IVI-RMA, 140 Allen Road, Basking Ridge, Basking Ridge NJ 07920, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA 19107, USA.
IVI-RMA, 140 Allen Road, Basking Ridge, Basking Ridge NJ 07920, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA 19107, USA.
Reprod Biomed Online. 2020 Jul;41(1):19-27. doi: 10.1016/j.rbmo.2020.03.008. Epub 2020 Mar 19.
Is intracytoplasmic sperm injection (ICSI) operator experience associated with fertilization, usable blastocyst development and sustained implantation rates (SIR) when at least two embryologists carry out ICSI for a single cohort of oocytes?
A retrospective cohort study of all IVF/ICSI cycles at a single large infertility centre between 2008 and 2018. Cycles were included if a cohort of oocytes was split between two embryologists for ICSI. The embryologist's experience of ICSI was used to evaluate laboratory and clinical outcomes overall and by pairs of inseminating embryologists. Logistic regression, analysis of variance and Kruskal-Wallis testing were used where appropriate.
Analysis of 14,362 ICSI procedures showed an association between least ICSI experience and lower mean fertilization rates (P < 0.0001), higher odds of failed fertilization (adjusted OR 4.3; P < 0.0001) and lower number of fertilization 'wins' per cohort (P < 0.0001). Usable blastocyst development rates (number of usable blastocysts/number of two pronuclear zygotes) were not associated with ICSI embryologist experience (P = 0.44), but the odds of obtaining no usable blastocysts were higher (adjusted OR 1.4; P < 0.0001) and the proportion of usable blastocyst 'wins' was lower (P = 0.0001) when embryologists with the least experience carried out ICSI. Increased ICSI experience was associated with higher mean SIR (P < 0.0001). Laboratory and clinical outcomes were similar among embryologists once 1000 ICSI cycles and above were carried out.
Increased ICSI operator experience is associated with higher fertilization rates, SIR and a lower likelihood of failed fertilization and usable blastocyst development. Splitting a single oocyte cohort between more than one embryologist for ICSI is a quality-control measure that can be implemented.
当至少有两名胚胎学家为一批卵子进行卵胞浆内单精子注射 (ICSI) 时，ICSI 操作人员的经验是否与受精、可利用的囊胚发育和持续种植率 (SIR) 相关？
这是一项回顾性队列研究，纳入了 2008 年至 2018 年期间在一家大型不孕不育中心进行的所有体外受精/ICSI 周期。如果一批卵子由两名胚胎学家进行 ICSI ，则将该周期纳入研究。根据实验室和临床结果，使用胚胎学家的 ICSI 经验来评估整体和配对的授精胚胎学家的结果。在适当的情况下，使用逻辑回归、方差分析和 Kruskal-Wallis 检验。
对 14362 次 ICSI 手术的分析表明，ICSI 经验最少与平均受精率较低（P<0.0001）、受精失败的几率更高（调整后的比值比 4.3；P<0.0001）和每批卵子的受精“获胜”数量较低（P<0.0001）相关。可利用的囊胚发育率（可利用的囊胚数量/两个原核受精卵的数量）与 ICSI 胚胎学家的经验无关（P=0.44），但获得无可用囊胚的几率更高（调整后的比值比 1.4；P<0.0001），并且可用囊胚“获胜”的比例较低（P=0.0001），当经验最少的胚胎学家进行 ICSI 时。ICSI 操作人员经验的增加与较高的平均 SIR 相关（P<0.0001）。当进行 1000 次以上 ICSI 周期时，胚胎学家之间的实验室和临床结果相似。
ICSI 操作人员经验的增加与更高的受精率、SIR 以及受精失败和可利用囊胚发育的几率降低相关。将单个卵子批分配给多名胚胎学家进行 ICSI 是一种质量控制措施，可以实施。
