施常规体外受精(IVF)及卵胞浆内单精子注射(ICSI)治疗的受精情况、胚胎质量、临床结局与出生缺陷的差异,分析移植ICSI胚胎与常规IVF胚胎的临床结局与出生缺陷的差异,为探讨同期卵采用IVF及ICSI治疗的适应症和安全性提供依据。
资料和方法
分析2003年1月-2008年12月在南方医院生殖医学中心接受IVF结合ICSI治疗的不孕患者,共纳入研究对象149例。根据IVF的适应症及原发性、继发性不孕分类,分为以下两组:
(1)原发性不孕症(不明原因不孕症除外)组,不孕年限≥4年,共98例。其中合并男方精液参数属于行IVF或ICSI的临界值(1×10~6/ml≤精子密度＜5x10~6和(或)1%≤精子活力(a+b级)＜10%)者11例(11.2%);合并上周期IVF受精率偏低(30%≤受精率＜50%)者1例(1.0%),其它为盆腔输卵管因素性、子宫内膜异位症和PCOS的患者共86例(87.8%)。
(2)继发性不孕症组,共51例。其中合并男方临界精液者21例(41.0%);合并上周期IVF受精率偏低者1例(2.0%);合并其他指征不明原因不孕症者29例。其他原因者,如反复IVF治疗失败(周期数≥3)、不明原因继发性不孕症等,共29例(56.9%)。
女方超促排卵和取卵同第一部分,共取卵2175个。每例患者均对同一周期卵采用IVF结合ICSI授精,1095个卵子行常规IVF受精,1080个卵子行ICSI受精。分析各组的正常受精率、异常受精率、正常卵裂率、优质胚胎率、临床妊娠率和出生缺陷。
结果
1、对同期卵子进行常规IVF结合ICSI治疗时,ICSI部分之正常受精率、优质胚胎率及优质胚胎数高于常规IVF,多精异常受精率低于IVF(P＜0.05);
2、原发性不孕症组的常规IVF完全未受精率10.2%,高于继发性不孕症组3.9%,,无显著性差异(P＞0.05),原发性与继发性不孕症行ICSI均未出现受精失败;原发性不孕组与继发性不孕组患者的ICSI正常受精率高于常规IVF,多精异常受精率低于IVF(P＜0.05);原发性与继发性不孕症两组间及分别合并男方因素的两组间受精与临床结局无显著性差异(P＞0.05);
3、ICSI来源胚胎移植后的胚胎着床率、临床妊娠率及分娩率高于常规IVF胚胎移植组及IVF与ICSI混合胚胎移植组,出生缺陷率低于常规IVF胚胎组及混移胚胎组,尚无统计学差异(P＞0.05),可能与样本量较小有关。
结论
1.对同期卵采用常规IVF结合ICSI治疗时,ICSI技术可以提高正常受精率、降低多精异常受精率、改善胚胎质量,增加优质胚胎数目,提高临床妊娠率。
2.合并单项或多项男女不孕因素的原发性不孕症患者与继发性不孕症采用IVF结合ICSI治疗能获得满意的临床效果,尤其是对原发性不孕患者,可避免由于同时存在其它明确病因对选择受精方式及治疗结局的影响,因原发性不孕症患者较继发性不孕症患者,有更易发生IVF受精失败的趋势。
3.ICSI受精来源胚胎临床结局有优于IVF胚胎的趋势,且与常规IVF胚胎相比,无增加胎儿出生缺陷的趋势,但样本量不足,需增大样本量进一步研究。
PartⅠAnalysis of fertilization,clinical outcomes and birth defects undergoing ICSI treatment using different sources and parameter sperm
OBJECTIVE
To explore the fertilization,cilinical outcomes and birth defects of infertiled women undergoing ICSI treatment using nomal or mildly abnormal parameters semen because of non-male factor and highly abnormal semen,epididymal and testicular semen because of male factor and study the influence on ICSI treatment outcomes because of different sources and parameters sperm.
MATERIALS AND METHODS
980 cases of infertile women undergoing ICSI-ET treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008. According to the sources and parameters of sperm of husband,980 patients were divided into 4 groups.(1) The normal sperm group,refers to the ejaculated sperm for ICSI treatment,sperm density≥20.0x106/ml and sperm activity rate＞50%or sperm density＜20x106 and(or) activity rate of＜50%,a total of 168 circles.(2) The highly abnormal semen group,refers to the ejaculated sperm for ICSI treatment,sperm density＜5x106/ml and(or) activity rate of＜10%,a total of 610 circles.(3) Epididymal sperm groups,obstructive azoospermia patients with access to sperm through percutaneous epididymal sperm aspiration(PESA).A total of 156 circles.(4) Testicular sperm group,male sperm by masturbation obtained failure or epididymal sperm obtained failure or non-obstructive azoospermia patients with sperm obtained through testicular sperm acquisition(TESA) techniques,a total of 46 circles.
Infertile women using the conventional superovulation program of the Center to retrieve oocytes under the guiding of ultrasound.The semen of their husbands was acquired by masturbation or PESA or TESA on the day of oocyte retrieval and select motile sperm which eumorphism to proceed ICSI operation for every mature egg. Fertilization,cleavage and embtyo formation were observed and recorded.On the three day or five day of oocyte retrieval,high-grade embryos were selected to transfer and treatment outcomes was followed up.Embryo quality and clinical outcomes of patients were analyzed when they were treated with ICSI-ET by different sources and parameter semen.
