CAJ | 학술논문

目的：评估短时受精联合早期补救性卵胞浆内单精子注射（ICSI）术在重度畸形精子症患者中的临床应用。方法235例重度畸形精子症患者（1%≤精子正常形态率＜5%）行体外受精-胚胎移植（IVF-ET）周期随机分组，101例直接实施ICSI为A组，134例实施短时受精联合早期补救性ICSI为B组，短时受精后4~5h行极体观察，其中109例大于30%可见双极体列为B1组，25例早期判断未见双极体或小于30%未见双极体行早期补救性ICSI术列为B2组。比较不同组受精率、卵裂率、优质胚胎率、胚胎种植率及临床结局。结果3组的卵子成熟率分别为83.93%，87.03%和90.48%，正常受精率分别为78.76%，72.49%和75.61%，异常受精率分别为6.11%，14.88%和9.76%，卵裂率分别为83.93%，85.89%和84.96%，优质胚胎率分别为49.45%，50.49%和53.23%，胚胎植入率分别为28.10%，26.67%和32.00%，临床妊娠率分别为43.66%，43.04%和47.62%，流产率分别为6.45%，8.82%和10.00%。3组的卵子成熟率、正常受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率、流产率差异均无统计学意义（P＞0.05），异常受精率在B1组有增高趋势，与其它组比较差异无统计学意义（P＞0.05）。结论短时受精联合早期补救性ICSI在重度畸形精子症患者有应用价值，可以最大限度的减少ICSI比率，获得好的临床结局。
목적：평고단시수정연합조기보구성란포장내단정자주사（ICSI）술재중도기형정자증환자중적림상응용。방법235례중도기형정자증환자（1%≤정자정상형태솔＜5%）행체외수정-배태이식（IVF-ET）주기수궤분조，101례직접실시ICSI위A조，134례실시단시수정연합조기보구성ICSI위B조，단시수정후4~5h행겁체관찰，기중109례대우30%가견쌍겁체렬위B1조，25례조기판단미견쌍겁체혹소우30%미견쌍겁체행조기보구성ICSI술렬위B2조。비교불동조수정솔、란렬솔、우질배태솔、배태충식솔급림상결국。결과3조적란자성숙솔분별위83.93%，87.03%화90.48%，정상수정솔분별위78.76%，72.49%화75.61%，이상수정솔분별위6.11%，14.88%화9.76%，란렬솔분별위83.93%，85.89%화84.96%，우질배태솔분별위49.45%，50.49%화53.23%，배태식입솔분별위28.10%，26.67%화32.00%，림상임신솔분별위43.66%，43.04%화47.62%，유산솔분별위6.45%，8.82%화10.00%。3조적란자성숙솔、정상수정솔、란렬솔、우질배태솔、배태충식솔、림상임신솔、유산솔차이균무통계학의의（P＞0.05），이상수정솔재B1조유증고추세，여기타조비교차이무통계학의의（P＞0.05）。결론단시수정연합조기보구성ICSI재중도기형정자증환자유응용개치，가이최대한도적감소ICSI비솔，획득호적림상결국。
Objective To evaluate clinical application of short-period fertilization combined with early rescue intracytoplasmic sperm injection (ICSI) technique in fertilization of severe abnormal sperm. Methods Total 235 patients with severe teratozoospermia (1%≤Normal sperm morphology rate<5%)for in vitro fertilization-embryo transfer (IVF-ET) cycles for egg were randomly divided into two groups. 101 cases of direct implementation of the ICSI as group A, 134 cases for short-period fertilization combined with early rescue ICSI as group B. Among group B, cumulus cells were removed after fertilization 4~5h, second polar body of oocytes was observed, in which 109 cases more than 30%visible bipolar body as B1 group, 25 cases of early judgment no less than 30%of bipolar body performed early remedial ICSI surgery as a group B2.The fertilization rate, cleavage rate, high-quality embryo rate, implantation rate and clinical outcome were comparatively analyzed among different groups. Results Egg maturation rates of three groups were 83.93%, 87.03%and 90.48%respectively, normal fertilization rates were 78.76%, 72.49%and 75.61%, abnormal fertilization rates were 6.11%, 14.88%and 9.76%, cleavage rates were 83.93%, 85.89%and 84.96%, high-quality embryos were 49.45%, 50.49%and 53.23%, implantation rates were 28.10%, 26.67%and 32.00%, clinical pregnancy rates were 43.66%, 43.04%and 47.62%, miscarriage rates were 6.45%, 8.82%and 10.00%. there were no significant difference in egg maturation rate, normal fertilization rate, cleavage rate , high-quality embryo rate, implantation rate, clinical pregnancy, miscarriage rates among three groups different (P>0.05). Abnormal fertilization rate in group B had an increasing trend, but the difference was not statistically significant (P>0.05). Conclusion Short-period fertilization combined with early rescue Intracytoplasmic sperm injection (ICSI) show great value for fertilization of patients with severe abnormal sperm. A good clinical outcome can be obtained if minimizing the ICSI.