宋英伟　罗嘉　徐艳霞　李学荣　周颖莹　徐友花　何邵坚　赵山美子

【摘要】 目的 研究多次宫腔内人工授精（IUI）失败患者采用不同方法进行再治疗的效果。方法 回顾性分析80例接受2次以上IUI助孕失败患者的临床资料， 多次IUI失败后， 20例患者转行卵胞浆内单精子显微注射-胚胎移植（ICSI-ET）， 40例患者转行体外受精-胚胎移植（IVF-ET）治疗， 其余20例转行IVF-ET+ICSI-ET治疗， 观察其治疗效果。结果 在行IVF-ET助孕治疗的40例患者中， 受精失败患者为5例（12.5%）；在行ICSI-ET助孕治疗的20例患者中无一例受精失败；在行IVF-ET+ICSI-ET助孕治疗的20例患者中， 受精失败的患者共计4例（20.0%）；本研究中的多次IUI助孕失败患者在转行IVF-ET/ICSI-ET治疗后， 其受精失败率总计为11.3% （9/80）。结论 针对多次IUI助孕失败患者， IVF-ET技术的疗效确切；在常规体外受精时， 部分患者存在不同程度的卵细胞受精障碍， 针对此类患者， 有效疗法为ICSI-ET；针对多次IUI助孕失败患者， 在全面地掌握患者的既往病史的基础上可以适当地放宽IVF-ET+ICSI-ET的指征， 但是相关的研究仍然有待于深化。

【关键词】 多次人工授精失败；体外受精-胚胎移植；受精成功率

DOI：10.14163/j.cnki.11-5547/r.2016.29.011

Observation of retreatment for patients with multiple artificial insemination failure SONG Ying-wei， LUO Jia， XU Yan-xia， et al. Dongguan Kanghua Hospital， Dongguan 523000， China

【Abstract】 Objective To research effects by different retreatment measures for patients with multiple intrauterine insemination （IUI）. Methods Clinical data of 80 patients with more than 2 times of IUI failure were retrospectively analyzed. After their multiple IUI failure， 20 patients received intracytoplasmic sperm injection-embryo transfer （ICSI-ET）， 40 patients received in vitro fertilization-embryo transfer （IVF-ET）， and the other 20 patients received IVF-ET+ICSI-ET for treatment. Their curative effects were observed. Results Among 40 patients receiving IVF-ET， there were 5 cases with failed fertilization （12.5%）. Among 20 patients receiving ICST-ET， there was no failed fertilization case. Among 20 patients receiving IVF-ET+ICSI-ET， there were 4 cases with failed fertilization （20.0%）. Patients with multiple IUI had total fertilization failure rate as 11.3% （9/80） after receiving IVF-ET+ICSI-ET. Conclusion IVF-ET shows precisely curative effect for patients with multiple IUI failure. In conventional in vitro fertilization， some patients have various degree of oocyte fertilization failure， and effective treatment method for them is ICSI-ET. On the basis of overall comprehension of past medical history in patients with multiple IUI failure， it is appropriate for broaden indication of IVF-ET+ICSI-ET， while related research requires further development.

【Key words】 Multiple artificial insemination failure； In vitro fertilization-embryo transfer； Fertilization success rate

IUI在临床上属于使用率较高的一种助孕技术， 指的是在体外去除丈夫精液的精浆后， 将优选出来的精子及时地注入女性的子宫内， 以确保优选精子与卵子的有效结合， 从而实现妊娠的治疗目的。但是截至目前， IUI助孕的妊娠率较低， 难以满足临床治疗的需求， 而针对多次IUI助孕的患者而言， 妊娠率会伴随着其IUI次数的增加而不断地降低[1]。本研究选取本院收治的80例接受2次以上IUI助孕失败的患者资料进行回顾性研究， 旨在分析在IUI失败患者中应用IVF-ET技术的实际价值， 现报告如下。……