目的：分析体外授精（IVF）短时授精中受精率高（受精率＞60%）与受精完全失败（受精率=0%）早补救卵母细胞胞浆内单精子注射（ICSI）患者的临床结局和精子参数，探讨IVF失败的相关因素。方法对比322例IVF短时授精周期中153例受精率达到60%以上的患者（受精率高组即 A组）与同期接受IVF短时授精发现受精完全失败后进行早补救ICSI治疗的53名患者（受精完全失败组即B组）的临床结局及其精子参数。结果 A组与B组各获卵1619和393枚，各有133名和47名患者接受了新鲜胚胎移植。两组间的正常卵裂率分别为98.02%（940/959）和97.70%（254/260），优质胚胎率分别为33.51%（315/940）和35.43%（90/254），平均移植胚胎数分别为2.15±0.39和2.05±0.52，移植日内膜厚度分别为（12.99±2.53）mm和（12.38±2.45）mm，胚胎种植率分别为29.41%（85/289）和24.73%（23/93），临床妊娠率分别为44.36%（59/133）和42.55%（20/47），流产率分别为2.26%（3/133）和2.13%（1/47），继续妊娠率分别为41.35%（55/133）和38.30%（18/47），差异均无统计学意义。而A组的正常受精率较B组低[65.55%（959/1463）vs 77.61%（260/335）]，同时多原核受精率较B组高[14.56%（213/1463）vs 6.27%（21/335）]，差异均具有统计学意义。A组与B组平均精子密度分别为（74.63±36.05）×106/mL和（76.97±36.64）×106/mL，前向精子密度分别为（46.02±13.79）×106/mL和（40.63±16.08）×106/mL，正常形态精子分别为（3.74±1.73）%和（4.21±1.86）%，顶体酶活性分别为（79.18±24.89）uIU和（71.81±32.30）uIU，均存在一定的差异，但是并无统计学意义。结论短时授精后受精率高与受精完全失败行早补救患者具有接近的临床妊娠率，但受精率高组较受精失败行早补救组具有更高的多原核受精率和更低的正常受精率，前向精子密度和精子形态对受精有重要影响，但是其对受精失败的预测作用有限。%Objective To analyze the clinical outcomes and sperm parameters of patents after short co-incubation of gametes combined with early rescue ICSI, and investigate the causes of complete fertilization failure. Methods Among 322 short co-incubation of gametes cycles, 153 cases had high fertilization rate (IVF fertilization rate>60%: Group A) and 53 cases had complete un-fertilization and rescued by early ICSI (IVF fertilization rate=0%: Group B). The clinical outcomes and sperm parameters were comparatively analyzed between above two groups. Results The patients in Group A and Group B received (1916 vs 393) eggs, and 133 and 47 patients accepted embryo-transfer in their fresh cycles, respectively. There were no significant differences in the rates of cleavage[98.02%(940/959)vs 97.70%(254/260)], good quality embryo[33.51%(315/940)vs 35.43%(90/254)], implantation[29.41%(85/289)vs 24.73%(23/93)], clinical pregnancy[44.36%(59/133)vs 42.55%(20/47)], abortion[2.26%(3/133)vs 2.13%(1/47)] and ongoing pregnancy[41.35%(55/133)vs 38.30%(18/47)] between two groups. The normal fertilization (2PN) rate in Group A was significant lower than that in Group B, and the polyspermy rate was significant higher than that in GroupB. The average sperm density (74.63×106/mL vs 76.97×106/mL), forward movement sperm density (46.02×106 vs 40.63×106), normal sperm morphology (3.74%vs 4.21%) and acrosin (79.18 vs 71.81) were difference between above two groups, but the difference was not significant. Conclusion The patients in Group A and Group B presented similar clinical pregnancy rates, but the patients in Group A had higher polyspermy rate and lower normal fertilization (2PN) rate. Forward movement sperm density and sperm morphology showed some effects on fertilization, but accurate prediction of fertilization failure by sperm parameters still needs to be further investigated.
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