RESULTS
There were no significant difference of the normal fertilization rate,abnormal fertilization rate,normal cleavage rate and good-quality embryo rate among four groups(P＞0.05),the embryo implantation rate and clinical pregnancy rate of C group were higher than A and B groups(P＜0.05).The birth defects rate of A group was 2.3 %,B group was 5.3%,C group 6.9%,the differences were not significant(P＞0.05).
CONCLUSIONS
1.Different parameters and sources of semen used in ICSI treatment achieved satisfactory fertilization rate,cleavage rate and good- quality embryo rates and delivery rate.
2.The higher embryo implantation rate and clinical pregnancy rate of epididymal sperm group than A and B groups may be related to the younger patients and the more number eggs.
3.The probability of occurrence of birth defects in ICSI offspring may increased by different parameters and sources of semen used in ICSI treatment respect to decrease in quantity,reduction in vitality and degree of maturity in sperm.,we can not believe that the probability of occurrence of birth defects in ICSI offspring is directly related to the ICSI operation itself.
PartⅡThe analysis of fertility,clinical outcomes and birth defects by IVF and ICSI treatment in the same cycle
OBJECTIVE
To analyze and compare the discrepancy of fertilization,clinical outcomes and birth defects using the implementation of conventional in vitro fertilization(IVF) and intracytoplasmic sperm injection(ICSI) respectively in the same cycle because of single or a number of infertile factors in primary and secondary infertility patients.To analyze the discrepancy of clinical outcomes and birth defects between ICSI embryos and conventional IVF embryos transplantation.To provide a basis for exploring with respect to the indication and security of IVF + ICSI treatment.
MATERIALS AND METHODS
149 cases of infertile women by IVF+ICSI treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008.
According to the indication and primary or secondary infertility,the following was divided into two groups,(1) Primary infertility group(excepting unexplained infertility),infertile time≥four years,a totle of 98 cases.Of the group,there were 11 cases(11.2%) which combining male semen parameter belongs to the line of IVF or ICSI threshold(1×106/ml≤sperm density＜5x106 and(or) 1%≤sperm motility (a + b grades)＜10%),1 case(1.0%) of which have the low IVF fertilization(30≤fertilization rate≤50%) in prior cycles,86 cases(87.8%) which have other factors as pelvic tubal factors,endometriosis or PCOS.(2) Secondary infertility group,a totle of 51 cases.Of the group,there were 21 cases(41.0%) which combining male semen parameter belongs to the line of IVF or ICSI threshold,1 case (2.0%) of which have the low IVF fertilization in prior cycles,29 cases(56.9%) which with other indication as repeated IVF treatment failure(≥3 cycles),unexplained secondary infertility and so on.
The superovulation program and retrieving oocytes of infertile women were the same as PartⅠ.There were 2175 eggs retrieved,each patient using IVF+ICSI insemination on the same cycle eggs.Of which,there were 1095 eggs for the IVF insemiation and 1080 for ICSI insemination.To analyze the normal fertilization,abnormal fertilization,normal cleavage rate,high- quality embryo rate clinical pregnancy rate and birth defects rate.
RESULTS
1.When insemination on eggs retrieved in same circle by IVF+ICSI,the normal fertilization rate,high-quality embryo rate,and the number of high-quality embryos of ICSI insemination were higher than that of IVF,more sperm abnormal feitilization rate was lower than IVF.
2.The fully un-fertilization rate of conventional IVF part in primary infertility group was 10.2%,which was higher than in secondary infertility group(3.9%),there was no significant difference between the two groups(P＞0.05).There was no fully un-fertilization rate in ICSI insemination in the two groups.The normal fertilization rate in ICSI part was higher than conventional IVF part,more sperm abnormal fertilization was lower than IVF in the two groups(P＜0.05).There were no significant difference in fertilization and clinical outcomes between the two groups which combining male factor or not(P＞0.05).
3.The embryo implantation rate,clinical pregnancyrate and dilivery rate from the ICSI embryo transferation were higher than conventional IVF embryo group and IVF+ICSI embryo groups,birth defects rate lower than the other groups,There was no significant difference amoung the three groups temporarily(P＞0.05),which may be related to insufficient sample size.
CONCLUSIONS
1.When insemination on eggs retrieved in same circle by IVF+ICSI,ICSI treatment can improve normal fertilization rate,decrease more sperm abnormal fertilization rate,improve embtyo quality,increase the number of high-quality embryo and improve clinical pregnancy rate.
2.There are more susceptible to the trend of IVF insemination failure in Patients with primary infertility than in patients with secondary infertility.
3.Combining single or a number of infertile factors,primary infertility patients and secondary infertility patients by IVF+ICSI treatment can get satisfied clinical results, particularly in patients with primary infertility.
4.The trend of clinical outcomes by ICSI embryos transferation was better than IVF embryos,and compared with IVF embryos,and there were no increase in birth defects.But the sample size was insufficient,we should increase the sample size for further study.
