精液优化处理后DNA碎片指数与IVF-ET胚胎质量及妊娠结局的关系

Relationship between optimized sperm DNA fragmentation index and IVF-ET embryo quality and pregnancy outcomes

目的:评估经密度梯度离心联合上游法优化处理后的精子DNA碎片指数(DFI)与辅助生殖体外受精-胚胎移植(IVF-ET)胚胎质量及妊娠结局的关系。方法:回顾性分析2022年4月至12月在郑州大学第一附属医院生殖医学中心因单纯输卵管因素行IVF-ET的257个周期,比较男方精液优化前后精液参数和精子DFI;按优化后精子DFI将其分为高DFI组(DFI>5)与低DFI组(DFI≤5),比较两组的胚胎发育及妊娠结局;根据临床妊娠情况分为妊娠组与非妊娠组、持续妊娠组及早期流产组,比较精子DFI情况。结果:与处理前相比,精液优化处理后前向运动精子及正常形态精子百分比提高,精子DFI下降(P<0.001)。精子优化处理后高DFI组的早期流产率高于低DFI组(P<0.05)。105例临床妊娠周期中早期流产组精液优化处理前、后DFI均高于持续妊娠组(P<0.05)。结论:密度梯度离心联合上游优化处理是一种有效的精液制备方法,可提高精子前向运动能力和正常形态精子比例,降低精子DFI;优化后精子高DFI可能增加临床妊娠后早期流产的风险。

Aim:To evaluate the relationship between the sperm DNA fragmentation index(DFI)optimized by density gradient centrifugation combined with swim-up,and embryo quality and pregnancy outcomes of assisted reproduction in vitro fertilization-embryo transfer(IVF-ET).Methods:A retrospective analysis was conducted on 257 IVF-ET cycles performed at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from April to December 2022,involving patients with tubal factor infertility.Semen parameters and sperm DFI were compared before and after optimization.Based on the optimized sperm DFI values,patients were allocated into high DFI group(DFI>5)and low DFI group(DFI≤5).The embryonic development and pregnancy outcome of the 2 groups were compared.According to the clinical pregnancy conditions,they were allocated into pregnant group and non-pregnant group,continuous pregnancy group and early miscarriage group,and the DFI of sperm was compared.Results:After semen optimization,the proportion of progressive motile sperm and normal morphology sperm increased,and sperm DFI significantly decreased(P<0.001).The early miscarriage rate in the high DFI group was significantly higher than that in the low DFI group(P<0.05)following sperm optimization.In 105 clinical pregnancy cycles,the average DFI before and after sperm optimization was higher in the early miscarriage group than that in the continuous pregnancy group(P<0.05).Conclusion:Density gradient centrifugation combined with swim-up is an effective method for semen preparation,improving the proportion of progressive motility and normal morphology of sperm while reducing sperm DFI.However,a high DFI after optimization may increase the risk of early miscarriage after clinical pregnancy.