不同来源精子对ICSI助孕结局的影响

Influence of sperm from different sources on the clinical outcomes after intracytoplasmic sperm injection

目的探讨不同来源精子对卵胞浆内单精子注射助孕结局的影响。方法回顾分析我中心2008年1月至2012年6月1129个ICSI治疗周期,射出A组858例,附睾穿刺B组229例,睾丸穿刺C组42例,比较3组的临床结局。结果 A组年龄较B、C组大,内膜厚度薄;C组获卵数及ICSI卵数较A、B组多;B组优质胚胎率高于A组,种植率及活产率高于A、C两组(P<0.05)。通过多元逻辑斯蒂回归模型分析精子来源与活产率的相关性,校正混杂因素后,A组相对于B组的OR值为0.559(95%CI 0.416-0.752),C组相对于B组的OR值为0.513(95%CI 0.264-0.998)。结论附睾穿刺来源精子行ICSI可获得较好的临床结局。

Objective： To evaluate the effect of sperm from different sources on pregnancy outcomes after intracytoplasmic sperm injection. Methods： Retrospectively summarized the 1129 cycles of ICSI in our center from january 2008 to June 2012. The data were divided into three groups according to the source of sperm： Group A, 858 cycles used jaculated semen, Group B, 229 cycles used testicular sperm by PESA and Group C 42 cycle used sperm after TSE. The clinical outcomes of the three group were compared. Results： The age was higher and the endometrium was thinner in Group A in comparison with the other groups. The number of oocytes for ICSI in group C was greater than A and B group, （P〈0.05） ; There is no statistical difference in the fertilization rate, cleavage rate or pregnancy rate between the three groups. The higher quality embryo rate, implantation rate and live birth rate were significantly higher in Group B （P〈0.05） . The correlation between Sperm sources and live birth rate was analyized by the multivariate logistic regression model. Adjusted by confounding factors, the OR of group A versus group B was 0. 559 （95% CI 0. 416-0. 752） and the OR of group B versus group C value was 0. 513 （95% CI 0. 264-0. 998） . Conclusion： sperms originated from epididymis can achieve good clinical outcomes.