研究目的
回顾性分析因非男性因素及男性因素不孕而采用行卵胞浆内单精子注射-胚胎移植(ICSI-ET)治疗时的受精情况、临床结局以及子代出生缺陷的发生有无差异,非男性因素精子来源于射精液,其精液常规参数正常或轻度异常,男性因素精子来源于射精液(严重少弱精子症)、附睾和睾丸,探索不同参数、不同来源精子采用ICSI治疗对临床结局和出生缺陷的影响。
资料与方法
分析2003年1月-2008年12月在南方医院生殖医学中心接受ICSI-ET治疗的不孕患者,其中资料完整并列入统计分析的共980周期。根据男方精液参数与精子来源不同,共分为以下四组:
A组:精子密度和活率正常:精子密度≥20.0x10~6/ml且精子活动率＞50%,或轻度异常:精子密度10～20x10~6和(或)活动率＜50%,共168周期;
B组:重度少弱精子症:精液密度＜5x10~6/ml和(或)活动率＜10%,共610周期;
C组:附睾精子组:男方梗阻性无精子症,共156周期;
D组:睾丸精子组:分为以下三种情况:a.男方精液常规正常,但取卵当日取精困难,共16周期;b.梗阻性无精子症附睾取精失败,共46周期;c.非梗阻性无精子症,共6周期。
女方采用本中心常规超促排卵方案,并在B超引导下取卵,男方于取卵当日手淫取精或附睾穿刺取精(PESA)或睾丸穿刺取精(TESA)取精,选取形态正常的活动精子对每个成熟卵母细胞行ICSI操作,培养观察患者所有的卵子受精、卵裂及形成胚胎情况,选择优质胚胎于取卵后第三天或第五天移植,并继续随访患者妊娠及分娩情况,分析患者的基本特征、受精和胚胎情况以及临床结局。
结果
四组的正常受精率、异常受精率、正常卵裂率及优质胚胎率无显著性差异(P＞0.05);C组的胚胎着床率、临床妊娠率高于A组与B组(P＜0.05);A组(正常或轻度异常精液)的出生缺陷率为2.3%,B组(严重少弱精子症)为5.3%,C组(附睾精子)为6.9%,无显著性差异(P＞0.05),D组(睾丸精子)未发生出生缺陷。
结论1.不同参数、不同来源精子行ICSI治疗均能获得相似的令人满意的受精率、卵裂率、优质胚胎率和分娩率。
2.附睾精子组获得的胚胎着床率与临床妊娠率较高,可能与本组患者年龄较轻、获卵数较多有关。
3.ICSI子代出生缺陷发生的机率随着精子数量的减少、活力的降低以及成熟度的降低有升高的趋势,尚不能认为ICSI子代出生缺陷的发生与ICSI操作技术本身直接相关。
第二部分同一取卵周期采用IVF结合ICSI治疗的受精情况、临床结局和出生缺陷的分析
研究目的
分析和比较由于因单项或多项不孕因素的原发性及继发性不孕症患者于同一取卵周期实施常规体外受精(IVF)及卵胞浆内单精子注射(ICSI)治疗的受精情况、胚胎质量、临床结局与出生缺陷的差异,分析移植ICSI胚胎与常规IVF胚胎的临床结局与出生缺陷的差异,为探讨同期卵采用IVF及ICSI治疗的适应症和安全性提供依据。
资料和方法
分析2003年1月-2008年12月在南方医院生殖医学中心接受IVF结合ICSI治疗的不孕患者,共纳入研究对象149例。根据IVF的适应症及原发性、继发性不孕分类,分为以下两组:
(1)原发性不孕症(不明原因不孕症除外)组,不孕年限≥4年,共98例。其中合并男方精液参数属于行IVF或ICSI的临界值(1×10~6/ml≤精子密度＜5x10~6和(或)1%≤精子活力(a+b级)＜10%)者11例(11.2%);合并上周期IVF受精率偏低(30%≤受精率＜50%)者1例(1.0%),其它为盆腔输卵管因素性、子宫内膜异位症和PCOS的患者共86例(87.8%)。
(2)继发性不孕症组,共51例。其中合并男方临界精液者21例(41.0%);合并上周期IVF受精率偏低者1例(2.0%);合并其他指征不明原因不孕症者29例。其他原因者,如反复IVF治疗失败(周期数≥3)、不明原因继发性不孕症等,共29例(56.9%)。
女方超促排卵和取卵同第一部分,共取卵2175个。每例患者均对同一周期卵采用IVF结合ICSI授精,1095个卵子行常规IVF受精,1080个卵子行ICSI受精。分析各组的正常受精率、异常受精率、正常卵裂率、优质胚胎率、临床妊娠率和出生缺陷。
结果
1、对同期卵子进行常规IVF结合ICSI治疗时,ICSI部分之正常受精率、优质胚胎率及优质胚胎数高于常规IVF,多精异常受精率低于IVF(P＜0.05);
2、原发性不孕症组的常规IVF完全未受精率10.2%,高于继发性不孕症组3.9%,,无显著性差异(P＞0.05),原发性与继发性不孕症行ICSI均未出现受精失败;原发性不孕组与继发性不孕组患者的ICSI正常受精率高于常规IVF,多精异常受精率低于IVF(P＜0.05);原发性与继发性不孕症两组间及分别合并男方因素的两组间受精与临床结局无显著性差异(P＞0.05);
3、ICSI来源胚胎移植后的胚胎着床率、临床妊娠率及分娩率高于常规IVF胚胎移植组及IVF与ICSI混合胚胎移植组,出生缺陷率低于常规IVF胚胎组及混移胚胎组,尚无统计学差异(P＞0.05),可能与样本量较小有关。
结论
1.对同期卵采用常规IVF结合ICSI治疗时,ICSI技术可以提高正常受精率、降低多精异常受精率、改善胚胎质量,增加优质胚胎数目,提高临床妊娠率。
2.合并单项或多项男女不孕因素的原发性不孕症患者与继发性不孕症采用IVF结合ICSI治疗能获得满意的临床效果,尤其是对原发性不孕患者,可避免由于同时存在其它明确病因对选择受精方式及治疗结局的影响,因原发性不孕症患者较继发性不孕症患者,有更易发生IVF受精失败的趋势。
3.ICSI受精来源胚胎临床结局有优于IVF胚胎的趋势,且与常规IVF胚胎相比,无增加胎儿出生缺陷的趋势,但样本量不足,需增大样本量进一步研究。
PartⅠAnalysis of fertilization,clinical outcomes and birth defects undergoing ICSI treatment using different sources and parameter sperm
OBJECTIVE
To explore the fertilization,cilinical outcomes and birth defects of infertiled women undergoing ICSI treatment using nomal or mildly abnormal parameters semen because of non-male factor and highly abnormal semen,epididymal and testicular semen because of male factor and study the influence on ICSI treatment outcomes because of different sources and parameters sperm.
