精子染色质完整性对IVF/ICSI临床结局的预测价值

Sperm chromatin integrity test for predicting the outcomes of IVF and ICSI

目的:通过分析精子染色质完整性与体外受精胚胎移植(IVF-ET)、卵细胞胞质内单精子注射(ICSI)结局之间的关系,探讨精子染色质完整性检测在辅助生殖技术(ART)中的预测价值。方法:采用精子染色质结构分析试验(SCSA)方法检测187个ART周期中精子的染色质完整性,以精子DNA损伤指数(DFI)为参数,分为高DFI组(DFI≥30%)和低DFI组(DFI<30%),两组中根据采用不同的体外受精方式分为IVF亚组和ICSI亚组。分别比较高DFI组、低DFI组中IVF亚组和ICSI亚组间受精率、卵裂率、D2天胚胎质量、D3天胚胎质量、临床妊娠率差异性。结果:在高DFI组中,行ICSI治疗的夫妇临床妊娠率显著高于行IVF治疗的夫妇,具有统计学意义;在行IVF治疗的夫妇中,比较高DFI组与低DFI组的各临床结局,未见统计学差异;在行ICSI夫妇中,比较高DFI组与低DFI组的各临床结局,未见统计学差异。结论:精子染色质完整性影响辅助生育技术的结局,在选择辅助生殖技术方案时,可作为常规精液检查的一个补充。

Objective： To explore the predictive value of sperm chromatin integrity test （SCIT） in assisted reproductive technology （ART） by analyzing the relationship of sperm chromatin integrity （SCI） with the outcomes of IVF-ET and ICSI. Methods： Sperm chromatin structure assay （SCSA） was performed to test SCI in 187 ART cycles, and the results were expressed as DNA fragmentation index （DFI）. According to the level of DFI, the 187 cycles were allocated to a high DFI group （DFI≥30%） and a low DFI group （ DFI 〈 30% ） , each of which was again divided into an IVF and an ICSI subgroup. Comparisons were made between the IVF and ICSI subgroups of the high and low DFI groups in the fertilization rate, cleavage rate, embryo quality, and clinical pregnancy rate. Results ： The clinical pregnancy rate of ICSI was significantly higher than that of IVF in the high DFI group, while the clinical outcomes showed no significant differences between the high and low DFI groups in either the IVF or the ICSI subgroup. Conclusion： Sperm DNA damage affects the outcome of ART, and therefore SCIT can be used as a supplementary option to standard semen analysis in choosing the method for ART.