供精液参数对供精常规体外受精临床结果的影响

Infulence of sperm parameters on clinical outcomes of routine IVF with donor sperm

目的分析影响供精常规体外受精(IVF)临床结果的供精液参数,探讨其对临床结果的预测价值。方法回顾性分析2007年1月至2012年6月共228个供精常规IVF/卵胞浆内单精子注射(ICSI)周期。按临床妊娠结果分组,并对冷冻前和解冻后以及处理后精子浓度和活动率等参数进行分析,探究其对供精常规IVF临床结果的影响;采用Logistic多因素回归分析影响供精常规IVF临床结果的供精液参数;通过ROC曲线分析能够预测临床结果指标的阈值;比较预测指标低于阈值时常规IVF和ICSI周期的临床结果。结果按临床妊娠结果进行分组的分析和Logistic多因素回归分析表明,解冻后精子活动率显著影响供精常规IVF的临床妊娠率;ROC曲线分析显示解冻后精子活动率的预测阈值为37.5%,高于此阈值可获得显著高的受精率、临床妊娠率和胚胎种植率,而低于此阈值行ICSI的受精率和临床妊娠率显著高于供精常规IVF。结论解冻后精子活动率可做为供精常规IVF临床结果的预测指标,其预测阈值为37.5%,低于此阈值改行供精ICSI可显著改善临床结果。

Objective： To investigate the influence of sperm parameters on clinical outcomes of routine IVF with donor sperm. Methods： The data of 228 cycles of routine IVF and ICSI with donor sperm between January 2007 and June 2012 were retrospectively analyzed. The influence of sperm parameters including the pre-frozen, postthawed, and post-processed sperm concentration and motility on clinical outcomes of routine IVF was analyzed. The predictive factor for clinical outcomes was identified by multivariate logistic regression. The threshold of the predictor was obtained by ROC curve. The clinical results of routine IVF and ICSI cycles were compared when the predictor was lower than the threshold. Results： Comparison of clinical results between pregnancy and non-pregnancy group and multivariate logistic regression analysis showed that the pregnancy rate of routine IVF with donor sperm was affected by post-thawed sperm motility. The results of ROC curve showed that predictive threshold of post-thawed sperm motility was 37.5%. When the post-thawed sperm motility was ≥ 37.5%, the fertilization rate, implantation rate and pregnancy rate were higher than those of 〈 37.5%. When post-thawed sperm motility was 37.5%, the fertilization rate and pregnancy rate of ICSI were higher than those of routine IVF. Conclusion： Post-thawed sperm motility is a predictor for clinical outcomes of IVF with donor sperm. The predictive threshold of post-thawed sperm motility is a7. 5%. When it is lower than 37. 5%, ICSI could be performed instead of routine IVF for better clinical outcomes.