MATERIALS AND METHODS
980 cases of infertile women undergoing ICSI-ET treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008. According to the sources and parameters of sperm of husband,980 patients were divided into 4 groups.(1) The normal sperm group,refers to the ejaculated sperm for ICSI treatment,sperm density≥20.0x106/ml and sperm activity rate＞50%or sperm density＜20x106 and(or) activity rate of＜50%,a total of 168 circles.(2) The highly abnormal semen group,refers to the ejaculated sperm for ICSI treatment,sperm density＜5x106/ml and(or) activity rate of＜10%,a total of 610 circles.(3) Epididymal sperm groups,obstructive azoospermia patients with access to sperm through percutaneous epididymal sperm aspiration(PESA).A total of 156 circles.(4) Testicular sperm group,male sperm by masturbation obtained failure or epididymal sperm obtained failure or non-obstructive azoospermia patients with sperm obtained through testicular sperm acquisition(TESA) techniques,a total of 46 circles.
Infertile women using the conventional superovulation program of the Center to retrieve oocytes under the guiding of ultrasound.The semen of their husbands was acquired by masturbation or PESA or TESA on the day of oocyte retrieval and select motile sperm which eumorphism to proceed ICSI operation for every mature egg. Fertilization,cleavage and embtyo formation were observed and recorded.On the three day or five day of oocyte retrieval,high-grade embryos were selected to transfer and treatment outcomes was followed up.Embryo quality and clinical outcomes of patients were analyzed when they were treated with ICSI-ET by different sources and parameter semen.
RESULTS
There were no significant difference of the normal fertilization rate,abnormal fertilization rate,normal cleavage rate and good-quality embryo rate among four groups(P＞0.05),the embryo implantation rate and clinical pregnancy rate of C group were higher than A and B groups(P＜0.05).The birth defects rate of A group was 2.3 %,B group was 5.3%,C group 6.9%,the differences were not significant(P＞0.05).
CONCLUSIONS
1.Different parameters and sources of semen used in ICSI treatment achieved satisfactory fertilization rate,cleavage rate and good- quality embryo rates and delivery rate.
2.The higher embryo implantation rate and clinical pregnancy rate of epididymal sperm group than A and B groups may be related to the younger patients and the more number eggs.
3.The probability of occurrence of birth defects in ICSI offspring may increased by different parameters and sources of semen used in ICSI treatment respect to decrease in quantity,reduction in vitality and degree of maturity in sperm.,we can not believe that the probability of occurrence of birth defects in ICSI offspring is directly related to the ICSI operation itself.
PartⅡThe analysis of fertility,clinical outcomes and birth defects by IVF and ICSI treatment in the same cycle
OBJECTIVE
To analyze and compare the discrepancy of fertilization,clinical outcomes and birth defects using the implementation of conventional in vitro fertilization(IVF) and intracytoplasmic sperm injection(ICSI) respectively in the same cycle because of single or a number of infertile factors in primary and secondary infertility patients.To analyze the discrepancy of clinical outcomes and birth defects between ICSI embryos and conventional IVF embryos transplantation.To provide a basis for exploring with respect to the indication and security of IVF + ICSI treatment.
MATERIALS AND METHODS
149 cases of infertile women by IVF+ICSI treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008.
