精子DNA碎片指数和精子畸形率对ICSI临床结局的影响

Impact of sperm DNA fragmentation index and sperm malformation rate on the clinical outcome of ICSI

目的：通过评估ICSI治疗前的精子畸形率（SMR）和精子DNA碎片指数（DFI），探讨精子DFI和SMR对卵胞浆内单精子注射（ICSI）助孕结局的影响。方法：共入组79对因少弱精子症实施第一周期ICSI治疗的不孕夫妇，在进入治疗周期前3～6个月，评价精子浓度、前向运动精子百分率、SMR及DFI。主要观察SMR和DFI与ICSI结局参数的关系。结果：79例少弱精子症患者DFI正常51例，异常28例，异常组的DFI值明显升高（14．18％VS41．47％）；巧合的是，SMR正常组同样为51例，异常组28例，异常组的SMR值亦明显升高（87．88％懈98．46％）。按DFI正常（DFI≤25％）与异常（DFI〉25％）分组，或按SMR正常（≤96％）与异常（〉96％）分组，组间的双方年龄、女方BMI、获卵数、移植胚胎数等基本情况差异无统计学意义。DFI正常和异常组间，SMR正常和异常组间的受精卵子数、可移植胚胎数、早期流产率无显著差异；异常组生化妊娠率（43．5％zw61．5％）和临床妊娠率（39．1％US56．4％）降低，但差异无统计学意义（P=0．19及0．10）。精子DFI与SMR呈显著正相关（r=0．231，P〈0．05）。结论：精子DFI增高（〉25％），与按严格标准检测的SMR增高（〉96％）男性行ICSI治疗，生化妊娠率和临床妊娠率降低，但与正常者比较未发现有统计学差异，可能与样本量小有关，有必要深入研究。

Objective： To evaluate the sperm DNA fragmentation index （DFI） and sperm malformation rate （SMR） before in- tracytoplasmic sperm injection （ICSI） and their impact on the clinical outcome of ICSI. Methods： This study included 79 cycles of ICSI because of oligoasthenozoospermia. We detected the sperm concentration, percentage of progressively motile sperm, DFI and SMR at 3 to 6 months before ICSI, and analyzed the relationship of DFI and SMR with the outcome parameters. Results ： Of the 79 oligoas- thenozoospermia cases, DFI was found to be normal （ ≤25% ） in 51 and abnormal （ 〉 25% ） in the other 28, significantly increased in the latter （ 14.18% vs 41.47% ）, and coincidently, SMR, too, was normal （ ≤96% ） in 51 cases and abnormal （ 〉96% ） in 28, significantly higher in the abnormal than in the normal cases （87.88% vs 98.46% ）. There were no significant differences between the normal and abnormal DFI groups in age, females＇ BMI, number of oocytes retrieved, and number of embryos transferred, nor between the normal and abnormal SMR groups in the number of fertilized oocytes and quality embryos, biochemical pregnancy, clinical pregnan- cy, and early pregnancy loss. Sperm DFI was significantly positively correlated with SMR （ r = 0.231, P 〈 O. 05）. Conclusion ： ICSI may reduce the rates of biochemical pregnancy and clinical pregnancy for men with increased sperm DFI （ 〉 25% ） and SMR （ 〉 96% ） by strict detection criteria, but with no statistically significant difference from normal males. Our findings need to be supported by further studies with larger sample sizes.