精子形态与精液其他参数的关系及对体外受精结局的影响

Relationship of sperm and semen parameters and effect of normal morphology on IVF outcomes

目的了解精子形态在体外受精(in vitro fertilization,IVF)中的作用。方法回顾性调查在本生殖中心接受常规IVF治疗者共397个周期的精子正常形态率,397个周期按精子正常形态率不同分为A组(≤5%)、B组(5%<B组≤14%)及C组(>14%),按IVF临床结局分为临床妊娠、未妊娠及未移植组,分析其与精液其他参数的关系以及对IVF结局的影响。结果精子正常形态率与精液其他参数如精子密度、活率及前向运动精子百分率(PMS)呈显著的正相关(r分别为0.188、0.197、0.190,P<0.01),精子正常形态率、精子密度、活率及PMS与受精率均呈显著的正相关关系(r分别为0.237、0.171、0.155、0.187,P<0.01)。A、B组及C组间受精率差异存在统计学意义(P<0.05),未移植组的精子正常形态率为(15.53±7.54)%,明显低于临床妊娠组的(20.05±9.51)%(P<0.05),但临床妊娠组与未妊娠组(19.06±9.14)%之间差异无统计学意义(P>0.05)。在继发不孕患者中,A组年龄[(41.4±14.1)岁]明显大于B组[(35.4±6.4)岁]和C组[(34.7±4.6)岁](P<0.05,P<0.01)。结论精子形态对IVF受精率和结局有影响,精子正常形态率可能是预测IVF结果更好的参数;随着年龄的增长,精子正常形态率下降。

Objective To investigate the role of sperm morphology in in vitro fertilization （IVF）.Methods Relationship between sperm morphology and other sperm parameters and effects of normal forms on IVF outcomes were retrospectively analyzed from 397 IVF cycles in our department from 2008 to 2009.Three group were divided based on sperm morphology,which defined ≤5% normal forms as group A,5% and ≤14% as group B,and 14% as group C.The IVF outcomes included the clinical pregnancy,pregnancy failure and no embryo transfer.Results The percentage of sperm normal forms was significantly correlated with sperm density,motility,percentage of progressive motile sperm （PMS%） （r=0.188,0.197 and 0.190,all P0.01）.The normal form rate,density,motility and PMS% were positively correlated with the fertilization rates （r= 0.237,0.171,0.155 and 0.187,P0.01）.There were significant differences in the fertilization rates among groups A,B and C （P0.05）.The normal form rates of sperms in patients with no embryo transfer were markedly lower than that in patients with clinical pregnancy [（15.53±7.54）% vs （20.05±9.51）%,P0.05],but no differences was found between the clinical pregnancy group and the pregnancy failure group.The age in group A was significantly older than that in groups B and C （41.4±14.1 vs 35.4±6.4 and 34.7±4.6,P0.05 and P0.01） among patients with secondary sterility.Conclusion The sperm morphology affects fertilization rates and clinical outcomes in IVF,and may be a better predictive parameter for fertilization in IVF.The sperm normal forms will be decreased with patient age.