IVF Unit, Wolfson Medical Center, Holon, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Reprod Biol Endocrinol. 2019 Mar 7;17(1):30. doi: 10.1186/s12958-019-0474-y.
In order to maximize In vitro fertilization (IVF) success rates in advanced- age patients, it has been suggested to favor the use of intracytoplasmic sperm injection (ICSI) over conventional insemination (CI), with the notion that ICSI would serve as a tool to overcome interference in sperm oocyte interaction and sperm oocyte penetration issues that can be related to maternal age and are not due to sperm abnormalities. We therefore aim to evaluate the role of ICSI in the treatment of non-male factor infertile patients aged ≥35 in terms of fertilization and top-quality embryo rates.
In this retrospective cohort study, data were collected and analyzed for all patients with non-male factor infertility, aged ≥35 treated, undergoing their first IVF cycle attempt with 6 or more oocytes yield, in whom a 50% ICSI-CI division was performed.
Five hundreds and four oocytes were collected from 52 eligible patients. Overall, 245 oocytes underwent ICSI and 259 oocytes underwent CI. The fertilization rate was 71.0% following ICSI, compared to 50.1% in the CI treated oocytes (P < 0.001). The top quality embryo rate was 62.8% following ICSI compared to 45.5% following CI (P < 0.001). Subdividing the study population to two age groups revealed that the above differences remained significant in patients aged 35-39 yrs., whereas in those aged 40-45 yrs., the differences were non-significant but still inclined in favor of ICSI.
This study favors the use of ICSI in the older IVF population in order to increase both the fertilization rate and the number of top quality embryos that result per IVF cycle. Further studies are needed to establish our observations and use ICSI as the preferred approach to overcome egg sperm abnormal interactions related to advanced maternal age.
为了提高高龄患者体外受精（IVF）的成功率，有人建议优先使用卵胞浆内单精子注射（ICSI）而不是常规授精（CI），其理念是 ICSI 可以作为一种工具来克服与年龄相关的精子-卵子相互作用和精子-卵子穿透问题，这些问题不是由于精子异常引起的。因此，我们旨在评估 ICSI 在治疗≥35 岁非男性因素不孕患者中的作用，从受精和优质胚胎率方面进行评估。
在这项回顾性队列研究中，对所有≥35 岁、接受首次 IVF 周期治疗且获得 6 个或更多卵子的非男性因素不孕患者的数据进行了收集和分析，这些患者进行了 50%的 ICSI-CI 分割。
从 52 名符合条件的患者中收集了 504 个卵子。总共 245 个卵子接受了 ICSI，259 个卵子接受了 CI。ICSI 后的受精率为 71.0%，而 CI 处理的卵子受精率为 50.1%（P<0.001）。ICSI 后的优质胚胎率为 62.8%，而 CI 后的优质胚胎率为 45.5%（P<0.001）。将研究人群细分为两个年龄组后发现，在 35-39 岁的患者中，上述差异仍然显著，而在 40-45 岁的患者中，差异不显著，但仍倾向于 ICSI。
本研究支持在高龄 IVF 人群中使用 ICSI，以提高每个 IVF 周期的受精率和优质胚胎数量。需要进一步的研究来证实我们的观察结果，并将 ICSI 作为克服与高龄相关的卵子-精子异常相互作用的首选方法。
