影响常规IVF体外受精的相关因素探讨

Discussion on relevant influencing factors of conventional IVF

目的：探讨常规体外受精-胚胎移植（IVF-ET）过程中影响受精的相关危险因素。方法：选取2011年12月~2013年12月在该中心行常规IVF-ET助孕480周期,排除获成熟卵子数〈5或精子正常形态〈4%的患者进行回顾性分析。应用单因素及多因素Logistic回归分析男方年龄、精液量、精子密度、精子正常形态百分率、精子向前活动力、女方年龄、女方体重（BMI）指数、不孕年限、总Gn量、月经第3日的基础FSH、LH、E2、窦卵泡数、HCG注射前的LH、E2、P、获卵数、男方原发/继发不育、女方原发/继发不孕、夫妇间孕史和是否有输卵管因素对受精失败发生的影响。结果：受精失败组的精子正常形态率（12.25±6.92）%和精子向前运动率（42.00±16.55）%低于受精正常组（15.28±5.68）%和（54.83±15.04）%,差异有统计学意义（P〈0.05）。而受精失败组的男性原发不育构成比（82.35%）、女性原发不孕构成比（70.59%）和夫妇间无孕史的构成比（85.29%）高于受精正常组（60.31%、44.84%和62.11%）,差异有统计学意义（P〈0.05）。其他临床资料两组间比较差异无统计学意义（P〉0.05）。Logistic回归分析显示精子向前运动率与受精失败差异有统计学意义（P〈0.05）。结论：男性精液指标是影响常规IVF受精的重要因素。在常规IVF周期中,精子正常形态率低、精子向前运动率低、男性原发不育、女性原发不孕和夫妇间无孕史为受精失败的危险因素,尤其应注意精子向前运动率这一指标。对存在受精风险的高危人群,可考虑实行短时受精或部分ICSI技术,对防止受精失败有积极意义。

Objective： To explore the related risk factors of fertilization during conventional in vitro fertilization - embryo transfer （IVF -ET） . Methods： A retrospective analysis was performed among 480 assisted reproductive technology （ART） cycles of conventional IVF - ET （ except the patients whose retrieved mature oocytes number 〈 5 or sperm normal morphology percentage 〈4% ） in the hospital from December 2011 to December 2013. Univariate and multivariate logistic regression analysis were used to analyze the effects of various factors on the occurrence of fertilization failure, including male age, semen volume, semen density, percentage of morphologically normal sperm, sperm progressive motility, maternal age, BMI, infertility duration years, total quantity of gonadotropin （ Gn）, the concentrations of based FSH, LH, estradiol and based sinus follicle on the third day of HCG injection during menstrual period, the concentrations of LH, estradiol and progestogen before HCG injection, the number of oocytes retrieved, the infertility types of couples （primary or secondary）, pregnancy history between the couples and the existence of tubal factor. Results ： The sperm normal morphology percentage and sperm progressive mo- tility in fertilization failure group were （12. 25 ± 6. 92 ）% and （42. 00 ± 16. 55 ）% , respectively, which were statistically significantly lower than those in normal fertilization group （ 15.28 ± 5.68 ） % （ 54. 83 ± 15.04 ） % （ P 〈 0.05 ） . In addition, the composition percentages of male primary infertility, female primary infertility and non -pregnancy history in couples of fertilization failure group was 82. 35%, 70. 59% and 85.29%, respectively, which were statistically significantly higher than tbose of normal fertilization group （60. 31%, 44. 84% and 62. 11% ） （P 〈 0. 05 ） . There was no statistically significant difference in the other clinical data between the two groups （P 〉 0. 05） . Logistic regression analysis revealed that the sperm progressive motility and the fertilization failure had significant correlation （ P 〈 0. 05 ） .Conclusion： The parameters of sperm are important factors influencing fertilization of conventional IVF. Low sperm normal morphology proportion, low sperm progressive motility, male or female primary infertility and non - pregnancy history in couples are risk factors influencing conventional IVF fertilization outcome. In particular, doctors should pay more attention to sperm progressive motility. In view of the high risk population facing the risk of fertilization failure, short - term fertilization or part - ICSI fertilization can be considered, it may have positive significance to prevent fertilization failure.