Chen Jinghua, Liu Lanlan, Liu Zhenfang, Pan Luxiang, Zhou Liying, Chen Kaijie, Yang Xiaolian, Chen Yurong, Jiang Xiaoming, Ren Jianzhi, Cai Jiali
Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Xiamen, 361003, Fujian, China.
School of Medicine, Xiamen University, Xiamen, 361005, Fujian, China.
Arch Gynecol Obstet. 2025 Apr 30. doi: 10.1007/s00404-025-08033-3.
To compare the clinical outcomes of extremely poor responders with one or two oocytes who receive in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
A retrospective study was carried out on 2572 patients with one or two oocytes retrieved from 2013 to 2022, of which 2159 patients were scheduled to receive IVF treatment and 413 patients were scheduled to receive ICSI treatment. The laboratory parameters and clinical outcomes were compared with adjusted multivariate regression and propensity score (PS) matching.
In both matched and non-matched cohorts, The ICSI group had a significantly higher total fertilization failure (TFF) rate and lower multiple fertilization rate than the IVF group (P < 0.05). After matching, the cumulative pregnancy rate per initiated cycle in the IVF group was significantly higher than in the ICSI group (28.7% vs 21.7, P < 0.05). However, the difference in cumulative live births did not reach statistical significance (21.2% vs 17.2%, P > 0.05). The adjusted odds ratios for TFF, cumulative pregnancy, and cumulative live birth comparing ICSI versus IVF in multivariate models were 1.65(95% CI: 1.12, 2.43), 0.65(95% CI: 0.46, 0.91), and 0.76(95% CI: 0.55, 1.04), respectively.
In poor responders with one or two oocytes retrieved, ICSI insemination cannot avoid TFF, and it may hamper the cumulative pregnancy rate.
比较接受体外受精（IVF）和卵胞浆内单精子注射（ICSI）的极低反应者（获卵数为1或2个）的临床结局。
对2013年至2022年期间2572例获卵数为1或2个的患者进行回顾性研究，其中2159例患者计划接受IVF治疗，413例患者计划接受ICSI治疗。通过调整多因素回归和倾向评分（PS）匹配比较实验室参数和临床结局。
在匹配和未匹配队列中，ICSI组的总受精失败（TFF）率显著高于IVF组，多精受精率低于IVF组（P＜0.05）。匹配后，IVF组每个启动周期的累积妊娠率显著高于ICSI组（28.7%对21.7%，P＜0.05）。然而，累积活产率的差异未达到统计学意义（21.2%对17.2%，P＞0.05）。多变量模型中比较ICSI与IVF的TFF、累积妊娠和累积活产的调整比值比分别为1.65（95%CI：1.12，2.43）、0.65（95%CI：0.46，0.91）和0.76（95%CI：0.55，1.04）。
对于获卵数为1或2个的低反应者，ICSI授精不能避免TFF，且可能会妨碍累积妊娠率。
