精子DNA完整率、精子顶体完整率及反应率对补救卵泡浆内单精子注射术的影响

Impact of sperm DNA and acrosome integrity and acrosome reaction rate on outcomes of rescue intracytoplasmic sperm injection

目的探讨精子DNA完整率、精子顶体完整率及反应率对补救卵胞浆内单精子注射(ICSI)结局的影响。方法回顾性分析我院生殖中心行常规试管受精(IVF)失败需行补救ICSI的97对不孕不育夫妇,根据妊娠情况分为妊娠组(41例)及未妊娠组(56例),分析两组患者精子DNA完整率(用精子DNA断裂指数DFI表示)、精子顶体完整率及反应率对ICSI结局的影响。结果两组患者男方年龄、睾酮值、睾丸体积、FSH值、女方年龄、获卵数均无显著差异(P>0.05),但不育年限未妊娠组长于妊娠组,差异有统计学意义(P<0.05)。两组患者行补救ICSI时受精率及卵裂率无显著差异(P>0.05),但优胚率妊娠组高于未妊娠组,差异有统计学意义(P<0.05)。两组精子DNA完整率(DFI)、顶体反应率均无显著差异(P>0.05),但顶体完整率妊娠组高于未妊娠组,差异有统计学意义(P<0.05);精子DNA完整率、顶体完整率、顶体反应率分别与受精率、卵裂率、优胚率均无显著相关性(P>0.05)。补救ICSI临床妊娠率为42.3%,双胎率为10.3%,单胎率为32.0%。结论补救ICSI是体外受精-胚胎移植受精失败后有效的补救方案,精子顶体完整率与其妊娠结局相关。

Objective To explore the effects of sperm DNA integrity rate, acrosome integrity rate and acrosome reaction rate on the outcomes of rescue intracytoplasmic sperm injection（ICSI）. Methods This retrospective analysis was conducted among 97 infertile couples receiving rescue ICSI due to failure of in vitro fertilization procedures in our Reproductive Medicine Center.Of these 97 women, 41 had clinical pregnancy and 56 did not, and the effects of sperm DNA integrity rate（estimated by DNA fragmentation index, DFI）, acrosome integrity rate and acrosome reaction rate on rescue ICSI outcomes were analyzed. Results No significant difference was found in paternal age, testosterone value, testicular volume, FSH, female patient＇ age or the number of eggs retrieved between the two groups（P0.05）, but the infertility years was significantly shorter in the pregnancy group than in the non-pregnancy group（P0.05）. The fertilization rate and cleavage rate were similar between the two groups（P0.05）, but the good embryo rate was significantly higher in the pregnancy group（P0.05）. The sperm DNA integrity or acrosome reaction rate did not differ significantly between the two groups（P0.05）, but the acrosome integrity rate was significantly higher in the pregnancy group（P0.05）. The sperm DNA integrity rate, acrosome integrity or acrosome reaction rate were not correlated with the fertilization rate, cleavage rate or good embryo rate（P0.05）. The pregnancy rate, twin and single fetus rates were 42.3%, 10.3% and 32.0% in this cohort after recue ICSI, respectively. Conclusion Rescue ICSI is an effective treatment after failed in vitro fertilization procedure, and sperm acrosome integrity rate is associated with the outcome of rescue ICSI.