精子功能检测对选择IVF或ICSI治疗不育症的临床意义

Important Role of Assessment of Sperm Function in Clinical Management of Infertility in IVF/ICSI

本文评价了精子功能检测对选择体外受精(IVF)或卵胞浆精子注射(ICSI)治疗不育症的临床意义。精子功能缺陷所导致的精子与透明带结合反应(即透明带结合、透明带诱发顶体反应和透明带穿透)异常是IVF受精失败的主要原因。在常规精液分析中,精子形态学测定对预测精子受精能力最有价值,但精子形态学评估则是最难做准确和稳定。IVF受精失败的卵子是很有用的生物材料,可用来测定精子形态和顶体功能。人卵透明带有选择性地与正常形态和完整顶体的精子相结合。透明带诱发顶体反应与精子穿透明带的能力呈显著正相关。在不明原因不育症患者中,约25%的不育原因可能是透明带诱发顶体反应缺陷或低下所引起。在严重畸形精子症(正常形态率≤5%)、少精子症的不育病人中,精子与透明带结合异常比率很高。因此,临床上应把这些有精子缺陷,尤其是会影响精子与透明带结合的患者检测出来,采用ICSI治疗,避免这些病人用IVF治疗而导致很低的受精率。精子形态学分析和精子与透明带结合试验有助于临床选择IVF或ICSI治疗不育患者。

Objective: A literature review on the clinical value of human sperm function tests for diagnosisand management of infertility by conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).Results: Sperm defects impairing sperm-zona pellucida (ZP) interaction including ZP-binding, ZP-induced acrosomereaction (AR) and ZP-penetration are the major causes of failure of fertilization in conventional IVF. For routinesemen analysis, sperm morphology is one of the most important tests for prediction of sperm fertilizing ability butit also is the most difficult test to perform accurately and consistently. Oocytes that failed to fertilize in clinical IVFare valuable biological materials for testing sperm function. The human ZP selectively binds sperm with normalmorphology and an intact acrosome. The ZP-induced AR is highly correlated with sperm-ZP penetration and disor-dered ZP-induced AR causing serve infertility in about 25% men with unexplained infertility with normal semenanalysis. Both oligozoospermic (sperm count < 20 ×106/mL) and severe teratozoospermic (strict normal spermmorphology ≤5%) men have a very higher frequency of defective sperm-ZP interaction. Thus patients with spermdefects affecting sperm-ZP interaction should be identified and treated with ICSI since they have high risk for lowor zero fertilization rate in IVF. Conclusion: Careful assessment of sperm function with conventional semenanalysis and sperm-ZP interaction tests could improve clinical management of infertility in IVF/ICSI programs.