According to the indication and primary or secondary infertility,the following was divided into two groups,(1) Primary infertility group(excepting unexplained infertility),infertile time≥four years,a totle of 98 cases.Of the group,there were 11 cases(11.2%) which combining male semen parameter belongs to the line of IVF or ICSI threshold(1×106/ml≤sperm density＜5x106 and(or) 1%≤sperm motility (a + b grades)＜10%),1 case(1.0%) of which have the low IVF fertilization(30≤fertilization rate≤50%) in prior cycles,86 cases(87.8%) which have other factors as pelvic tubal factors,endometriosis or PCOS.(2) Secondary infertility group,a totle of 51 cases.Of the group,there were 21 cases(41.0%) which combining male semen parameter belongs to the line of IVF or ICSI threshold,1 case (2.0%) of which have the low IVF fertilization in prior cycles,29 cases(56.9%) which with other indication as repeated IVF treatment failure(≥3 cycles),unexplained secondary infertility and so on.
The superovulation program and retrieving oocytes of infertile women were the same as PartⅠ.There were 2175 eggs retrieved,each patient using IVF+ICSI insemination on the same cycle eggs.Of which,there were 1095 eggs for the IVF insemiation and 1080 for ICSI insemination.To analyze the normal fertilization,abnormal fertilization,normal cleavage rate,high- quality embryo rate clinical pregnancy rate and birth defects rate.
RESULTS
1.When insemination on eggs retrieved in same circle by IVF+ICSI,the normal fertilization rate,high-quality embryo rate,and the number of high-quality embryos of ICSI insemination were higher than that of IVF,more sperm abnormal feitilization rate was lower than IVF.
2.The fully un-fertilization rate of conventional IVF part in primary infertility group was 10.2%,which was higher than in secondary infertility group(3.9%),there was no significant difference between the two groups(P＞0.05).There was no fully un-fertilization rate in ICSI insemination in the two groups.The normal fertilization rate in ICSI part was higher than conventional IVF part,more sperm abnormal fertilization was lower than IVF in the two groups(P＜0.05).There were no significant difference in fertilization and clinical outcomes between the two groups which combining male factor or not(P＞0.05).
3.The embryo implantation rate,clinical pregnancyrate and dilivery rate from the ICSI embryo transferation were higher than conventional IVF embryo group and IVF+ICSI embryo groups,birth defects rate lower than the other groups,There was no significant difference amoung the three groups temporarily(P＞0.05),which may be related to insufficient sample size.
CONCLUSIONS
1.When insemination on eggs retrieved in same circle by IVF+ICSI,ICSI treatment can improve normal fertilization rate,decrease more sperm abnormal fertilization rate,improve embtyo quality,increase the number of high-quality embryo and improve clinical pregnancy rate.
2.There are more susceptible to the trend of IVF insemination failure in Patients with primary infertility than in patients with secondary infertility.
3.Combining single or a number of infertile factors,primary infertility patients and secondary infertility patients by IVF+ICSI treatment can get satisfied clinical results, particularly in patients with primary infertility.
4.The trend of clinical outcomes by ICSI embryos transferation was better than IVF embryos,and compared with IVF embryos,and there were no increase in birth defects.But the sample size was insufficient,we should increase the sample size for further study.
引文
1.Palermo G,Joris H,Deveroey P,et al.Pregnancies after intracytoplasmic injection of single sperm atozoon into an oocyte[J].Lancet,1992,340(1):17-18.
2.Andersen AN,Carisen E,Loft A.Trends in the use of intracytoplasmatic sperm injection marked variability between countries[J].Hum Reprod Update,2008,14:593-604.
3,.Jain T;Gupta RS.Trends in the use of intracytoplasmatic Sperm Injection in the United States[J].N Engl J Med 2007,357:251-257.
4.CDC.Center for Disease Control.National Summary and Fertility Clinic Reports,2005.US Department of Health and Human Services.Reproductive Health.Assisted Reproductive Teclmology,2007.www.Cdc.org.
5.Liu DY,Baker HWG.Test of human sperm function and fertilization in vitro[J].Fertil Steril,1992,58:465-83.
6.Liu DY,Baker HWG.Defective sperm-zona pellucida interaction:a major cause of failure of fertilization in clinical in-vitro feitilization[J].Hum Reprod,2000,15:702-708.
7.Mohamed A,Ragaa T,Gamal I,et al.Fertilization and Pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm.Fertil Steril,1997,68(1):108-11.
8.Goker EN,Sendag F,Levi R,et al.Comparison of the ICSI outcome of ejaculated sperm with normal,abnormal parameters and testicular sperm.Eur J Obstet Gynecol Reprod Biol,2002,104(2):129-36.
9.Hammadeh ME,al-Hasani S,Doerr S,et al.Comparison between chromatin condensation and morphology from testis biopsy extracted and ejaculated spermatozoa and their relationship to ICSI outcome[J].Hum Reprod,1999,14(2):363-7.
10.许张晔,叶碧绿,黄学峰等.不同来源精子对ICSI治疗后妊娠结局的影响[J].中国男科学杂志,2007,21(1):41-44.
11.王晶,丛林,曹云霞等.原发不孕患者IVF/ICSI方案的选择[J].现代妇产科 进展,2008,17(8):579-581.
12.Roest J,Van Heusden AM,Zeilmaker GH,et al.Treatment Policy After Fertilization in the First IVF Cycle[J].J Assist Reprod Genet,1998,15:18-21.
13.Lucette van der Westerlaken,M.Sc.,Nico Naaktgeboren,Ph.D.,Harjo Verburg,M.D.et al.Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen:a randomized study using sibling oocytes[J].Fertility and Sterility,2006,85(2).
