精子DNA碎片指数与年龄和精液参数的相关性及其对IVF-ET的影响

Correlation of sperm DNA fragmentation index with age and semen parameters and its influence on the outcomes of IVF-ET

目的:探讨不育男性精子DNA碎片指数(DFI)与年龄和精液其他参数的相关性及其对IVF-ET的影响。方法:(1)6 162例精液样本来自2017年7月至2018年12月在中山大学附属江门医院生殖医学中心就诊的不育男性,利用计算机辅助精液分析系统(CASA)分析精子浓度和前向运动精子百分率,采用改良巴氏染色法结合人工显微镜检测计算正常形态精子百分率,并使用精子染色质结构分析法结合流式细胞术计算精子DFI。6 162例患者按精子DFI分为DFI≤15%、15%30%4组,对比受精率、卵裂率、胚胎形成率、妊娠率等关键指标。结果:(1)精子DFI与患者年龄呈密切的正相关(r=0.508,P<0.05),与精子浓度、前向运动精子百分率、正常形态精子百分率均呈不密切的负相关(r分别为-0.155、-0.111、-0.315,P<0.05)。(2)当DFI>20%时,IVF临床妊娠率显著下降;当DFI>30%时,IVF可利用胚胎率也显著下降,且生化妊娠率明显上升。(3)精子DFI对IVF总受精率、正常受精率、总卵裂率、正常卵裂率、优质胚胎率无显著性影响。结论:不育男性精子DFI与年龄呈正相关性,与精子浓度、前向运动精子百分率、正常形态精子百分率呈不同程度的负相关性,且显著影响IVF-ET结局,是重要的精液参数。

Objective: To explore the correlation of the sperm DNA fragmentation index(DFI) with age and other semen parameters in infertile men and its influence on the outcomes of in vitro fertilization and embryo transplantation(IVF-ET). Methods: Semen samples were obtained from 6 162 infertile males in our hospital between July 2017 and December 2018. Sperm concentration, the percentages of progressively motile sperm(PMS) and morphologically normal sperm(MNS) and sperm DFI were determined by computer-assisted semen analysis, modified Papanicolaou staining and sperm chromatin structure assay, respectively. According to the sperm DFI, the samples were divided into three groups: DFI≤15%, 15%<DFI<30%, and DFI≥30%, followed by analysis of the correlation of sperm DFI with age and other semen parameters. The clinical data were also collected from 1 206 couples undergoing IVF-ET between January 2015 and December 2018, who fell into four DFI groups: DFI≤10%, 10%<DFI≤20%, 20%<DFI≤30%), and DFI>30%. Comparisons were made among different groups in the rates of fertilization, embryo cleavage, embryo formation and pregnancy. Results: Spearman correlation analysis showed that DFI was correlated positively with age(r = 0.508, P < 0.05), but negatively with sperm concentration(r =-0.155, P < 0.05) and the percentages of PMS(r =-0.111, P < 0.05) and MNS(r =-0.315, P < 0.05). With sperm DFI >20%, the clinical pregnancy rate of IVF-ET was significantly reduced, while with sperm DFI >30%, the rate of available embryos markedly decreased and that of biochemical pregnancy remarkably increased. No correlation was found between sperm DFI and the rates of fertilization, embryo cleavage and high-quality embryos in IVF-ET. Conclusion: In infertile males, sperm DFI is correlated positively with age but negatively with sperm concentration and the percentages of PMS and MNS, and it significantly affects the outcomes of IVF-ET.