目的:与常规ICSI相比,早期救援ICSI(E-RICSI)是一种有效且安全的技术吗?
结论:尽管与常规ICSI相比,多核(PN)率更高,E-RICSI并未增加临床和新生儿结局的额外风险。
背景:基于发现第二极体在暴露于精子后4小时在80%的受精卵母细胞中释放,在6小时后在90%的受精卵母细胞中释放,E-RICSI将救援ICSI的时间提前到初始授精后6小时,并有效防止卵母细胞老化和胚胎子宫不同步。然而,一些研究人员仍然对E-RICSI的疗效和安全性表示担忧,比较研究是有限的。
对2015年1月至2020年12月在一所大学附属医院接受常规ICSI或E-RICSI治疗的患者进行了一项回顾性队列研究。使用1:1倾向得分匹配,每组1496例。
方法:总共,1496对接受常规ICSI卵母细胞回收周期的夫妇和1496对接受E-RICSI卵母细胞回收周期的夫妇被纳入本研究。和基本临床特征,胚胎数据,比较两组的临床结局和新生儿资料.E-RICSI组的胚胎分为两个亚组:通过iIVF受精的胚胎(IVF亚组)和通过E-RICSI受精的胚胎(E-RICSI亚组);胚胎数据,临床结果,这些亚组的新生儿数据也与常规ICSI组进行了比较.使用Logistic回归进行统计分析,并进行潜在的混淆调整。
结果:2PN率,囊胚形成率,与常规ICSI组相比,E-RICSI组和活囊胚形成率显着降低(2PN率:P<0.001;囊胚形成率:P<0.001;活囊胚形成率:P=0.004),E-RICSI组的多PN发生率明显高于常规ICSI组(P<0.001)。然而,2PN胚胎的数量,正常卵裂胚胎率,第3天优质卵裂胚胎率,两组之间的优质囊胚率相似。当独立考虑E-RICSI组中的IVF胚胎和E-RCSI胚胎时,常规ICSI组的2PN率显著低于E-RICSI亚组,但高于IVF亚组,而囊胚形成率和活囊胚形成率高于E-RICSI胚胎,但与IVF胚胎相当。至于临床和新生儿结局,E-RICSI亚组的植入率显著低于IVF亚组,但与常规ICSI组相当,与常规ICSI组相比,低出生体重(LBW)率显着降低,但与IVF亚组相似。三组间累积临床妊娠率无其他差异,累计活产率,以及每次转移的妊娠结果,包括临床妊娠,异位妊娠,流产,和活产,无论是新鲜或冷冻胚胎移植周期。此外,新生儿结局,包括剖腹产,性别比例,LBW,早产,巨大儿,群体之间是相似的。
结论:这项研究受到回顾性设计的限制,样本量有限,短随访期。然而,我们的研究强调了大规模的必要性,长期随访的多中心随机对照试验。
结论:短期授精(3h)联合E-RICSI可能是预防全受精失败的安全有效方法。可以鼓励精子正常或临界的患者先尝试IVF。
背景:本研究得到了中国国家重点发展计划(编号:2021YFC2700603)和国家自然科学基金(No.81801443)。作者声明没有利益冲突。
背景:不适用。
OBJECTIVE: Is early rescue ICSI (E-RICSI) an effective and safe technique compared to conventional ICSI?
CONCLUSIONS: Despite the higher multi-pronucleus (PN) rate compared to conventional ICSI, E-RICSI did not add extra risks to clinical and neonatal outcomes.
BACKGROUND: Based on the finding that the second polar body was released in 80% of fertilized oocytes by 4 h after exposure to spermatozoa and in ∼90% of fertilized oocytes by 6 h, E-RICSI brings forward the timing of rescue ICSI to 6 h after initial insemination, and effectively prevents oocyte aging and embryo-uterus asynchrony. However, some researchers still voice concerns about the efficacy and safety of E-RICSI, and comparative studies are limited.
UNASSIGNED: A retrospective cohort study was conducted on patients who underwent conventional ICSI or E-RICSI treatment between January 2015 and December 2020 at a university-affiliated hospital. Using 1:1 propensity score matching, 1496 cases entered each group.
METHODS: In total, 1496 couples undergoing conventional ICSI oocyte retrieval cycles and 1496 undergoing E-RICSI oocyte retrieval cycles were enrolled in this study, and basic clinical characteristics, embryologic data, clinical outcomes and neonatal data were compared between groups. The embryos in the E-RICSI group were divided into two subgroups: those fertilized by iIVF (IVF subgroup) and those fertilized by E-RICSI (E-RICSI subgroup); the embryologic data, clinical outcomes, and neonatal data for these subgroups were also compared with the conventional ICSI group. Logistic regression was used for statistical analysis with potential confounder adjustment.
RESULTS: The 2PN rate, blastocyst formation rate, and viable blastocyst formation rate of the E-RICSI group were significantly lower compared to the conventional ICSI group (2PN rate: P < 0.001; blastocyst formation rate: P < 0.001; viable blastocyst formation rate: P = 0.004), and the multi-PN rate in the E-RICSI group was significantly higher than the conventional ICSI group (P < 0.001). However, the number of 2PN embryos, normal cleavage embryo rate, Day 3 high-quality cleavage embryo rate, and high-quality blastocyst rate were similar between groups. When considering the IVF embryos and E-RCSI embryos in the E-RICSI group independently, the 2PN rate of the conventional ICSI group was significantly lower than E-RICSI subgroup but higher than the IVF subgroup, whereas the blastocyst formation rate and viable blastocyst formation rate were higher than E-RICSI embryos but comparable to IVF embryos. As for the clinical and neonatal outcomes, the implantation rate of the E-RICSI subgroup was significantly lower than the IVF subgroup but comparable to the conventional ICSI group, while the low birthweight (LBW) rate was significantly lower compared with the conventional ICSI group but similar with the IVF subgroup. No other differences were observed among the three groups for cumulative clinical pregnancy rate, cumulative live birth rate, and the pregnancy outcomes per transfer including clinical pregnancy, ectopic pregnancy, miscarriage, and live birth, either in fresh or frozen embryo transfer cycles. Furthermore, neonatal outcomes, including cesarean section, sex ratio, LBW, preterm birth, and macrosomia, were similar among groups.
CONCLUSIONS: This study is limited by the retrospective design, limited sample size, and short follow-up period. However, our study underlies the need for large-scale, multi-center randomized controlled trials with long-term follow-up.
CONCLUSIONS: Short-term insemination (3 h) combined with E-RICSI may be a safe and effective method to prevent the occurrence of total fertilization failure, and patients with normal or borderline sperm could be encouraged to try IVF first.
BACKGROUND: This study was supported by grants from the National Key & Development Program of China (No. 2021YFC2700603) and the National Natural Science Foundation of China (No. 81801443). The authors declare no conflicts of interest.
BACKGROUND: N/A.