胚胎植入前遗传学诊断——我们是否应该对所有患者都采用卵胞浆内单精子注射技术？
Pre-implantation genetic diagnosis-should we use ICSI for all?
机构信息
Infertility and IVF Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel.
Danek Gertner Institute of Human Genetics, Sheba Medical Center, Ramat-Gan, Israel.
出版信息
J Assist Reprod Genet. 2017 Sep;34(9):1179-1183. doi: 10.1007/s10815-017-0966-7. Epub 2017 Jun 13.
OBJECTIVE
Intracytoplasmic sperm injection (ICSI) is commonly used during pre-implantation genetic diagnosis (PGD) in vitro fertilization (IVF), aiming to eliminate the risk of contamination from extraneous sperm DNA. Recently, ICSI "overuse" in non-male infertility has been doubted, since it does not offer an advantage over IVF. Prompted by the aforementioned observations, we sought to assess the accuracy of IVF vs ICSI in PGD cases, as might be reflected by a difference in the prevalence of discarded embryos as a consequent of parental contamination.
METHODS
Cohort-historical study of all consecutive patients admitted to the IVF-PGD program in a large tertiary center. The percentages of complete, incomplete diagnosis, PCR failure, abnormal embryos, and the contamination rate with paternal DNA in the IVF-only and the ICSI-only groups. We reviewed the computerized files of all consecutive women admitted to our IVF for a PGD-PCR cycle. Patients were divided accordingly into three groups: an IVF group-where all the oocytes underwent IVF only, an ICSI group-where all oocytes underwent ICSI, and a mixed group-where sibling oocytes underwent both IVF and ICSI. The laboratory data and the genetic diagnostic results were collected and compared between the different insemination groups.
RESULTS
Nine-hundred and twenty-seven patients underwent IVF-PGD cycles in our program, 315 in the IVF group, 565 in the ICSI group, and 47 in the mixed group. No differences were observed in fertilization rates, the percentage of embryos available for biopsy, and the percentages of complete, incomplete diagnosis, PCR failure, or abnormal embryos, between the IVF-only and the ICSI-only groups and between the IVF and the ICSI of sibling oocytes in the mixed group. Moreover, contamination with paternal DNA, through contamination with sperm cells, was negligible. Not one single case of misdiagnosis was encountered during the study period.
CONCLUSION
It might be therefore concluded that IVF should be the preferred insemination methods in PGD cycles, and ICSI should be indicated only in cases of male-factor infertility.
目的
在体外受精（IVF）的胚胎植入前遗传学诊断（PGD）中，常采用胞质内单精子注射（ICSI），旨在消除外源精子 DNA 污染的风险。最近，由于 ICSI 并没有优于 IVF 的优势，因此人们对其在非男性不育症中的“过度使用”产生了怀疑。受上述观察结果的启发，我们试图评估 IVF 与 ICSI 在 PGD 病例中的准确性，这可能反映在由于父母污染而导致丢弃胚胎的比例有所不同。
方法
对一家大型三级中心的所有连续接受 IVF-PGD 计划的患者进行队列历史研究。IVF 组和 ICSI 组的完全、不完全诊断、PCR 失败、异常胚胎和父源性 DNA 污染率。我们回顾了所有连续接受我们的 IVF 进行 PGD-PCR 周期的女性的计算机文件。患者据此分为三组：仅接受 IVF 的 IVF 组-所有卵子均接受 IVF，仅接受 ICSI 的 ICSI 组-所有卵子均接受 ICSI，以及混合组-同胞卵子均接受 IVF 和 ICSI。收集并比较了不同授精组之间的实验室数据和遗传诊断结果。
结果
在我们的计划中，有 927 名患者接受了 IVF-PGD 周期，其中 315 名在 IVF 组，565 名在 ICSI 组，47 名在混合组。IVF 组和 ICSI 组之间以及混合组中同胞卵的 IVF 和 ICSI 之间，受精率、可用于活检的胚胎百分比、完全、不完全诊断、PCR 失败或异常胚胎的百分比均无差异。此外，通过精子细胞污染导致的父源性 DNA 污染可忽略不计。在研究期间，未遇到一例误诊。
结论
因此，可以得出结论，IVF 应该是 PGD 周期中首选的授精方法，而 ICSI 仅应在男性因素不育症的情况下使用。
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