正常形态精子百分率与常规体外受精-胚胎移植结局的相关性

Normal sperm morphology and the outcomes of routine in vitro fertilization

目的：探讨未经优化处理的精子形态参数在常规体外受精（IVF）中的应用价值。方法：分析优化处理前后精子形态差异,并根据处理前精子形态将因单纯输卵管因素进行IVF的908个周期进行分组：研究1为≤4%组、〉4%~≤15%组及〉15%组;研究2为≤1%组、〉1%~≤2%组、〉2%~≤3%组及〉3%~≤4%组,分别比较各组间的受精率、卵裂率、优质胚胎率、囊胚转化率及妊娠率等指标有无显著性差异。结果：正常形态精子百分率≤4%组的总受精率显著低于〉4%~≤15%组及〉15%组（74.40%vs 78.61%及80.03%）（P〈0.01）;〉3%~≤4%组的2PN受精率（85.47%vs 77.23%、78.97%及78.99%）、卵裂率（98.73%vs 95.71%、96.01%和97.27%）、囊胚形成率（63.41%vs 53.85%、49.01%和49.55%）均显著高于≤1%组、〉1%~≤2%组及〉2%~≤3%组（P〈0.01或0.05）,而临床妊娠率、种植率、早期流产率、活产率、出生畸形率各组间均无统计学差异（P〉0.05）。结论：正常形态精子百分率≤4%可影响IVF的总受精率,正常形态精子百分率≤3%时IVF的正常受精率下降。但即使正常形态精子百分率≤1%仍不会造成受精障碍或受精失败,因此,畸形精子症不能单独成为决定ICSI的指征。同时,精子形态检测对IVF的胚胎质量、临床妊娠率及抱婴率等无明显预测意义。

Objective： To explore the application value of morphology assessment of sperm from fresh semen in routine in vitro fertilization（ IVF）. Methods： We analyzed the morphology of the sperm from fresh or optimized semen samples and,based on the sperm morphology of the raw semen,allocated 908 IVF cycles due to the pure tubal factor to different groups： morphologically normal sperm（ MNS） ≤4%, 4%- ≤15%,and 15% in Trial 1 and MNS ≤1%, 1%- ≤2%, 2%- ≤3%,and 3%-≤4% in Trial 2. We compared the rates of fertilization,cleavage,high-quality embryo,blastocyst formation,and pregnancy among different groups. Results： The total fertilization rate was significantly lower in the MNS ≤4% than in the MNS 4%- ≤15% and 15% groups（ 74. 40% vs 78. 61% and 80. 03%,P〈0. 01）. Compared with the MNS ≤1%, 1%- ≤2%,and 2%- ≤3%groups,the MNS 3%- ≤ 4% group showed remarkably increased rates of 2PN normal fertilization（ 77. 23%,78. 97% and78. 99% vs 85. 47%,P〈0. 01）,cleavage（ 95. 71%,96. 01% and 97. 27% vs 98. 73%,P〈0. 05）,and blastocyst formation（ 53. 85%,49. 01% and 49. 55% vs 63. 41%,P〈0. 01）. No statistically significant differences were observed in the rates of clinical pregnancy,implantation,early abortion,live birth,or malformation at birth among different groups（ P〈0. 05）. Conclusion： MNS≤4% affected the total rate of fertilization while MNS ≤3% reduced the rate of normal fertilization in IVF. However,even MNS≤1% did not result in fertilization disorder or failure. Therefore,teratozoospermia alone was not an indicator of ICSI and sperm morphology assessment had no obvious value for predicting the rates of embryo quality,clinical pregnancy,and live birth in IVF.