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目的分析体外授精(IVF)短时授精中受精率高(受精率>60%)与受精完全失败(受精率=0%)早补救卵母细胞胞浆内单精子注射(ICSI)患者的临床结局和精子参数,探讨IVF失败的相关因素。方法对比322例IVF短时授精周期中153例受精率达到60%以上的患者(受精率高组即A组)与同期接受IVF短时授精发现受精完全失败后进行早补救ICSI治疗的53名患者(受精完全失败组即B组)的临床结局及其精子参数。结果 A组与B组各获卵1 619和393枚,各有133名和47名患者接受了新鲜胚胎移植。两组间的正常卵裂率分别为98.02%(940/959)和97.70%(254/260),优质胚胎率分别为33.51%(315/940)和35.43%(90/254),平均移植胚胎数分别为2.15±0.39和2.05±0.52,移植日内膜厚度分别为(12.99±2.53)mm和(12.38±2.45)mm,胚胎种植率分别为29.41%(85/289)和24.73%(23/93),临床妊娠率分别为44.36%(59/133)和42.55%(20/47),流产率分别为2.26%(3/133)和2.13%(1/47),继续妊娠率分别为41.35%(55/133)和38.30%(18/47),差异均无统计学意义。而A组的正常受精率较B组低[65.55%(959/1463)vs 77.61%(260/335)],同时多原核受精率较B组高[14.56%(213/1463)vs 6.27%(21/335)],差异均具有统计学意义。A组与B组平均精子密度分别为(74.63±36.05)×106/m L和(76.97±36.64)×106/m L,前向精子密度分别为(46.02±13.79)×106/m L和(40.63±16.08)×106/m L,正常形态精子分别为(3.74±1.73)%和(4.21±1.86)%,顶体酶活性分别为(79.18±24.89)u IU和(71.81±32.30)u IU,均存在一定的差异,但是并无统计学意义。结论短时授精后受精率高与受精完全失败行早补救患者具有接近的临床妊娠率,但受精率高组较受精失败行早补救组具有更高的多原核受精率和更低的正常受精率,前向精子密度和精子形态对受精有重要影响,但是其对受精失败的预测作用有限。
Objective To analyze the clinical outcomes of early remission oocyte intracytoplasmic sperm injection (ICSI) in IVF short fertilization (fertilization> 60%) and complete failure of fertilization (fertilization rate = 0%) And sperm parameters to explore the factors related to the failure of IVF. Methods A total of 322 patients with IVF short-fertilization cycles in 153 cases of fertilization rate of more than 60% (high fertilization group that A group) and IVF short-term insemination during the same period were found to have failed to complete fertilization after ICSI treatment of 53 patients (Complete failure of fertilization group B group) and the clinical outcome of sperm parameters. Results A total of 1 619 and 393 eggs were obtained in group A and group B, and 133 and 47 patients each received fresh embryo transfer. The normal cleavage rates of the two groups were 98.02% (940/959) and 97.70% (254/260), respectively. The rates of high quality embryos were 33.51% (315/940) and 35.43% (90/254) The numbers of embryo implantation were 29.41% (85/289) and 24.73% (23.7%), respectively. The thickness of endometrium was (12.99 ± 2.53) mm and (12.38 ± 2.45) 93). The clinical pregnancy rates were 44.36% (59/133) and 42.55% (20/47), respectively. The rates of miscarriage were 2.26% (3/133) and 2.13% (1/47) respectively, and the pregnancy rates were 41.35 % (55/133) and 38.30% (18/47), respectively, with no significant difference. While the normal fertilization rate in group A was lower than that in group B [65.55% (959/1463) vs 77.61% (260/335)], while the multiple prokaryotic fertilization rate was higher than that in group B [14.56% (213/1463) vs 6.27% 21/335)], the differences were statistically significant. The average sperm densities in group A and group B were (74.63 ± 36.05) × 106 / m L and (76.97 ± 36.64) × 106 / m L, respectively, and the preanatomic sperm densities were 46.02 ± 13.79 × 106 / m L and 40.63 ± 16.08 × 106 / m L, respectively. The normal spermatozoa were (3.74 ± 1.73)% and (4.21 ± 1.86)%, respectively. The acrosin activities were 79.18 ± 24.89 u IU and 71.81 ± 32.30 uU , There are some differences, but there is no statistical significance. Conclusion The high fertilization rate after short-term fertilization and early recovery patients with complete failure of fertilization have close clinical pregnancy rates. However, the high fertilization rate group has higher multiple pronuclear fertilization rate and lower normal fertilization rate , The pre-sperm density and sperm morphology have a significant impact on fertilization, but its prediction of fertilization failure is limited.