精子DNA碎片对夫精人工授精助孕结局的预测价值

Predictive value of sperm DNA fragmentation on pregnancy outcome of artificial insemination

目的探讨精子脱氧核糖核酸(DNA)碎片对精液参数及夫精人工授精助孕结局的影响。方法选取2020年1月至2022年10月在广州市花都区妇幼保健院生殖科的318例行夫精人工授精(AIH)助孕周期患者作为研究对象,按照精子DNA碎片指数(DFI)分为A组(DFI<15%,133例)、B组(15%≤DFI≤30%,156例)与C组(DFI>30%,29例)。比较三组精液参数、妊娠结局,并绘制受试者工作特征(ROC)曲线,评估DFI对AIH妊娠结局的预测价值。结果A组与B组处理前前向运动(PR)级精子百分率和总数、处理后精子浓度均高于C组,差异有统计学意义(P<0.05);A组处理后精子PR总数高于C组,差异有统计学意义(P<0.05);A组处理前PR级精子百分率、处理后PR级总数高于B组,差异有统计学意义(P<0.05);三组的精子正常形态率、精液体积、处理前精子浓度和总数、回收率比较,差异无统计学意义(P>0.05);三组的生化妊娠率、临床妊娠率、流产率比较,差异无统计学意义(P>0.05)。ROC曲线显示精子DFI预测临床妊娠和流产的曲线下面积(AUC)分别为0.509和0.718。结论精子DFI影响精子前向运动率和前向运动精子总数,DFI对夫精人工授精流产预测有重要指导意义。

Objective To investigate the effect of sperm DNA fragmentation on semen parameters and the outcome of artificial insemination.Methods A total of 318 patients with AIH assisted pregnancy cycle in the Reproductive Department of Huadu Maternal and Child Health Hospital of Guangzhou from January 2020 to October 2022 were selected as the study objects.According to the DNA fragmentation index(DFI),sperm were divided into group A with DFI<15%(133 cases),group B with 15%≤DFI≤30%(156 cases)and group C with DFI>30%(29 cases).Semen parameters and pregnancy outcomes of the three groups were compared,and receiver operating characteristic(ROC)curves were drawn to evaluate the predictive value of DFI in AIH pregnancy outcomes.Results The percentage and total number of forward motility(PR)sperm in group A and group B were higher than those in group C,and the differences were statistically significant(P<0.05).The total sperm PR in group A was higher than that in group C,and the difference was statistically significant(P<0.05).The percentage of PR sperm before treatment and the total number of PR sperm after treatment in group A were higher than those in group B,and the differences were statistically significant(P<0.05).There were no significant differences in normal sperm morphology rate,semen volume,sperm concentration and total number before treatment,and recovery rate among three groups(P>0.05).There were no significant differences in biochemical pregnancy rate,clinical pregnancy rate and abortion rate among the three groups(P>0.05).ROC curves showed that the area under the curve(AUC)of sperm DFI for predicting clinical pregnancy and miscarriage were 0.509 and 0.718,respectively.Conclusion The sperm DFI affects the sperm forward movement rate and the total forward movement sperm count,and the DFI is important for the prediction of artificial insemination abortion.