精液优化处理后DNA碎片指数、精子畸形率与IVF胚胎发育、早期自然流产的相关性

Correlation of the DNA fragmentation index and malformation rate of optimized sperm with embryonic development and early spontaneous abortion in IVF-ET

目的:探讨精液优化处理后DNA碎片指数(DFI)、精子畸形率(SMR)与常规体外受精-胚胎移植(IVF-ET)中早期自然流产的相关性和预测价值。方法:选取2013年1月至2015年6月因单纯输卵管性不孕行常规IVF获得临床妊娠的602个周期,分为早期自然流产组(97个周期)和继续妊娠组(505个周期)。取卵日,将受精剩余精子分别采用精子染色质扩散实验(SCD)和快速染色法(Diff-Quik),完成DNA碎片和精子形态检测。Logistic方程建立联合预测因子(JP),受试者工作特征(ROC)曲线分析DFI、SMR对IVF早期自然流产的预测价值。结果:早期自然流产组DFI、SMR分别为(15.91±3.69)%、(82.85±10.24)%,继续妊娠组DFI、SMR分别为(9.30±4.22)%、(77.32±9.19)%,差异均有统计学意义(P均<0.05)。两组优质胚胎率分别为46.53%(342/735)、56.43%(2 263/4 010),差异有统计学意义(P<0.05)。DFI、SMR均是IVF早期自然流产的危险因素,OR分别为5.96、1.66(P均<0.01)。DFI、SMR及JP的ROC曲线下面积(AUC)分别为0.893±0.019、0.685±0.028、0.898±0.018。根据约登指数得出DFI、SMR的预测阈值分别为15%、80%。DFI与SMR呈正相关(r=0.31,P<0.01),DFI、SMR均与优质胚胎率呈负相关(r=-0.45、-0.22,P均<0.01)。结论:精液优化处理后DFI、SMR与IVF胚胎发育密切相关,DFI对早期自然流产有预测价值,阈值约为15%,SMR预测效能低。

Objective： To investigate the effects of the DNA fragmentation index（DFI） and malformation rate（SMR） of optimized sperm on embryonic development and early spontaneous abortion in conventional in vitro fertilization and embryo transfer（ IVFET）. Methods： We selected 602 cycles of conventional IVF-ET for pure oviductal infertility that had achieved clinical pregnancies,including 505 cycles with ongoing pregnancy and 97 cycles with early spontaneous abortion. On the day of ovum retrieval,we examined the DNA integrity and morphology of the rest of the optimized sperm using the SCD and Diff-Quik methods,established the joint predictor（ JP） by logistic equation,and assessed the value of DFI and SMR in predicting early spontaneous abortion using the ROC curve.Results： The DFI,SMR,and high-quality embryo rate were（15. 91 ± 3. 69） %,（82. 85 ± 10. 24） %,and 46. 53%（342 /735） in the early spontaneous abortion group and（9. 30 ± 4. 22） %,（77. 32 ± 9. 19） %,and 56. 43%（2263 /4010） respectively in the ongoing pregnancy group,all with statistically significant differences between the two groups（ P〈0. 05）. Both the DFI and SMR were the risk factors of early spontaneous abortion（ OR = 5. 96 and 1. 66; both P〈0. 01）. The areas under the ROC curve for DFI,SMR and JP were 0. 893 ± 0. 019,0. 685 ± 0. 028,and 0. 898 ± 0. 018,respectively. According to the Youden index,the optimal cut-off values of the DFI and SMR obtained for the prediction of early spontaneous abortion were approximately 15% and 80%. The DFI was correlated positively with SMR（ r = 0. 31,P〈0. 01） but the high-quality embryo rate negatively with both the DFI（ r =- 0. 45,P〈0. 01）and SMR（ r =- 0. 22,P〈0. 01）. Conclusion： The DFI and SMR of optimized sperm are closely associated with embryonic development in IVF. The DFI has a certain value for predicting early spontaneous abortion with a threshold of approximately 15%,but SMR may have a lower predictive value.