胞浆内形态学筛选精子注射（IMSI）技术能否改善反复体外受精-卵胞浆内单精子注射（IVF-ICSI）失败患者的治疗结局？一项比较研究。

Can intra cytoplasmatic morphologically selected sperm injection (IMSI) technique improve outcome in patients with repeated IVF-ICSI failure? a comparative study.

作者信息

Shalom-Paz Einat, Anabusi Saja, Michaeli Medeia, Karchovsky-Shoshan Etti, Rothfarb Nechami, Shavit Tal, Ellenbogen Adrian

机构信息

IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Hillel Yaffe Medical Center, Technion - Israel Institute of Technology , Hadera , Israel.

出版信息

Gynecol Endocrinol. 2015 Mar;31(3):247-51. doi: 10.3109/09513590.2014.982085. Epub 2014 Nov 21.

DOI:10.3109/09513590.2014.982085

PMID:25413992

Abstract

OBJECTIVE

Spermatozoal morphology was reported to effect fertilization, embryo quality and pregnancy results in spontaneous conception and ART. Intracytoplasmic morphologically selected sperm injection (IMSI) is an innovative, not invasive technique, which examines the sperm with no harm at a magnification of 6000 × in order to obtain optimal sperm to perform IVF-ICSI. We evaluated the efficiency of IMSI technique in patients with repeated IVF-ICSI failure of at least three cycles with no viable pregnancy and/or very poor sperm quality.

STUDY DESIGN AND METHODS

All couples who performed IMSI between the years 2009 to 2012 were enrolled retrospectively to the study. Couples with male infertility who were treated with IMSI were included in the study. All their treatments were evaluated and divided into two subgroups: conventional IVF-ICSI treatment and their subsequent IMSI treatment. Demographic data, clinical parameters and outcome were recorded. The IMSI treatments were compared to previous non-IMSI treatments in terms of fertilization rates, cleavage rates, number of embryos and their quality, number of embryos transferred and pregnancy outcome.

MAIN RESULTS

Forty-two couples were reviewed. Basic characteristics of the groups were comparable. Fertilization and cleavage rates of the two groups were comparable. The embryos quality demonstrated a trend toward superior quality (grade 1-2) embryos in the IMSI versus ICSI (60% versus 47%; p = 0.07 and 53% versus 40%; p = 0.07), respectively. Implantation and clinical pregnancy rates were significantly superior in IMSI group (19.2% versus 7.8%; p = 0.042 and 41.3% versus 10.5%; p = 0.02, respectively). Miscarriage rate was significantly higher in conventional IVF-ICSI group (100% versus 15.8%; p = 0.04), and live birth rate was significantly higher in IMSI group (0 in conventional IVF-ICSI and 34.7% per transfer in IMSI group; p = 0.003).

CONCLUSION

IVF outcome of IMSI resulted in a higher implantation rate, pregnancy rate and most importantly delivery rate compare to non IMSI treated cycles.

摘要

目的

据报道，精子形态会影响自然受孕和辅助生殖技术（ART）中的受精、胚胎质量及妊娠结局。胞浆内形态学筛选精子注射（IMSI）是一项创新的、非侵入性技术，它能在6000倍放大率下对精子进行无害检查，以获取最优精子来进行体外受精-卵胞浆内单精子注射（IVF-ICSI）。我们评估了IMSI技术在至少经历三个周期IVF-ICSI失败且无存活妊娠和/或精子质量极差的患者中的有效性。

研究设计与方法

回顾性纳入2009年至2012年间接受IMSI治疗的所有夫妇。纳入接受IMSI治疗的男性不育夫妇。评估他们所有的治疗情况并分为两个亚组：传统IVF-ICSI治疗及其后续的IMSI治疗。记录人口统计学数据、临床参数和结局。将IMSI治疗与先前的非IMSI治疗在受精率、卵裂率、胚胎数量及其质量、移植胚胎数量和妊娠结局方面进行比较。

主要结果

对42对夫妇进行了评估。两组的基本特征具有可比性。两组的受精率和卵裂率相当。与ICSI相比，IMSI组的胚胎质量有呈现出优质（1-2级）胚胎的趋势（分别为60%对47%；p = 0.07和53%对40%；p = 0.07）。IMSI组的着床率和临床妊娠率显著更高（分别为19.2%对7.8%；p = 0.042和41.3%对10.5%；p = 0.02）。传统IVF-ICSI组的流产率显著更高（100%对15.8%；p = 0.04）且IMSI组的活产率显著更高（传统IVF-ICSI组为0，IMSI组每次移植为34.7%；p = 0.003）。