精子形态对体外受精-胚胎移植治疗结局及新生儿的影响

Influence of sperm morphology on the outcomes and neonatal status in IVF-ET

目的:探讨正常形态精子百分率对体外受精-胚胎移植(IVF-ET)治疗结局及新生儿的影响。方法:采用WHO严格标准法将精液标本分为3组:中度畸形组:正常形态精子百分率5%～10%,轻度畸形组:10%<正常形态精子百分率<15%,正常组:正常形态精子百分率≥15%,比较各组间正常受精率、卵裂率、优质胚胎率、种植率、临床妊娠率及新生儿情况。结果:各组间患者年龄(男、女方)差异不显著(P>0.05);中度畸形组正常受精率显著低于轻度畸形组(63.70%vs73.74%,P<0.05),但与正常组差异无统计学意义(63.70%vs68.05%,P>0.05);正常组的优质胚胎率最高,显著高于中度畸形组(44.83%vs35.75%,P<0.05),其他各指标3组间差异无统计学意义(P>0.05);280个移植周期共分娩125个婴儿,其中单胎分娩73例,双胎分娩26例,出生婴儿未见先天异常,3组间流产率、异位妊娠率、孕周、早产率、出生体重差异无统计学意义(P>0.05)。结论:正常形态精子百分率为5%～10%对常规体外受精的受精率无影响,但显著降低优质胚胎率,而10%<正常形态精子百分率<15%对常规体外受精治疗结局的各项指标均无明显影响;正常形态精子百分率在预测IVF-ET的助孕结局及新生儿情况方面存在一定局限性。

Objective：To determine the influence of sperm morphology on the outcomes and status of the neonates in in vitro fertilization and embryo transfer （IVF-ET）. Methods：Strictly based on the WHO criteria,we divided semen samples into a moderately abnormal group （sperm of normal morphology 5%-10%）,a mildly abnormal group （10%sperm of normal morphology15%） and a normal group （sperm of normal morphology ≥15%）,and compared the rates of fertilization,cleavage,quality embryos,implantation,clinical pregnancy and live births among the three groups. Results：There were not significant differences in the patients＇ age among the three groups （P 0.05）. The fertilization rate was markedly lower in the moderately abnormal than in the mildly abnormal group （63.70% vs 73.74%,P 0.05）,but not significantly different from the normal group （63.70% vs 68.05%,P 0.05）. The rate of quality embryos of the normal group was the highest,significantly higher than that of the moderately abnormal group （44.83% vs 35.75%,P 0.05）,but no statistically significant differences were observed in the rates of cleavage,implantation and clinical pregnancy among the three groups （P 0.05）. A total of 125 babies were born from the 280 ET cycles,including 73 singletons and 26 twins,of whom none showed any congenital birth defects. No statistically significant differences were found in the rates of abortion,ectopic pregnancy and premature delivery,nor in the mean gestational period and average body weight of the neonates among the three groups （P 0.05）. Conclusion：Moderately abnormal sperm morphology did not affect the fertility rate of IVF,but significantly decreased the quality of embryos; mildly abnormal sperm morphology had no obvious influence on the rates of fertilization,cleavage,quality embryos,implantation,clinical pregnancy and live births; while normal sperm morphology played a limited role in predicting the outcomes and status of the neonates in IVF-ET.