14.Dumoulin JCM,Derhaag JG,Bras M,et al.Growth rate of human preimplantation embryos is sex dependent after ICSI but not IVF[J].Hum Reprod,2005,20(2):484-491.
15.Ashwood-Smith MJ,Edwards RG.DNA repair by oocytes Mol[J].Hum Reprod,1996,2:46.
16.胡海燕,郭小燕,吕淑兰.单精子卵胞浆内注射后代安全性的评估[J].中国妇幼健康研究,2006,17(4):319-321.
17.Sbracia M,Baldi M,Cao D,et al.Preferential location of sex chromosomes,their aneuploidy in human sperm,and their role in determining sex chromosome aneuploidy in embryos after ICSI.Hum Reprod 2002,17(2):320-324.
18.陈士岭,黎淑贞,孙玲等.1274例经体外受精-胚胎移植治疗分娩新生儿结局分析[J].南方医科大学学报,2007,27(4):439-41.
19.Palermo G,Adler A,Cohen J.Intracytoplasmic sperm injection:a novel treatment for all forms of male factor infertility[J].Fertil Steril,1995,63:1231-1240.
20.Sathananthan A,Ratman S,Ng S,et al.Hum Reprod Update,1999,5:552-560.
21.Aytoz A,Camus M,Tournaye H,et al.Outcomes of pregnancy intracyopasmic sperm injection and the effect of sperm quality on this outcome[J].Fertil Steril,1998,70(3):500-504.
22.郑菊芬,黄学锋,李澄隶等.不同来源精子单精子卵胞浆内注射治疗不育症[J].温州医学院学报,2000,30(40):23-28.
23.Pasqualotto FF,Rossi LM,Guilherme P,et al.Etiology specific outcomes of intracytop lasmic sperm injection in azoospermic patients[J].Fertil Steril,2005,83 (3):606-611.
24.Oldereid NB,Abyholm T,Tanbo T,et al.Congenital malformations in children born after assisted fertilization in Norway.Tidsskr Nor Laegeforen 2003,123(19):2696-2699.
25.Bonduelle M,Liebaers I,Deketelaere V,et al.Neonatal data on a cohort of 2889infants born after ICSI(1991-1999) and of 2995 infants born after IVF(1983-1999).Hum Reprod 2002,17(3):671-694.
26.Ludwig M,Katalinic A.Malformation rate in fetuses and children conceived after ICSI:results of a prospective cohort study.Reprod Biomed Online2002,5(2):171-178.
27.World Health Organization.WHO manual for the standardized investigation,diagnosis and management of the infertile male.Cambridge:Cambridge University Press,2000:40-43.
28.van der Westerlaken,L,et al.Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low feitilization after conventional in vitro fertilization[J].Fertil Steril,2005,83(3):612-7.
29.Kuczynski,W,et al.Rescue ICSI of unfertilized oocytes after IVF[J].Hum Reprod,2002,17(9):2423-7.
30.Esfandiari,N,et al.Ongoing twin pregnancy after rescue introcytoplasmic sperm injection of unfertilized abnormal oocytes[J].Fertil Steril,2008 Mar 6[Epub ahead of print].
31.丁卫,刘嘉茵,钱云等.不明原因原发性不孕者宫腔内人工授精失败后治疗方案的选择[J].中华男科学杂志,2004,10:737-742.
32.Jaroundi K,Al-Hassan S,Al-Sufayan H,et al.Intracytoplasmic sperm injection and conventional invitro fertilization are complementary techniques in management of unexplained infertility[J].Assist Reprod Genet,2003:20(9):377-381.
33.黄敏珍,陈士岭,邢福祺.单精子注入卵胞浆过程对胚胎发育的影响[J].第一军医大学学报,2001:21(5):363-364.
34.Khamsi F,Yavas Y,Roberge S,et al.Intracytoplasmic sperm injection increased fertilization and good quality embryo formation in patients with nonmale factor indications for invit ro fertilization : A prospective randomized study [ J ] .Fertil Steril, 2001 , 75 (2) :342 - 347.
35. Jaroundi K, Al-Hassan H, et al. Intracytoplasmic sperm injection and conventional in vitro fertilization are complementary techniques in management of unexplained infertility[J]. Assist Reprod Genet, 2003, 20(9): 377-381.
36. Katz MG, Chu B, Mclachlan R, et al. Genetic follow-up of male offspring born by ICSI., using a multiplex flu-orescent PCR-based test for Yq deletion[J]. Mol Hum Reprod, 2002, 8(6):589-595.
37. Lee SH, Ahn SY, Lee KW, et al. Intracytoplasmic sperm injection may lead to vertical transmission, expansion, and denovo occurrence of Y chromosome microdeletions in male fetuses[J]. Fertil Steril, 2006, 85(5): 1512-1515.
38. Gekas J, Thepot F, Turlear C, et al. Chromosomal factors of infertility in candidate couples for ICSI:an equal risk of constitutional aberrations in women and men[J]. Hum Reprod, 2001, 16(1):82-90.
39. Lee SH, Ahn SY, Lee KW, et al. Intracytoplasmic sperm injection may lead to vertical transmission, expansion, and denovo occurrence of Y-chromosome microdeletion in male fetuses[J]. Fertil Steril, 2006, 85(5): 1512-1515.
