挽救性卵胞浆内单精子注射提高了年轻女性第二极体排出率<50%周期的累积活产率：广义相加模型

Rescue intracytoplasmic sperm injection improved cumulative live birth rate for cycles with second polar body extrusion rate <50% in young women: generalized addictive model.

作者信息

Chen Xiaolei, Wang Yanan, Yang Chaoyan, Li Cheng, Yin Changjian, Zhao Maoning, Wu Keliang, Zhao Han

机构信息

Institute of Women, Children and Reproductive Health, Shandong University, Jinan, Shandong, People's Republic of China; State Key Laboratory of Reproductive Medicine and Offspring Health, Shandong University, Jinan, Shandong, People's Republic of China; National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, People's Republic of China; Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, Shandong, People's Republic of China; Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, People's Republic of China; Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China; Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No.2021RU001), Jinan, Shandong, People's Republic of China.

出版信息

Fertil Steril. 2025 Mar;123(3):415-427. doi: 10.1016/j.fertnstert.2024.09.017. Epub 2024 Sep 11.

DOI:10.1016/j.fertnstert.2024.09.017

PMID:39265651

Abstract

OBJECTIVE

To determine the indications for early rescue intracytoplasmic sperm injection (ICSI) application.

DESIGN

A retrospective cohort study.

SUBJECTS

The study included 19,808 patients who underwent conventional in vitro fertilization (IVF) or rescue ICSI for their first cycles between February 2017 and December 2021.

EXPOSURE

Rescue ICSI cycles constituted the study group, where oocytes that had not extruded the second polar body 4-6 hours after insemination were rescued by ICSI. The control group consisted of conventional IVF cycles with no interventions to rescue oocytes without the second polar body. Generalized additive models were constructed to describe the relationship between the second polar body extrusion rate and cumulative live birth rate in conventional IVF and rescue ICSI cycles, respectively. The cutoff value of the second polar body extrusion rate guiding rescue ICSI application was determined from the intersection point of generalized additive models. Maternal age range applicable to rescue ICSI was further analyzed using the same method. Clinical outcomes were compared between conventional IVF and rescue ICSI cycles across different second polar body extrusion rate and maternal age subgroups.

MAIN OUTCOME MEASURES

The second polar body extrusion rate and maternal age range for rescue ICSI application, normal fertilization rate, and cumulative live birth rate.

RESULTS

Generalized additive models showed that the cutoff value for the second polar body extrusion rate about rescue ICSI application was 50%. When the rate <50%, normal fertilization rate and cumulative live birth rate (63.7% vs. 46.1%; odds ratio, 1.609; 95% confidence interval, 1.276-2.030) were significantly higher in rescue ICSI cycles than conventional IVF cycles. When the rate ≥50%, rescue ICSI cycles had similar normal fertilization rate and cumulative live birth rate compared with conventional IVF cycles. Further analysis on maternal age in cycles with second polar body extrusion rate <50% released that rescue ICSI cycles showed a higher cumulative live birth rate (67.7% vs. 48.3%; odds ratio, 1.732; 95% confidence interval, 1.361-2.202) than conventional IVF cycles for women aged <38 years.

CONCLUSION

In vitro fertilization cycles with second polar body extrusion rate <50% in women aged <38 years was applicable to early rescue ICSI.

摘要

目的

确定早期补救性卵胞浆内单精子注射（ICSI）应用的指征。

设计

一项回顾性队列研究。

研究对象

该研究纳入了19808例在2017年2月至2021年12月期间首次进行常规体外受精（IVF）或补救性ICSI的患者。

暴露因素

补救性ICSI周期构成研究组，在该组中，授精后4 - 6小时未排出第二极体的卵母细胞通过ICSI进行补救。对照组由未对未排出第二极体的卵母细胞进行干预的常规IVF周期组成。构建广义相加模型分别描述常规IVF和补救性ICSI周期中第二极体排出率与累积活产率之间的关系。从广义相加模型的交点确定指导补救性ICSI应用的第二极体排出率的截断值。使用相同方法进一步分析适用于补救性ICSI的产妇年龄范围。比较不同第二极体排出率和产妇年龄亚组中常规IVF和补救性ICSI周期的临床结局。

主要观察指标

补救性ICSI应用的第二极体排出率和产妇年龄范围、正常受精率以及累积活产率。

结果

广义相加模型显示，关于补救性ICSI应用的第二极体排出率的截断值为50%。当该率<50%时，补救性ICSI周期的正常受精率和累积活产率（63.7%对46.1%；优势比，1.609；95%置信区间，1.276 - 2.030）显著高于常规IVF周期。当该率≥50%时，补救性ICSI周期与常规IVF周期的正常受精率和累积活产率相似。对第二极体排出率<50%的周期中的产妇年龄进行进一步分析发现，对于年龄<38岁的女性，补救性ICSI周期的累积活产率（67.7%对48.3%；优势比，1.732；95%置信区间，1.361 - 2.202）高于常规IVF周期。