Fishel S, Lisi F, Rinaldi L, Lisi R, Timson J, Green S, Hall J, Fleming S, Hunter A, Dowell K
NURTURE (Nottingham University Research and Treatment Unit in Reproduction), Department of Obstetrics and Gynaecology, Queen's Medical Centre, UK.
Reprod Fertil Dev. 1995;7(2):169-74; discussion 174-5. doi: 10.1071/rd9950169.
The use of high insemination concentration (HIC) for in vitro fertilization (IVF) was compared with intracytoplasmic sperm injection (ICSI) in cases of male factor infertility. Sibling oocytes (n = 252) from 24 patients were used, 123 for HIC and 129 for ICSI. Although the incidence of fertilization was decreased with HIC (48% v. 61%), this treatment was nevertheless a viable option for many patients, especially when ICSI was not available. However, there was a higher incidence of cytoplasmic fragmentation of embryos after HIC compared with ICSI (36% v. 10%, P = 0.003) and the outcome was significantly affected by the severity of teratozoospermia. Using a cut-off of 5% normal forms, the incidence of fertilization with HIC for the group with < 5% normal forms was 37% compared with 72% for the group with > 5% normal forms; there was also a significant decrease in cleavage rate (P = 0.05) and the number of regular embryos (P = 0.005), and an increase in cytoplasmic fragmentation (P = 0.006) in patients with < 5% normal forms. No distinction was made between cases of teratozoospermia when ICSI was used. The present study confirms the value of HIC as a first line treatment for male infertility, as long as ICSI remains significantly more expensive and concerns on safety are mooted. However, the use of sibling oocytes for ICSI is recommended, especially in cases with < 5% normal sperm morphology.
在男性因素不育的病例中，对体外受精（IVF）使用高授精浓度（HIC）与卵胞浆内单精子注射（ICSI）进行了比较。使用了来自24名患者的同胞卵母细胞（n = 252），其中123个用于HIC，129个用于ICSI。尽管HIC组的受精率有所下降（48%对61%），但这种治疗方法对许多患者来说仍然是一个可行的选择，尤其是在无法进行ICSI的情况下。然而，与ICSI相比，HIC后胚胎的细胞质碎片发生率更高（36%对10%，P = 0.003），并且精子畸形症的严重程度对结果有显著影响。以正常形态精子比例5%为界值，正常形态精子比例<5%的组使用HIC的受精率为37%，而正常形态精子比例>5%的组为72%；正常形态精子比例<5%的患者的卵裂率（P = 0.05）和正常胚胎数量（P = 0.005）也显著降低，细胞质碎片增加（P = 0.006）。使用ICSI时未区分精子畸形症的病例。本研究证实了HIC作为男性不育一线治疗方法的价值，只要ICSI仍然昂贵得多且对安全性的担忧尚无定论。然而，建议对ICSI使用同胞卵母细胞，尤其是在正常精子形态<5%的情况下。