40. Bienvenu T, Patrat C, Jouannet P. Molencular detection of Y chromosome microdeletion: a new approach based on the denaturing gradient gel elelctrophoresis[J]. Gynecol Obstet Fertil, 2003, 31(7-8):639-646.
41. Sutcliffe AG, Taylor B, Saunders K, et al. Outcome in the second year of life after in-vitro fertilization by intracytoplasmic sperm injection: a UK case-control study[J].Lancet, 2001, 357(4):2080-2084.
42. Sills ES, Palermo GD. Major birth defects after assisted reproduction[J]. N Engl J Med, 2002, 347(18): 1449-1451.
43. Hansen M, Kurinczuk JJ, Bower C, et al. The risk of major birth defects associated with intracytoplasmic sperm injection and in-vitro fertilization[J]. N Engl J Med, 2002,346:725-730.
44. Leslie GI, Gibson FL, McMabon C, et al. Children conceived using ICSI do not have an increase risk of delayed mental development at 5 years of age[J].Hum Reprod, 2003,18(10):2067-2072.
45. Retzloff MG, Hornstein MD. Is intracytoplasmic sperm injection safe ? [J ]. Fertil Steril, 2003, 80 (4): 851-859.
46. Munne S ,Marquez C,Reing A ,et al. Chromosome abnormalities in embryos obtained after conventional in vitro fertilization and intracytoplasmic sperm injection[J]. Fertil steril 1998 , 69(5) :904.
2.Andersen AN,Carisen E,Loft A.Trends in the use of intracytoplasmatic sperm injection marked variability between countries[J].Hum Reprod Update,2008,14:593-604.
3,.Jain T;Gupta RS.Trends in the use of intracytoplasmatic Sperm Injection in the United States[J].N Engl J Med 2007,357:251-257.
4.CDC.Center for Disease Control.National Summary and Fertility Clinic Reports,2005.US Department of Health and Human Services.Reproductive Health.Assisted Reproductive Teclmology,2007.www.Cdc.org.
5.Liu DY,Baker HWG.Test of human sperm function and fertilization in vitro[J].Fertil Steril,1992,58:465-83.
6.Liu DY,Baker HWG.Defective sperm-zona pellucida interaction:a major cause of failure of fertilization in clinical in-vitro feitilization[J].Hum Reprod,2000,15:702-708.
7.Mohamed A,Ragaa T,Gamal I,et al.Fertilization and Pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm.Fertil Steril,1997,68(1):108-11.
8.Goker EN,Sendag F,Levi R,et al.Comparison of the ICSI outcome of ejaculated sperm with normal,abnormal parameters and testicular sperm.Eur J Obstet Gynecol Reprod Biol,2002,104(2):129-36.
9.Hammadeh ME,al-Hasani S,Doerr S,et al.Comparison between chromatin condensation and morphology from testis biopsy extracted and ejaculated spermatozoa and their relationship to ICSI outcome[J].Hum Reprod,1999,14(2):363-7.
10.许张晔,叶碧绿,黄学峰等.不同来源精子对ICSI治疗后妊娠结局的影响[J].中国男科学杂志,2007,21(1):41-44.
11.王晶,丛林,曹云霞等.原发不孕患者IVF/ICSI方案的选择[J].现代妇产科 进展,2008,17(8):579-581.
12.Roest J,Van Heusden AM,Zeilmaker GH,et al.Treatment Policy After Fertilization in the First IVF Cycle[J].J Assist Reprod Genet,1998,15:18-21.
13.Lucette van der Westerlaken,M.Sc.,Nico Naaktgeboren,Ph.D.,Harjo Verburg,M.D.et al.Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen:a randomized study using sibling oocytes[J].Fertility and Sterility,2006,85(2).
14.Dumoulin JCM,Derhaag JG,Bras M,et al.Growth rate of human preimplantation embryos is sex dependent after ICSI but not IVF[J].Hum Reprod,2005,20(2):484-491.
15.Ashwood-Smith MJ,Edwards RG.DNA repair by oocytes Mol[J].Hum Reprod,1996,2:46.
16.胡海燕,郭小燕,吕淑兰.单精子卵胞浆内注射后代安全性的评估[J].中国妇幼健康研究,2006,17(4):319-321.
17.Sbracia M,Baldi M,Cao D,et al.Preferential location of sex chromosomes,their aneuploidy in human sperm,and their role in determining sex chromosome aneuploidy in embryos after ICSI.Hum Reprod 2002,17(2):320-324.
18.陈士岭,黎淑贞,孙玲等.1274例经体外受精-胚胎移植治疗分娩新生儿结局分析[J].南方医科大学学报,2007,27(4):439-41.
19.Palermo G,Adler A,Cohen J.Intracytoplasmic sperm injection:a novel treatment for all forms of male factor infertility[J].Fertil Steril,1995,63:1231-1240.
20.Sathananthan A,Ratman S,Ng S,et al.Hum Reprod Update,1999,5:552-560.
21.Aytoz A,Camus M,Tournaye H,et al.Outcomes of pregnancy intracyopasmic sperm injection and the effect of sperm quality on this outcome[J].Fertil Steril,1998,70(3):500-504.
22.郑菊芬,黄学锋,李澄隶等.不同来源精子单精子卵胞浆内注射治疗不育症[J].温州医学院学报,2000,30(40):23-28.
