常规体外受精（IVF）或卵胞浆内单精子注射（ICSI）：对于获卵数为5个或更少的高龄患者，哪种方法更可取？
Conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI): which is preferred for advanced age patients with five or fewer oocytes retrieved?
作者信息
Liu Hui, Zhao Haibin, Yu Guanling, Li Mei, Ma Shuiying, Zhang Haozhen, Wu Keliang
机构信息
Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, National Research Center for Assisted Reproductive Technology and Reproductive Genetics, No. 157 Jingliu Road, Jinan, 250001, People's Republic of China.
The Key laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Shandong Provincial Key Laboratory of Reproductive Medicine, No. 157 Jingliu Road, Jinan, 250001, People's Republic of China.
出版信息
Arch Gynecol Obstet. 2018 May;297(5):1301-1306. doi: 10.1007/s00404-018-4696-6. Epub 2018 Feb 7.
PURPOSE
To investigate the clinical outcomes of conventional IVF and ICSI in female patients aged 40 years and over with no more than five oocytes retrieved and non-male factor infertility.
METHODS
A retrospective study of a cohort of 644 patients undergoing IVF/ICSI treatment. The 534 female patients aged ≧ 40 years with no more than five oocytes retrieved and non-male factor infertility undergoing their first conventional IVF cycles were assigned in IVF group. The rest of 110 patients aged 40 years and over with no more than five oocytes retrieved and non-male factor infertility undergoing first ICSI cycles were recruited in ICSI group.
RESULTS
Our results showed the clinical pregnancy, live birth and miscarriage rates were similar between the IVF and ICSI groups (21.59% vs. 13.25%, P > 0.05; 12.16% vs. 6.02%, P > 0.05; 43.68% vs. 54.55%, P > 0.05; respectively), however, the implantation and cumulative live-birth rates were significantly higher in the IVF compared to the ICSI group (15.11% vs. 7.75%, 14.59% vs. 5.56%, P < 0.05), though the IVF group had a lower normal fertilization rate (61.56% vs. 76.00%, P < 0.001).
CONCLUSIONS
Our study provides strong evidences that the conventional IVF exhibits advantages over the ICSI method in non-male factor infertility for advanced age patients with five or fewer oocytes retrieved.
目的
探讨常规体外受精（IVF）和卵胞浆内单精子注射（ICSI）在年龄40岁及以上、获卵数不超过5个且非男性因素不孕的女性患者中的临床结局。
方法
对644例行IVF/ICSI治疗的患者进行回顾性研究。将534例年龄≥40岁、获卵数不超过5个且非男性因素不孕、正在接受首次常规IVF周期治疗的女性患者纳入IVF组。其余110例年龄40岁及以上、获卵数不超过5个且非男性因素不孕、正在接受首次ICSI周期治疗的患者纳入ICSI组。
结果
我们的结果显示，IVF组和ICSI组的临床妊娠率、活产率和流产率相似（分别为21.59%对13.25%，P>0.05；12.16%对6.02%，P>0.05；43.68%对54.55%，P>0.05），然而，与ICSI组相比，IVF组的着床率和累积活产率显著更高（15.11%对7.75%，14.59%对5.56%，P<0.05），尽管IVF组的正常受精率较低（61.56%对76.00%，P<0.001）。
结论
我们的研究提供了强有力的证据，表明在获卵数为5个及以下的高龄非男性因素不孕患者中，常规IVF比ICSI方法具有优势。
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