二代试管婴儿（ICSI）成功案例全记录：严重少弱精患者的生育突破
一、患者基本情况张先生夫妇
二、关键检查报告男方精液分析（三次复查平均值） 项目 检测值 正常参考值
精液量1.8ml≥1.5ml
精子浓度1.9×10⁶/ml≥15×10⁶/ml
前向运动精子2.8%≥32%
正常形态率0.5%≥4%
女方评估 AMH：3.2ng/ml 输卵管造影：双侧通畅 宫腔镜：正常宫腔形态
诊断结论
原发性不孕症（男方因素为主）
三、治疗方案制定1. 精子获取方案 2. 促排卵方案 拮抗剂方案（预防OHSS） 用药：果纳芬225IU+乐芮75IU 促排天数：10天
3. 实验室技术 卵胞浆内单精子注射（ICSI） 胚胎时差监控培养（EmbryoScope+）
四、治疗过程全记录周期时间轴 日期 关键步骤 数据记录
D1月经期检查基础卵泡左5右6
D3启动促排果纳芬225IU
D6首次监测卵泡12-14mm×8个
D8添加拮抗剂卵泡16-18mm×6个
D10夜针（HCG）最大卵泡22mm
D12取卵手术获卵15枚
D13受精报告成熟卵子12枚→ICSI受精9枚
D15胚胎发育8细胞Ⅰ级×4枚
D17囊胚培养4AA×2枚、4BB×3枚
D20冻胚保存玻璃化冷冻5枚囊胚
五、胚胎移植阶段1. 内膜准备 2. 移植操作 解冻4AA囊胚1枚 移植导管：Cook Sydney IVF 移植后用药：黄体酮针60mg/天+雪诺酮
六、妊娠监测数据时间点 检测项目 结果
移植第10天血HCG286mIU/ml
移植第12天HCG翻倍658mIU/ml
孕5周阴道B超宫内孕囊6mm
孕7周胎心监测心率128次/分
孕12周NT检查1.3mm
七、技术难点突破精子筛选技术
采用PICSI（生理学筛选）选择最佳精子 使用HBA精子结合试验评估精子成熟度
胚胎培养优化 调整培养液葡萄糖浓度（0.2mmol/L） 低氧培养环境（5%O₂）
八、费用明细（人民币）项目 金额
促排卵药物18,000
ICSI操作费8,000
胚胎培养冷冻12,000
睾丸取精手术5,000
移植手术6,000
总计49,000
九、患者见证"结婚5年一直没能怀孕，检查发现丈夫精子质量极差。经过ICSI技术，我们一次性获得5枚优质囊胚！现在宝宝已经健康出生，特别感谢实验室胚胎师在显微镜下为我们精心挑选的那条'超级精子'。"
十、专家点评生殖中心主任医师点评：
"该案例典型展示了ICSI技术的价值： （注：为保护隐私，案例细节已做脱敏处理）
1、 Basic information of the patient Mr. and Mrs. Zhang Age: Husband 35 years old, wife 32 years old Infertility duration: 5 years Medical history: 3 failed artificial insemination attempts Special condition: Husband diagnosed with "severe oligozoospermia" (semen routine: concentration 2.1 × 10 ⁶/ml, forward motile sperm 3%) 2、 Key Inspection Report Analysis of male semen (average of three follow-up examinations) Normal reference value for project testing values Semen volume 1.8ml ≥ 1.5ml Sperm concentration 1.9 × 10 ⁶/ml ≥ 15 × 10 ⁶/ml Forward motile sperm 2.8% ≥ 32% Normal morphology rate 0.5% ≥ 4% Female evaluation AMH：3.2ng/ml Hysterosalpingography: Bilateral patency Hysteroscopy: Normal morphology of the uterine cavity Diagnostic conclusion Primary infertility (mainly caused by male factors) 3、 Development of treatment plan 1. Sperm acquisition plan Testicular Puncture Sperm Extraction (TESA) Sperm freezing backup 2. Ovulation induction plan Antagonist regimen (prevention of OHSS) Medication: Gonafene 225IU+Liriopide 75IU Promotion days: 10 days 3. Laboratory technology Intracytoplasmic sperm injection (ICSI) Embryo Time Difference Monitoring and Culture (EmbryoScope+) 4、 Full record of treatment process Cycle timeline Date key step data recording D1 Menstrual Examination Basic Follicles Left 5 Right 6 D3 activation promotes the excretion of guanafen 225IU D6 first monitored 8 follicles measuring 12-14mm in size D8 adds antagonist to 16-18mm x 6 follicles D10 night needle (HCG) maximum follicle size 22mm D12 egg retrieval surgery yielded 15 eggs D13 Fertilization Report: 12 Mature Eggs → ICSI Fertilization: 9 Eggs D15 embryo development, 8 cells, grade I, 4 embryos D17 blastocyst culture: 4AA x 2, 4BB x 3 D20 frozen embryo preservation vitrification freezing of 5 blastocysts 5、 Embryo Transfer Stage 1. Endometrial preparation Artificial cycle: Bu Jia Le 6mg/day (inner membrane grows to 9.8mm) Add aspirin (improves blood flow) 2. Transplantation operation Thaw 1 4AA blastocyst Transplant catheter: Cook Sydney IVF Post transplant medication: 60mg/day progesterone injection+corticosterone 6、 Pregnancy monitoring data Time point detection project results On the 10th day of transplantation, the blood HCG level was 286mIU/ml On the 12th day of transplantation, HCG doubled by 658mIU/ml 5-week pregnancy, transvaginal ultrasound, intrauterine gestational sac 6mm Fetal heart rate monitoring at 7 weeks of pregnancy with a heart rate of 128 beats per minute NT examination at 12 weeks of pregnancy 1.3mm 7、 Breakthrough in technical difficulties Sperm screening technology Using PICSI (physiological screening) to select the best sperm Evaluating sperm maturity using HBA sperm binding assay Embryo culture optimization Adjust the glucose concentration of the culture medium (0.2mmol/L) Low oxygen culture environment (5% O ₂) 8、 Cost Details (RMB) Project amount Ovulation inducing medication 18000 ICSI operation fee 8000 Embryo culture frozen 12000 Testicular Sperm Extraction Surgery 5000 Transplantation surgery 6000 Total 49000 9、 Patient Witness We have been married for 5 years and have not been able to conceive. Upon examination, it was found that our husband's sperm quality is extremely poor. Through ICSI technology, we obtained 5 high-quality blastocysts at once! Now that the baby has been born healthy, we would like to express our special thanks to the laboratory embryologist who carefully selected the 'super sperm' for us under the microscope. " 10、 Expert review Comment from the Chief Physician of the Reproductive Center: This case exemplifies the value of ICSI technology: Breaking through the birth barrier of severe oligozoospermia and asthenospermia Obtaining usable sperm through testicular extraction High quality blastocyst rate of up to 55% (industry average of 40%) It should be noted that offspring of such patients are recommended to undergo childhood reproductive system examinations. " (Note: To protect privacy, the details of the case have been desensitized.)
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