23.Pasqualotto FF,Rossi LM,Guilherme P,et al.Etiology specific outcomes of intracytop lasmic sperm injection in azoospermic patients[J].Fertil Steril,2005,83 (3):606-611.
24.Oldereid NB,Abyholm T,Tanbo T,et al.Congenital malformations in children born after assisted fertilization in Norway.Tidsskr Nor Laegeforen 2003,123(19):2696-2699.
25.Bonduelle M,Liebaers I,Deketelaere V,et al.Neonatal data on a cohort of 2889infants born after ICSI(1991-1999) and of 2995 infants born after IVF(1983-1999).Hum Reprod 2002,17(3):671-694.
26.Ludwig M,Katalinic A.Malformation rate in fetuses and children conceived after ICSI:results of a prospective cohort study.Reprod Biomed Online2002,5(2):171-178.
27.World Health Organization.WHO manual for the standardized investigation,diagnosis and management of the infertile male.Cambridge:Cambridge University Press,2000:40-43.
28.van der Westerlaken,L,et al.Intracytoplasmic sperm injection as a treatment for unexplained total fertilization failure or low feitilization after conventional in vitro fertilization[J].Fertil Steril,2005,83(3):612-7.
29.Kuczynski,W,et al.Rescue ICSI of unfertilized oocytes after IVF[J].Hum Reprod,2002,17(9):2423-7.
30.Esfandiari,N,et al.Ongoing twin pregnancy after rescue introcytoplasmic sperm injection of unfertilized abnormal oocytes[J].Fertil Steril,2008 Mar 6[Epub ahead of print].
31.丁卫,刘嘉茵,钱云等.不明原因原发性不孕者宫腔内人工授精失败后治疗方案的选择[J].中华男科学杂志,2004,10:737-742.
32.Jaroundi K,Al-Hassan S,Al-Sufayan H,et al.Intracytoplasmic sperm injection and conventional invitro fertilization are complementary techniques in management of unexplained infertility[J].Assist Reprod Genet,2003:20(9):377-381.
33.黄敏珍,陈士岭,邢福祺.单精子注入卵胞浆过程对胚胎发育的影响[J].第一军医大学学报,2001:21(5):363-364.
34.Khamsi F,Yavas Y,Roberge S,et al.Intracytoplasmic sperm injection increased fertilization and good quality embryo formation in patients with nonmale factor indications for invit ro fertilization : A prospective randomized study [ J ] .Fertil Steril, 2001 , 75 (2) :342 - 347.
35. Jaroundi K, Al-Hassan H, et al. Intracytoplasmic sperm injection and conventional in vitro fertilization are complementary techniques in management of unexplained infertility[J]. Assist Reprod Genet, 2003, 20(9): 377-381.
36. Katz MG, Chu B, Mclachlan R, et al. Genetic follow-up of male offspring born by ICSI., using a multiplex flu-orescent PCR-based test for Yq deletion[J]. Mol Hum Reprod, 2002, 8(6):589-595.
37. Lee SH, Ahn SY, Lee KW, et al. Intracytoplasmic sperm injection may lead to vertical transmission, expansion, and denovo occurrence of Y chromosome microdeletions in male fetuses[J]. Fertil Steril, 2006, 85(5): 1512-1515.
38. Gekas J, Thepot F, Turlear C, et al. Chromosomal factors of infertility in candidate couples for ICSI:an equal risk of constitutional aberrations in women and men[J]. Hum Reprod, 2001, 16(1):82-90.
39. Lee SH, Ahn SY, Lee KW, et al. Intracytoplasmic sperm injection may lead to vertical transmission, expansion, and denovo occurrence of Y-chromosome microdeletion in male fetuses[J]. Fertil Steril, 2006, 85(5): 1512-1515.
40. Bienvenu T, Patrat C, Jouannet P. Molencular detection of Y chromosome microdeletion: a new approach based on the denaturing gradient gel elelctrophoresis[J]. Gynecol Obstet Fertil, 2003, 31(7-8):639-646.
41. Sutcliffe AG, Taylor B, Saunders K, et al. Outcome in the second year of life after in-vitro fertilization by intracytoplasmic sperm injection: a UK case-control study[J].Lancet, 2001, 357(4):2080-2084.
42. Sills ES, Palermo GD. Major birth defects after assisted reproduction[J]. N Engl J Med, 2002, 347(18): 1449-1451.
43. Hansen M, Kurinczuk JJ, Bower C, et al. The risk of major birth defects associated with intracytoplasmic sperm injection and in-vitro fertilization[J]. N Engl J Med, 2002,346:725-730.
44. Leslie GI, Gibson FL, McMabon C, et al. Children conceived using ICSI do not have an increase risk of delayed mental development at 5 years of age[J].Hum Reprod, 2003,18(10):2067-2072.
45. Retzloff MG, Hornstein MD. Is intracytoplasmic sperm injection safe ? [J ]. Fertil Steril, 2003, 80 (4): 851-859.
46. Munne S ,Marquez C,Reing A ,et al. Chromosome abnormalities in embryos obtained after conventional in vitro fertilization and intracytoplasmic sperm injection[J]. Fertil steril 1998 , 69(5) :904.