精子DNA碎片对辅助生殖技术治疗方式的影响

Effect of sperm DNA fragmentation on treatment options of assisted reproductive technology

目的探讨精子DNA碎片(SDF)对常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)治疗方式的影响。方法选择235对夫妇的154个IVF和88个ICSI治疗周期,男方在女性配偶获卵日获取精液标本行精液常规分析和SDF检测,统计IVF和ICSI的胚胎结局:受精率、卵裂率、优质胚胎率、种植率和临床妊娠率。结果 IVF和ICSI周期的精子DNA碎片指数(DFI)分别为(17.4±10.4)%和(25.3±15.8)%,差异有统计学意义(P<0.01)。精子DFI≥24%时,ICSI周期的受精率、胚胎种植率和临床妊娠率显著高于IVF周期,差异有统计学意义(P均<0.05)。单因素分析时,精子DFI≥24%时的ICSI周期和IVF周期获得临床妊娠的优势比(OR)为3.85,95%可信区间(95%CD为1.40～10.59。纳入精液量、精子浓度、精子活动力(a+b)和女性配偶的年龄作为变量进行多因素分析时,DFI≥24%时的ICSI周期和IVF周期获得临床妊娠的OR为4.61(95%CI 1.09～19.57)。结论高SDF水平可影响辅助生殖技术(ART)的治疗方式,SDF水平较高时行IVF治疗的结局较差,此时应选择ICSI的治疗方法。

Objective： To investigate the effect of sperm DNA fragmentation on the outcome of in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI）. Methods： A total of 242 cycles including 154 IVF and 88 ICSI from 235 couples were enrolled. Sperm DNA fragmentation and routine semen analysis were performed on the day of the retrieval. The rates of fertilization, embryo cleavage, good quality embryos, implantation and clinical pregnancy were measured. Results： Sperm DNA fragmentation index （DFI） in ICSI group was significantly higher than that in IVF group （P 〈 0. 01）. The rates of fertilization, implantation and clinieal pregnancy in ICSI were significantly higher than those in IVF with DFI≥24% （P〈0.05）. When DFI was more than 24%, the odds ratio （OR） for clinical pregnancy was 3.85 （95% CI 1.40-10.59） comparing ICSI with IVF. The OR for clinical pregnancy increased to 4. 61 （95% CI 1. 09-19. 57） after including the factors of sperm concentration, percentage progressively motile sperm and female age as covariates. Conclusions： High DNA fragmentation might affect the outcome of ICSI and IVF. When DFI exceeds 24 %, ICSI should be the method of choice.