The Study On Embryo Quality, Clinical Outcomes And Birth Defects Of Infertile Women By Intracytoplasmic Sperm Injection Treatment

PartⅠAnalysis of fertilization,clinical outcomes and birth defects undergoing ICSI treatment using different sources and parameter spermOBJECTIVETo explore the fertilization,cilinical outcomes and birth defects of infertiled women undergoing ICSI treatment using nomal or mildly abnormal parameters semen because of non-male factor and highly abnormal semen,epididymal and testicular semen because of male factor and study the influence on ICSI treatment outcomes because of different sources and parameters sperm.MATERIALS AND METHODS980 cases of infertile women undergoing ICSI-ET treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008. According to the sources and parameters of sperm of husband,980 patients were divided into 4 groups.(1) The normal sperm group,refers to the ejaculated sperm for ICSI treatment,sperm density≥20.0x106/ml and sperm activity rate＞50%or sperm density＜20x106 and(or) activity rate of＜50%,a total of 168 circles.(2) The highly abnormal semen group,refers to the ejaculated sperm for ICSI treatment,sperm density＜5x106/ml and(or) activity rate of＜10%,a total of 610 circles.(3) Epididymal sperm groups,obstructive azoospermia patients with access to sperm through percutaneous epididymal sperm aspiration(PESA).A total of 156 circles.(4) Testicular sperm group,male sperm by masturbation obtained failure or epididymal sperm obtained failure or non-obstructive azoospermia patients with sperm obtained through testicular sperm acquisition(TESA) techniques,a total of 46 circles.Infertile women using the conventional superovulation program of the Center to retrieve oocytes under the guiding of ultrasound.The semen of their husbands was acquired by masturbation or PESA or TESA on the day of oocyte retrieval and select motile sperm which eumorphism to proceed ICSI operation for every mature egg. Fertilization,cleavage and embtyo formation were observed and recorded.On the three day or five day of oocyte retrieval,high-grade embryos were selected to transfer and treatment outcomes was followed up.Embryo quality and clinical outcomes of patients were analyzed when they were treated with ICSI-ET by different sources and parameter semen.RESULTSThere were no significant difference of the normal fertilization rate,abnormal fertilization rate,normal cleavage rate and good-quality embryo rate among four groups(P＞0.05),the embryo implantation rate and clinical pregnancy rate of C group were higher than A and B groups(P＜0.05).The birth defects rate of A group was 2.3 %,B group was 5.3%,C group 6.9%,the differences were not significant(P＞0.05).CONCLUSIONS1.Different parameters and sources of semen used in ICSI treatment achieved satisfactory fertilization rate,cleavage rate and good- quality embryo rates and delivery rate.2.The higher embryo implantation rate and clinical pregnancy rate of epididymal sperm group than A and B groups may be related to the younger patients and the more number eggs.3.The probability of occurrence of birth defects in ICSI offspring may increased by different parameters and sources of semen used in ICSI treatment respect to decrease in quantity,reduction in vitality and degree of maturity in sperm.,we can not believe that the probability of occurrence of birth defects in ICSI offspring is directly related to the ICSI operation itself. PartⅡThe analysis of fertility,clinical outcomes and birth defects by IVF and ICSI treatment in the same cycleOBJECTIVETo analyze and compare the discrepancy of fertilization,clinical outcomes and birth defects using the implementation of conventional in vitro fertilization(IVF) and intracytoplasmic sperm injection(ICSI) respectively in the same cycle because of single or a number of infertile factors in primary and secondary infertility patients.To analyze the discrepancy of clinical outcomes and birth defects between ICSI embryos and conventional IVF embryos transplantation.To provide a basis for exploring with respect to the indication and security of IVF + ICSI treatment.MATERIALS AND METHODS149 cases of infertile women by IVF+ICSI treatment were recruited at reproductive medicine center of Nanfang Hospital in this study during January 2003 and December 2008.According to the indication and primary or secondary infertility,the following was divided into two groups,(1) Primary infertility group(excepting unexplained infertility),infertile time≥four years,a totle of 98 cases.Of the group,there were 11 cases(11.2%) which combining male semen parameter belongs to the line of IVF or ICSI threshold(1×106/ml≤sperm density＜5x106 and(or) 1%≤sperm motility (a + b grades)＜10%),1 case(1.0%) of which have the low IVF fertilization(30≤fertilization rate≤50%) in prior cycles,86 cases(87.8%) which have other factors as pelvic tubal factors,endometriosis or PCOS.(2) Secondary infertility group,a totle of 51 cases.Of the group,there were 21 cases(41.0%) which combining male semen parameter belongs to the line of IVF or ICSI threshold,1 case (2.0%) of which have the low IVF fertilization in prior cycles,29 cases(56.9%) which with other indication as repeated IVF treatment failure(≥3 cycles),unexplained secondary infertility and so on.The superovulation program and retrieving oocytes of infertile women were the same as PartⅠ.There were 2175 eggs retrieved,each patient using IVF+ICSI insemination on the same cycle eggs.Of which,there were 1095 eggs for the IVF insemiation and 1080 for ICSI insemination.To analyze the normal fertilization,abnormal fertilization,normal cleavage rate,high- quality embryo rate clinical pregnancy rate and birth defects rate.RESULTS1.When insemination on eggs retrieved in same circle by IVF+ICSI,the normal fertilization rate,high-quality embryo rate,and the number of high-quality embryos of ICSI insemination were higher than that of IVF,more sperm abnormal feitilization rate was lower than IVF.2.The fully un-fertilization rate of conventional IVF part in primary infertility group was 10.2%,which was higher than in secondary infertility group(3.9%),there was no significant difference between the two groups(P＞0.05).There was no fully un-fertilization rate in ICSI insemination in the two groups.The normal fertilization rate in ICSI part was higher than conventional IVF part,more sperm abnormal fertilization was lower than IVF in the two groups(P＜0.05).There were no significant difference in fertilization and clinical outcomes between the two groups which combining male factor or not(P＞0.05).3.The embryo implantation rate,clinical pregnancyrate and dilivery rate from the ICSI embryo transferation were higher than conventional IVF embryo group and IVF+ICSI embryo groups,birth defects rate lower than the other groups,There was no significant difference amoung the three groups temporarily(P＞0.05),which may be related to insufficient sample size.CONCLUSIONS1.When insemination on eggs retrieved in same circle by IVF+ICSI,ICSI treatment can improve normal fertilization rate,decrease more sperm abnormal fertilization rate,improve embtyo quality,increase the number of high-quality embryo and improve clinical pregnancy rate.2.There are more susceptible to the trend of IVF insemination failure in Patients with primary infertility than in patients with secondary infertility. 3.Combining single or a number of infertile factors,primary infertility patients and secondary infertility patients by IVF+ICSI treatment can get satisfied clinical results, particularly in patients with primary infertility.4.The trend of clinical outcomes by ICSI embryos transferation was better than IVF embryos,and compared with IVF embryos,and there were no increase in birth defects.But the sample size was insufficient,we should increase the sample size for further study.