精液参数及精子来源对妊娠结局的影响

Effects of different semen parameter and spermatozoa origin on pregnancy outcome after intracytoplasmic sperm injection

目的探讨精液参数及精子来源对卵胞浆内单精子注射（ICSI）妊娠结局的影响。方法选择2009年1月至2013年12月,在内蒙古医科大学附属医院妇产科生殖医学中心接受ICSI治疗的303对不育夫妇,共计324个周期的临床病历资料为研究对象。根据取卵当日精液参数及精子来源不同,将这324个ICSI周期分为正常精液组（精液参数及精子来源正常,56个周期）和研究组（精液参数或精子来源异常,268个周期）,其中精液参数异常包括极度少精子症亚组（43个周期）,极度弱精子症亚组（21个周期）,极度少、弱精子症亚组（33个周期）及中/重度少、弱精子症亚组（113个周期）;精子来源异常包括睾丸穿刺精子亚组（25个周期）及附睾穿刺精子亚组（33个周期）,共计6个研究亚组。回顾性分析324个周期的临床病历资料,分别将上述6个研究亚组的受精率,正常受精率,卵裂率、可移植胚胎率、优质胚胎率、临床妊娠率及胚胎种植率与正常精液组进行统计学分析。7组（6个研究亚组及正常精液组）受试者之间年龄、不孕年限、获卵数、MⅡ卵率及平均移植胚胎数等一般资料比较,差异无统计学意义（P〉0.05）。本研究遵循的程序符合内蒙古医科大学附属医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。结果 1受精率比较：极度少精子症亚组,极度少、弱精子症亚组,睾丸穿刺精子亚组及附睾穿刺精子亚组分别为65.1%,78.4%,71.8%及76.6%,均显著低于正常精液组的81.0%,且差异均有统计学意义（χ^2=48.349,P=0.000;χ^2=5.800,P=0.016;χ^2=19.884,P=0.000;χ^2=9.570,P=0.002）。2正常受精率比较：极度少精子症亚组,极度少、弱精子症亚组,睾丸穿刺精子亚组及附睾穿刺精子亚组分别为60.0%,72.0%,65.6%及69.0%,均显著低于正常精液组的79.0%,且差异有统计学意义（χ^2=38.945,P=0.000;χ^2=6.109,P=0.013;χ^2=17.315,P=0.000;χ^2=11.107,P=0.001）。36个研究亚组的卵裂率、可移植胚胎率、优质胚胎率、临床妊娠率及胚胎种植率分别与正常精液组比较,差异均无统计学意义（P〉0.05）。结论极度少精子、睾丸穿刺精子及附睾穿刺精子,虽然可显著降低卵子受精率,但对胚胎种植率及临床妊娠率影响不显著。故通过ICSI治疗,可使因男性因素导致的不孕患者达到妊娠目的。

Objective To analyze the effects of semen parameter and spermatozoa origin on pregnancy outcome after intracytoplasmic sperm injection（ICSI）.Methods The clinical case histories of 303 infertility couples who were underwent ICSI in Center for Reproductive Medicine,Department of Obstetrics and Gynecology,the Affiliated Hospital of Inner Mongolia Medical University from January 2009 to December 2013 were chosen as study objects.It included 324 ICSI cycles.According to semen parameters and spermatozoa origins on the day of ovum obtained,the 324 ICSI cycles were divided into normal semen group（normal semen parameters and spermatozoa origins,n=56 cycles）and research group（abnormal semen parameters or spermatozoa origins,n=268 cycles）,which including extreme oligozoospermia subgroup（n=43 cycles）,extreme asthenozoospermia subgroup（n=21 cycles）,extreme oligospermia and asthenospermia subgroup（n=33 cycles）,moderate or severe oligospermia and asthenospermia subgroup（n=113 cycles）for abnormal semen parameters,and testicular sperm extraction subgroup（n = 25 cycles）,percutaneous epididymal sperm aspiration subgroup（n=33 cycles）for abnormal spermatozoa origins,the total were six research subgroups.The clinical medical records of 324 cycles were analyzed retrospectivly.Statistically compared six subgroups with normal semen group respectively in fertilization rate,normal fertilization rate,cleavage rate,portable embryo rate,good quality embryo rate,clinical pregnancy rate and embryo implantation rate.There were no significant differences among the seven groups（six research subgroups and normal semen group）in age,duration of infertility,the number of obtained eggs,the rate of mature eggs and the average number of transfered embryo（P〉0.05）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Hospital of Inner Mongolia Medical University.Informed consents were obtained from all participants.Results 1 The fertilization rate of extreme oligozoospermia subgroup（65.1%）,extreme oligospermia and asthenospermia subgroup（78.4%）,testicular sperm extraction subgroup（71.8%）and percutaneous epididymal sperm aspiration subgroup（76.6%）was lower than that of normal semen group（81.0%）,respectively,and the difference was statistically significant（χ^2=48.349,P=0.000;χ^2=5.800,P=0.016;χ^2=19.884,P=0.000;χ^2=9.570,P=0.002）.2 The normal fertilization rate of extreme oligozoospermia subgroup（60.0%）,extreme oligospermia and asthenospermia subgroup（72.0%）,testicular sperm extraction subgroup（65.6%）and percutaneous epididymal sperm aspiration subgroup（69.0%）was lower than that of normal semen group（79.0%）,respectively,and the difference was statistically significant（χ^2=38.945,P=0.000;χ^2=6.109,P=0.013;χ^2=17.315,P=0.000;χ^2=11.107,P=0.001）.3 There were no significant differences between 6 research subgroups with normal semen group,respectively,in cleavage rate,portable embryo rate,good quality embryo rate,clinical pregnancy rate and embryo implantation rate（P〉0.05）.Conclusions All results indicates that the extreme oligozoospermia and the sperm obtained from testicular sperm extraction and percutaneous epididymal sperm aspiration might reduce the rate of fertilization,but had no obvious influence on the rates of embryo implantation and clinical pregnancy.So,male infertility can be treated by ICSI.