精子正常形态率、顶体完整率、顶体反应率与卵子体外受精率的相关性研究

Study on the correlations between sperm morphology,rate of acrosome intactness,rate of acrosome reaction and the rate of In Vitro Fertilization(IVF) of ovum

目的:通过检测常规体外受精中(in vitro fertilization IVF)精液常规分析正常男性的精子正常形态率、顶体完整率、顶体反应率并分析其与卵子的体外受精率之间的关系,旨在为辅助生殖技术提供几种可靠的判断精子生育力的参数与指标。方法:选择2008年7月1日到2009年12月30日间在广西医科大学第三附属医院生殖医疗中心进行控制性长方案超排卵下行常规IVF-ET的100对夫妻,共100个周期的资料做前瞻性分析,男方精液常规分析属正常范围,分析100份标本精子正常形态率、精子顶体完整率以及精子顶体反应率;观察并记录获卵个数、成熟卵个数、受精卵个数、未受精卵个数,计算其受精率。然后应用计量资料t检验,F检验以及线性相关等统计学方法对精子各项参数与卵子受精率之间的相关性进行分析。结果:实验组1,精液标本按其正常精子形态百分率分为3组,A组:≥5%而<10%、B组:≥10%而<15%、C组:≥15%,卵子体外受精率分别为67.05%、74.51%、82.49%,各组间两两相比差异有统计学意义(P<0.05)。实验组2,按顶体完整率分为两组,A组:≤85%组、B组:>85%组,卵子体外受精率分别为74.25%和82.14%,两组间比较差异有统计学意义(P<0.05)。实验组3,按顶体反应率分为三组,A组:<14%、B组:≥14%而≤25%、C组:>25%,其卵子体外受精率分别为73.45%、77.19%、82.74%,各组间的差异有统计学意义(P<0.05)。实验组4,按精子正常形态百分率分为两组<15%和>15%组,所对应的顶体完整率分别为79.51%、87.27%,两组间比较差异有统计学意义(P<0.05)。实验组5,用多重线性回归分析,精子正常形态率、顶体完整率、顶体反应率的标准化系数和P值分别为0.352、0.497、0.271;0.045、0.005、0.017,各个系数均有统计学意义。其中又以顶体完整率的标准化系数最大。结论:1.对于精液常规分析正常的男性,约有50%存在着不同程度的精子形态异常。卵子的受精率随正常形态精子所占百分率的升高而增高;其正常精子形态率≥5%,仍可得到一个较好的体外受精率,因此可行常规体外受精助孕。2.对于精液常规分析正常的男性,约有65%男性的精子顶体完整率>85%,随着精子顶体完整率的增加,卵子的受精率也明显增高;3.对于精液常规分析正常的男性,其78%男性精子顶体反应率≥14%,在体外受精中卵子的受精率随着精子顶体反应率所占百分比的增加而增高;4.上述三者都是影响卵子受精的重要因素,卵子体外受精率与以上三项指标间存在较强的相关关系,而其中又以顶体完整率对卵子体外受精率的影响程度最大。5.对于精液常规分析正常的男性,若正常精子形态率≥5%,在体外受精助孕前,精子顶体完整率和精子顶体反应率的检测,可不作为常规检查项目。

[ Abstract] Objective：To provide several reliable parameters and indicators which can judge fertility of sperm through analysis of the relationship between the sperm morphology, rate of acrosome intactness, rate of acrosome reaction and the rate of in vitro fertili- zation （IVF） of ovum during the process of in vitro fertilization （IVF）. Methods：From July 1 st, 2008 to December 30th, 2009, we chose 100 spouses to go through the IVF - ET of controlled snperovulation long - term scheme in the Reproductive Medical Centre of The Third Affiliated Hospital of Guangxi Medical University. During this time, 100 cycles of data were collected for the forward - loo- king analysis. 100 specimens of male sperm were subject to routine analysis of sperm and detection of sperm morphology, rate of acro- some intactness and rate of acrosome reaction ; we also observed and recorded numbers of collected ovum, mature ovum, fertilized ovum and unfertilized ovum to calculate the rate of fertilization. After that, statistical methods such as T test and F test of measurement data and linear correlation were applied to analyze the correlation between each parameter of the sperm and the fertilization rate. Results： The sperm specimens were divided into three groups according to the percentage of eupyrene sperm： ≥5% and 〈 10% ; ≥10% and〈 15% ; ≥15%. The corresponding rates of in vitro fertilization （IVF） of ovum were respectively 67.05% , 74.51% and 82.49%. Moreover, there was statistical significance in the difference of comparisons between every two groups （P 〈 0.05 ）. The sperm speci- mens were divided into two groups according to the rate of acrosome intactness： ≤85% and 〉 85%. The corresponding rates of in vitro fertilization （IVF） of ovum were respectively 74.25% and 82.14%. Moreover, there was statistical significance in the differenee of comparison between the two groups （ P 〈 0.05 ）. The sperm specimens were divided into three groups according to the rate of acro some reaction： 〈 14% ; ≥14% and ≤25% ; 〉 25%. The corresponding rates of in vitro fertilization （IVF） of ovum were respective ly 73.45% , 77.19% and 82.74%. Moreover, there was statistical significance in the difference among every group （P 〈 O. 05 ）. The sperm specimens were divided into two groups according to the percentage of normal sperm morphology： 〈 15% ; 〉 15%. The corre sponding rates of acrosome intactness were respectively 79.51% and 87.27%. Moreover, there was statistical significance in the difference of comparison between the two groups （ P 〈 0.05 ）. In the nmhi linear analysis, the correlation coefficients of sperm mor phology, rate of acrosome intactness and rate of acrosome reaction were respectivelyO. 352,0. 497,0. 271,0. 045,0. 005,0. 017, All these difference had shown statistical significance. The normalizing coefficient of Rate of Acrosome Intactness is the biggest. Conclu sions： For the men whose routine semen analysis is normal, about 50% of them have abnormal semen shape at different extent. The fertilization rate of ovum improves with the increase of the percentage of semen in normal morphology ; if the morphology rate of normal semen is more than or equal to 5% , a relatively better in vitro fertilization rate will be gained. Thus, it is possible to carry out normal in vitro impregnation helping pregnancy. For the men with normal routine semen analysis, about 65% of them have an intact acrosome rate of sperm more than 85%. With the increase of the same rate, the fertilization rate of ovum obviously is improved; For the men whose routine semen analysis is normal, 78% of them have an acrosome reacted rate of sperm more than or equal to 14% （ among which 53% of them have a rate more than 25% ）. In the in vitro fertilization, the fertilization rate is increased with the increase of the percentage of acrosome reacted rate of sperm; but the men have the same rate less than 14% （22% of the above men） still have rela- tively better in vitro fertilization rate. If the patients whose acrosome reacted rate less than or equal to 14% have ideal normal morphol- ogy rate of semen and the intact acrosome rate of sperm. The above three rates are all important elements influencing the fertilization of ovum. In vitro fertilization rate of ovum has relatively strong relation with the above indexes ; among which intact acrosome rate of sperm has the maximum influence upon IVF rate. For the men having normal routine semen analysis, if their normal morphology rate of semen is more than or equal to 5%, the test of intact acrosome rate of sperm and acrosome reacted rate of sperm need not to deal with routine cheek items before in vitro fertilization.