精液参数和来源对ICSI助孕患者胚胎质量及临床结局的影响

Effects of semen factors and origin on embryo quality and clinical outcome of patients received ICSI treatment

目的:分析精子因素对卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)临床结局的影响。方法:回顾性分析不同来源和参数精液行ICSI助孕的临床资料,A组为因精卵结合障碍重复周期行ICSI授精者228周期,B组少弱精子组790周期,C组为附睾穿刺取精(percutaneous epididymal sperm aspiration,PESA)/睾丸穿刺取精(testicular sperm aspiration,TESA)组225周期,比较各组患者行ICSI助孕的胚胎质量及临床结局。结果:3组患者的正常受精率和卵裂率均无统计学差异,A组患者可利用胚胎率明显低于B组,A组患者的优质胚胎率明显低于B、C 2组;新鲜移植周期中A组患者胚胎种植率明显低于B、C2组,临床妊娠率、多胎率、早期流产率、早产率、活产率及新生儿男女性别比例均无显著差异(P>0.05),A组患者新生儿体质量高于B、C 2组,且B组高于C组;复苏移植周期A组患者临床妊娠率和胚胎种植率明显低于B、C 2组,且C组大于B组,C组活产率明显大于A、B 2组(P<0.05),其他临床指标无统计学差异(P>0.05)。结论:精子的参数及来源不影响ICSI治疗的受精、卵裂及早期妊娠;ICSI能够改善受精障碍组的受精情况(A组),但胚胎的质量和发育潜能较低;PESA/TESA组有相对较高的临床妊娠率和种植率。

Objective：To evaluate the effects of sperm with different qualities on the outcomes of intracytoplasmic sperm injection（ICSI）. Methods：The clinical data of patients received ICSI treatment with different sources and parameters of semen were retrospectively analyzed. Group A were patients who received 228 cycles due to sperm-egg combination obstacles. Group B were patients who received 790 cycles due to oligo-asthenospermatism. Group C were patients who received percutaneous epididymal aspiration（PESA）/testicular sperm extraction（TESA） for 225 cycles. The embryonic development and pregnancy outcomes were compared. Results：There was no statistical difference in rate of fertilization rate and cleavage among three group. The rate of available embryo of group A was lower than that in group B;the rate of good-quality embryo of group A is lower than that in group B and C;group A has a significantly lower implantation rate than group B and C;there was no significant difference in clinical pregnancy rate,rate of multiplets,early miscarriage,premature birth rate,live birth rate and newborn sex ratio among three groups in the fresh transplantation cycles（P〉0.05）. The neonatal weight of group A was higher than that of groups B and C,while the neonatal weight of group B is higher than that of group C. In the vitrified-thawed cycles,the clinical pregnancy rate and the implantation rate of group A were lower than those of group B and group C,and the clinical pregnancy rate and the implantation rate of group C were higher than those of group B;group C has a higher live-birth rate than group A and group B;there was no statistical difference in other indexes. Conclusion：The parameters and source of sperm does not affect the ICSI fertilization,cleavage and early pregnancy. ICSI can improve the fertilization rate of sperm-egg combination obstacles（group A）,but the quality and developmental potential of embryos is lower. PESA/TESA groups have a relatively higher clinical pregnancy and implanation rate.