上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (8): 1000-.doi: 10.3969/j.issn.1674-8115.2012.08.009

• 专题报道（不孕不育症及辅助生殖技术） • 上一篇    下一篇

卵胞浆内单精子注射失败后改行供精人工授精的时机和妊娠结局分析

夏 兰, 赵晓明, 孙 赟, 洪 燕, 叶 梓, 高玉平   

  1. 上海交通大学 |医学院附属仁济医院生殖医学科, 上海 200001
  • 出版日期:2012-08-28 发布日期:2012-08-29
  • 通讯作者: 赵晓明, 电子信箱: zhao_xiao_ming@hotmail.com。
  • 作者简介:夏 兰(1980—), 女, 住院医师, 硕士；电子信箱: summer_ldh@126.corn。

Timing and pregnancy outcome of artificial insemination with donor semen after failure in intracytoplasmic sperm injection

XIA Lan, ZHAO Xiao-ming, SUN Yun, HONG Yan, YE Zi, GAO Yu-ping   

  1. Reproductive Medicine Center, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
  • Online:2012-08-28 Published:2012-08-29

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摘要：

目的 探讨重度少弱精子症或梗阻性无精子症患者卵胞浆内单精子注射（ICSI）失败后改行供精人工授精（AID）治疗的时机及效果。方法 回顾性分析因男方重度少弱精子症或梗阻性无精子症实施ICSI治疗失败而改行AID治疗（93个治疗周期）的46例妇女的周期妊娠率，并与同期直接行AID的患者（AID对照组，n=74）的周期妊娠率比较。同时，选择同期接受ICSI助孕的1 007例患者（1 128个治疗周期），根据不同ICSI精子来源分为射出精子组和附睾睾丸精子组，再根据参数分为轻度少弱畸精子症组（A组，n=157）、重度少弱畸精子症组（B组，n=305）、附睾或睾丸穿刺偶见活精组（C组，n=110）及其余穿刺组（D组，n=435），比较四组的受精率、卵裂率、优质胚胎率和妊娠率；比较B组患者ICSI第1~4周期助孕的受精率、卵裂率、优质胚胎率和妊娠率。结果 46例患者经过多周期的ICSI治疗失败，再改行1~4周期的AID，可以实现52.2%的累积妊娠率和25.8%的周期妊娠率，与AID对照组27.6%的周期妊娠率比较差异无统计学意义（P>0.05）；根据精子来源及参数的分组中，C组的受精率（75.3%）和妊娠率（28.7%）显著低于其他三组，差异有统计学意义（P<0.01），B组的优质胚胎率（40.7%）低于其他三组，妊娠率（35.1%）也低于A和D组，且差异有统计学意义（P<0.01和P<0.05）；进入第3和第4及以上周期的妊娠率分别为15.4%和0，显著低于第1和第2周期，差异均有统计学意义（P<0.05）。结论 经过3周期以上ICSI失败，或者重度少弱精子症及梗阻性无精子症穿刺后镜下偶见精子寻找精子困难者第2周期助孕时，可以在患者知情同意的情况下进行AID助孕，实现较高的妊娠率。

关键词: 卵胞浆内单精子注射, 供精人工授精, 临床妊娠率

Abstract:

Objective To investigate the timing and outcome of artificial insemination with donor sperm(AID) after failure in intracytoplasmic sperm injection (ICSI) in patients with severe oligoasthenospermia or obstructive azoospermia. Methods The cycle pregnancy rates of AID (93 treatment circles) after failure in ICSI in 46 infertile couples with severe oligoasthenospermia or obstructive azoospermia were retrospectively analysed, and were compared with those directly undergoing AID during the same period (AID group, n=74). Besides, 1 007 patients undergoing ICSI during the same period (1 128 treatment cycles) were selected, and were divided into ejaculated sperm group and epididymal sperm group according to different sources of sperm, and were also divided into mild oligoasthenoteratozoospermia group (group A, n=157), severe oligoasthenoteratozoospermia group (group B, n=305), testicular or epididymal aspiration group (group C, n=110) and the other aspiration group (group D, n=435) according to sperm parameters. The fertility rate, cleavage rate, excellent embryo rate and pregnancy rate were compared among group A, B, C and D, and the fertility rate, cleavage rate, excellent embryo rate and pregnancy rate of the first to fourth cycle of ICSI in group B were compared. Results The cumulative pregnancy rate of 46 patients who failed in multi-cycle ICSI treatment and transferred to 1 to 4 cycles of AID reached 52.2%, and the cycle pregnancy rate was 25.8%, which was not significantly different from the cycle pregnancy rate of AID control group (27.6%)(P>0.05). The fertility rate (75.3%) and pregnancy rate (28.7%) of group C were significantly lower than those of group A, B and D (P<0.01), the excellent embryo rate of group B (40.7%) were lower than group A, C and D, and the pregnancy rate of group B (35.1%) were significantly lower than those of group A (P<0.01) and group D (P<0.05). The pregnancy rates of the third cycle and fourth or above cycle of ICSI were 15.4% and 0 in group B, which were significantly lower than those of the first cycle and second cycle (P<0.05). Conclusion AID can be performed after informed consent in patients with failure in more than 3 cycles of ICSI or with severe asthenozoospermia and obstructive azoospermia whose sperm is few, and a high pregnancy rate can be achieved.

Key words: intracytoplasmic sperm injection, artificial insemination with donor semen, pregnancy rate