Application Of Half Intracytoplasmic Sperm Injection In Assisted Reproduction Techniques

ObjectiveTo retrospectively analysis the high risk factors of in vitro fertilization (IVF) fertilization failure, the clinical outcome of the half intracytoplasmic sperm injection (half-ICSI) cycles and investigate its significance in saving the fertilization failureMethodsA total 1846 cycles of the half-ICSI and conventional IVF performed in Xiangya reproductive center from January 2007 to December 2008 were retrospectively analysised. All was divided into two groups, one was half-ICSI, the other was conventional IVF,we called half-ICSI as group 1 and conventional IVF as group 2 for short. And the half-ICSI cycles include two parts, one was IVF, the other was ICSI. Group 1 was subdivided into three groups according to fertilization rate of IVF, normal fertilization rate (NFR) was called group NFR1, low fertilization rate (LFR) was called group LFR1, total fertilization failure (TFF) was called groupTFF1, the same was done to conventional IVF group (Group 2) which was called group NFR2, LFR2 and TFF2.1. To compare the age, infertility duration and its duration more than 10 years and the constituent ratio of infertility cause and pregnancy rate among group NFR 1,LFR 1 and TFF1, as well as groupNFR2, LFR2 and TFF2.2. All half-ICSI cycles were divided into two groups according to fertilization rate of IVF, one was the oocytes which were fertilized through IVF and ICSI, the other one was the oocytes which were total fertilized failure through IVF and only fertilized through ICSI, and the semen parameters between these two groups were compared.3. To compare the constituent ratio of LFR and TFF between the part of IVF in group land group2, as well as pregnancy rate between these two groups4. To compare the retrieved oocytes, mature oocytes, fertilization rate, cleavage rate and high-quality embryo rate between the parts of IVF and ICSI in groupl,as well as the constituent ratio of LFR and TFF.5. All half-ICSI cycles were divided into three groups according to the derivation of embryo transplanted, including IVF, IVF+ICSI, ICSI, the implantation rate and clinical pregnancy rate were compared.Results1. There was significant difference in the constituent ratio of infertility duration more than 10 years, primary infertility especially with infertility duration more than 10 years, endometriosis and mild-to-moderate oligoasthenotertozoospermia among group NFR1, LFR1 and TFF1 (p<0.05). There was no significantly difference in the rate of clinical pregnancy between these three groups (p>0.05)2. There was significant difference in the constituent ratio of infertility duration more than 10 years, primary infertility especially with infertility duration more than 10 years and mild-to-moderate oligoasthenotertozoospermia among group NFR2, LFR2 and TFF2 (p< 0.05). There was significantly difference in the rate of clinical pregnancy between these three groups (p<0.05)3. In half-ICSI group, couples with oocyte fertilized by both IVF and ICSI had slightly better semen parameters than those with oocyte fertilization only by ICSI, but there was significant difference only in pre-treatment semen and the rate of grade B sperm in post-treatment semen (p<0.05)4. The constituent ratio of LFR and TFF through IVF in group 1 was significantly higher than that in group 2(p<0.05).5. There was no significantly difference in clinical pregnancy rate between group 1 and group 2, group LFR1 and group2, as well as group TFF1 and group2 (p>0.05)6. There was no significant difference in retrieved oocytes, mature oocytes between the parts of IVF and ICSI in group 1; but the fertilization rate, cleavage rate, high-quality embryo rate in the part of IVF was significantly lower than that in ICSI (p<0.05); the constituent ratio of LFR and TFF in the part of IVF was significantly higher than that in ICSI(p<0.05). 7. Rates of implantation and clinical pregnancy were significantly higher in group of embryos derived from IVF and ICSI than that only derived from IVF or ICSI (p<0.05); but there was no significant difference in rates of implantation and clinical pregnancy between embryos only derived from IVF or ICSI(p>0.05).Conclusion1. Infertile couples who have one of the factors like primary infertility or (and) infertility duration more than 10 years, mild-to-moderate oligoasthenotertozoospermia may exist IVFfertilization failure.2. For these couples who may exist fertilization failure,half-ICSI is a better method which can increase the pregnancy rate of LFR and TFF cycles, avoid fertilization failure; in this way it can increase fertilization rate, gain more good-quality embryos and better pregnancy rate.3. When there are no high-quality embryos from IVF, to get better pregnancy rate in half-ICSI cycles, we should choose embryos according to embryo grading not only limit to choosing embryo according to the fertilization method.