精子形态与体外受精胚胎移植临床妊娠结局的关系

Relationship of sperm morphology with the outcomes of in vitro fertilization and embryo transfer

目的：当前精子形态对体外受精（IVF）的影响尚存争议,本研究旨在评估正常形态精子百分率在体外受精-胚胎移植（IVF-ET）中的应用价值。方法：选择生殖遗传中心659对IVF-ET治疗夫妇,按正常形态精子百分率分为4组,A组（〈2%）112个周期,B组（≥2%-〈4%）180个周期,C组（≥4%-〈5%）74个周期,D组（≥5%）293个周期。比较各组间的受精率、正常受精率、卵裂率、优胚率以及新鲜移植周期的生化妊娠率、临床妊娠率、流产率及活产率等指标。结果：4组间的受精率、正常受精率和可移植胚胎率有差异。C组（71.90%）和D组（72.89%）的受精率均显著高于A组（57.97%）和B组（63.29%）（P均〈0.05）,C组与D组间、A组和B组间均无显著差异（P均〉0.05）。D组的正常受精率（57.16%）显著高于A组（46.52%）和B组（50.89%）（P均〈0.05）,C组正常受精率（54.67%）显著高于A组（P〈0.05）,其余组间无显著差异（P均〉0.05）。D组的可移植胚胎率（55.62%）显著高于B组（45.75%）（P〈0.05）,其余组间均无显著差异（P均〉0.05）。D组的无可移植胚胎患者比例（8.87%）显著低于A组（20.54%）和B组（18.89%）（P均〈0.05）,C组（12.16%）与其余组间均无显著差异（P均〉0.05）。各组间新鲜移植周期的生化妊娠率、临床妊娠率、种植率、流产率和活产率均无显著差异（P均〉0.05）。结论：正常形态精子百分率对IVF-ET的受精率及胚胎形成有一定影响,用于评估IVF受精结局时,5%临界值略优于4%。

Objective ： To study the application value of normal sperm morphology on the outcomes of classic in vitro fertilization and embryo transfer （IVF-ET）. Methods ： This study included 659 infertile couples admitted to our center for IVF-ET. Based on the percentage of morphologically normal sperm （MNS）, we divided the patients into groups A （n = 112, MNS 〈2% ）, B （n = 180, MNS ≥2- 〈4% ）, C （n =74, MNS ≥4- 〈5% ）, and D （n =293, MNS ≥5% ）, and compared the rates of fertilization, normal fertilization, embryos obtained, biochemical pregnancy, clinical pregnancy, implantation, and live birth among different groups. Results： The mean fertilization rate was significantly higher in groups C （71.90%） and D （72.89%） than in A （57.97%） and B （ 63.29% ） （ P 〈 0.05 ）, with no remarkable differences either between A and B （ P 〉 0.05 ） or between C and D （ P 〉 0.05 ）. Thenormal fertilization rate was also significantly higher in group D （57.16 % ） than in A （46.52 % ） and B （50.89 % ） （ both P 〈0.05 ） as well as in C （54.67%） than in A （P 〈0.05 ）. The rate of embryos obtained, too, was markedly higher in group D （55.62%） than in B （45.75%） （P 〈 0.05 ）, but none with remarkable difference from other groups （all P 〉 0.05）. There were no statistically significant differences among the four groups in the rates of biochemical pregnancy, clinical pregnancy, implantation, abortion, and live birth （all P 〉0.05 ）. Conclusion ： The rate of MNS had some influence on IVF-ET, and 5 % MNS exhibited a higher value than 4% MNS in predicting the outcomes of IVF.