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目的探讨同期卵子采用IVF结合ICSI治疗原发性不孕症和继发性不孕症的临床价值及ICSI技术的安全性。方法 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149例,将同期卵子按各50%的比例随机分为两组,分别采用IVF和ICSI进行授精,比较原发性不孕症组与继发性不孕症组、IVF与ICSI组之间受精情况、临床结局及出生缺陷的差异。结果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%(P<0.05)有显著差异。ICSI组未出现受精失败;且正常受精率及优质胚胎率高于常规IVF,多原核受精率低于IVF组(P<0.05)。ICSI组来源胚胎的着床率、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,差异无统计学意义。结论长期不孕原发性不孕患者及可疑受精障碍患者宜选用IVF结合ICSI的授精方案,可获得较好的临床结局,对这类患者ICSI可能并不增加其子代的出生缺陷率。
Objective To investigate the clinical value of IVF combined with ICSI in the treatment of primary infertility and secondary infertility with synchronous ovum and the safety of ICSI technique. Methods From January 2003 to December 2008, 149 infertile patients receiving IVF combined with ICSI were enrolled in the Reproductive Medicine Center of Nanfang Hospital from January 2003 to December 2008. The ovaries of the same period were randomly divided into two groups according to the proportion of 50% The differences of fertilization, clinical outcomes and birth defects between primary infertility group and secondary infertility group, IVF and ICSI group were compared. Results In the group of primary infertility, the IVF rate was 10.2%, which was significantly higher than 3.9% (P <0.05) in the secondary infertility group. There was no fertilization failure in ICSI group. The rate of normal fertilization and high quality embryo was higher than that of routine IVF, and the rate of prokaryotic fertilization was lower than that of IVF (P <0.05). ICSI group embryo implantation rate, clinical pregnancy rate and delivery rate higher than conventional IVF embryo transfer group and IVF and ICSI mixed embryo transfer group, the difference was not statistically significant. Conclusion Long-term infertility patients with primary infertility and suspected infertility patients should choose IVF combined with ICSI insemination program to obtain better clinical outcomes, ICSI may not increase their children’s birth defects rate.