Clinical Analysis Of Early Rescue ICSI And Conventional ICSI In Patients With Primary Infertility

Objective:To investigate the effect of early rescue ICSI and conventional ICSI on the clinical outcome of primary infertility patients,in order to find the best assisted reproductive technology for these patients.Meanwhile,to explore the related factors affecting r-ICSI/ICSI clinical pregnancy outcome.Methods:A retrospective analysis was performed on 479 primary infertility patients <35 years old who underwent conventional ICSI treatment or early r-ICSI treatment due to IVF-ET partial insemination failure from December 2017 to June 2021 and were divided into r-ICSI group(a total of 77 cycles)and ICSI group(a total of 402 cycles)according to different fertilization methods.According to the semen quality of patients,ICSI group was divided into ICSI-1 group with normal semen parameters(144 cycles)and ICSI-2 group with abnormal semen parameters(258 cycles)to compare the general information,fertilization status and clinical outcomes of the three groups.Then,according to the different clinical pregnancy outcomes,479 cycles were further divided into clinical pregnancy group(171 cycles)and non-clinical pregnancy group(308 cycles),and the related factors affecting r-ICSI/ICSI clinical pregnancy were analyzed.Results:1.There were no significant differences in the median of female age,male age,BMI,infertility years,and basal FSH among the three groups(P > 0.05).2.The maturation rate,fertilization rate,2PN rate,available embryo rate and high quality embryo rate of MII oocytes in r-ICSI group were significantly higher than those in ICSI-1 group(P<0.05),and the cycle cancellation rate was significantly lower than that in ICSI-1 group(P<0.001).The maturation rate,fertilization rate and embryo availability rate of MII oocytes in r-ICSI group were significantly higher than those in ICSI-2 group(P<0.05).3.The cycle cancellation rate and embryo implantation rate were significantly lower than those in ICSI-2 group(P<0.05).The maturation rate of MⅡoocytes in ICSI-1 group was significantly higher than that in ICSI-2 group(P<0.001).The fertilization rate,2PN rate and available embryo rate of high quality embryo rate were significantly lower than those of ICSI-2 group(P< 0.05).4.There were no significant differences in biochemical pregnancy rate clinical pregnancy rate live birth rate early abortion rate and ectopic pregnancy rate among the three groups(P>0.05)5.What’s more,the overall clinical pregnancy of early r-ICSI/ICSI were analyzed.There were no significant differences in the female age,male age,BMI,infertility years,b FSH,available embryo rate and quality embryo rate between the clinical pregnancy group and the non-clinical pregnancy group(P>0.05).The endometrial thickness on the day of HCG in clinical pregnancy group was significantly higher than that in non-clinical pregnancy group(P<0.05).6.Univariate logistic regression was performed for female age,BMI,infertility years,b FSH,endometrial thickness on the day of HCG,available embryos,and high-quality embryos.The results showed that endometrial thickness on the day of HCG(OR=1.196,95%CI 1.093-1.309)was an independent influencing factor for clinical pregnancy(P<0.05).7.The area under ROC curve AUC(95%CI 0.558～0.662)was calculated with sensitivity as the vertical coordinate and 1-specificity as the horizontal coordinate.The area under the curve(AUC-ROC value)of the endometrial thickness on the day of HCG was0.610,and the corresponding endometrial thickness on HCG days was 11.22 mm,which was considered to be a cut-off value,with a specificity of 71.3% and a sensitivity of43.2%.Conclusions:Early r-ICSI is a safe and effective method to improve fertilization rates in patients younger than 35 years of age with primary infertility and can be used as the first choice for these patients.HCG day endometrial thickness has certain predictive value to early r-ICSI/ICSI clinical pregnancy outcome.