单纯男性因素不育患者行形态选择性卵胞浆内单精子注射对胚胎发育及临床结局的影响

Intracytoplasmic injection of morphologically selected spermatozoa from patients with male factor infertility: clinical and embryo development outcomes

目的使用放大系统对不育男性患者的精子进行形态选择性卵母细胞浆内单精子注射术（IMSI）,观察IMSI技术能否改善因男性精液问题而不孕不育夫妇的助孕结局。方法回顾分析本中心2013年1月-2014年11月共82例梗阻性无精子症患者,将行TESA（经皮睾丸穿刺抽吸精子术）获得的睾丸精子通过放大系统（×6600）挑选后行卵母细胞注射（IMSI组）,2013年1月-2014年11月共91例梗阻性无精子症患者经TESA取精术后行常规卵母细胞浆内单精子注射（ICSI组）;2014年1月-11月共44例畸精子症患者行形态选择性包浆内单精子注射治疗（IMSI组）,2014年1月-11月共71例畸精子症患者行常规ICSI治疗（ICSI组）。统计分析ICSI组和IMSI组患者的实验室结局和临床结局。结果梗阻性无精子症患者中正常受精率IMSI组显著高于ICSI组（84.3%vs 77.0%）（P〈0.05）;ICSI组的卵裂率95.5%,优胚率28.2%,囊胚形成率54.8%,种植率26.4%,临床妊娠率47.3%,流产率14%,梗阻性无精子症IMSI组患者的卵裂率96.7%,优胚率29.2%,囊胚形成率54.3%,种植率32.3%,临床妊娠率50.0%,流产率7.3%,两组无显著性差异（P〉0.05）。畸精子症患者的正常受精率IMSI组显著高于ICSI组（68%vs 75.5%）（P〈0.05）,囊胚形成率IMSI组显著高于ICSI组（54.6%vs 67.9%）（P〈0.05）,ICSI组的卵裂率96.2%,优胚率27.6%,种植率28.2%,临床妊娠率43.7%,流产率9.7%;IMSI组患者的卵裂率95.2%,优胚率27.1%,种植率30.7%,临床妊娠率43.2%,流产率10.5%,两组无显著性差异（P〉0.05）。结论梗阻性无精子症患者的睾丸精子经放大系统选择后行ICSI,正常受精率较传统ICSI有显著性提高;畸精子症患者射出的精液标本经放大系统挑选后行ICSI,正常受精率、囊胚形成率较传统ICSI有显著性提高。

Objective To test whether intracytoplasmic injection of morphologically selected spermatozoa（IMSI） from patients with male factor infertility can improve the clinical and embryo development outcomes of intracytoplasmic sperm injectionembryo transfer（ICSI-ET）. Methods We performed IMSI for 82 couples diagnosed with obstructive azoospermia at high magnification（× 6600） and traditional ICSI for another 91 couples using testicular sperms. We also performed IMSI for 44 couples with teratozoospermia at high magnification（×6600） and traditional ICSI for 71 patients using ejaculated sperms. The clinical and embryo development outcomes were compared between the cycles. Results For obstructive azoospermia, IMSI and ICSI showed no significant difference in the rates of cleavage（95.5% vs 96.7%）, D3 top quality embryos（28.2% vs 29.2%）,implantation（26.4% vs 32.3%）, pregnancy（47.3% vs 50%）, blastocyst formation（54.3% vs 54.6%）, or abortion（14% vs 7.3%）（P〉0.05）, but a significantly higher normal fertilization rate was achieved in IMSI group（84.3% vs 77%, P〈0.05）. For teratozoospermia, the 2 techniques resulted in no significant differences in the rates of cleavage（96.2% vs 95.2%）, D3 top quality embryo（27.6% vs 27.1%）, implantation（28.2% vs 30.7%）, pregnancy（43.7% vs 43.2%）, or abortion（9.7% vs 10.5%）（P〉0.05）, but the normal fertilization rate（68% vs 75.5%） and the blastocyst formation rate（54.6% vs 67.9%） were significantly higher in IMSI group（P〈0.05）. Conclusion IMSI can improve the normal fertilization rates in couples with male factor infertility（including obstructive azoospermia and teratozoospermia） and increase blastocyst formation rate in cases of azoospermia.