部分卵母细胞胞浆内单精子注射周期中影响其常规体外受精受精率的相关因素分析

Analysis of the influence factors of fertilization rate in half intra-cytoplasmic sperm injection cycles

目的探讨部分卵母细胞胞浆内单精子注射(half-ICSI)周期中,影响该周期常规体外受精(IVF)受精率的相关因素。方法选择2010年8月至2012年8月,于四川大学华西第二医院生殖医学中心接受half-ICSI助孕的180例不孕患者的共计180个half-ICSI周期为研究对象。按照常规IVF受精率高低,将ICSI受精率>50%且常规IVF受精率≤25%的46个周期,纳入低受精率组;ICSI受精率>50%且常规IVF受精率>50%的134个周期,纳入高受精率组。回顾性分析可能影响常规IVF受精率的因素,包括女方年龄及不孕年限等9项,以及涉及男方的包括精子浓度和前向运动精子百分率等8项,并对这17项因素进行单因素分析。根据临床经验及上述单因素分析结果,将精子浓度、前向运动精子百分率、弱精子症、畸形精子症及正常形态精子百分率等5项影响常规IVF受精率的相关因素,进行多因素非条件logistic回归分析,了解其独立危险因素。结果 1低受精率组男方精子浓度、前向运动精子百分率及正常形态精子百分率均较高受精率组低,而弱精子症和畸形精子症患者所占比例,则较高受精率组高,且差异均有统计学意义(P<0.05)。两组女方9项因素,包括年龄、不孕年限、不孕类型构成比、既往夫精人工授精(AIH)助孕率、子宫内膜异位症(EMS)发生率、多囊卵巢综合征(PCOS)发生率、自然流产率,以及年龄≥35岁者所占比例、不孕年限≥3年者所占比例比较,以及男方其他3项因素,包括精子总数、少精子症患者所占比例及精子全部畸形患者所占比例比较,差异均无统计学意义(P>0.05)。2多因素非条件logistic回归分析结果显示,影响half-ICSI周期常规IVF受精率的独立危险因素为男方弱精子症(OR=6.476,95%CI:1.621~25.877,P<0.05)。结论男方弱精子症可能增加half-ICSI周期常规IVF受精失败风险,而男方畸形精子症及女方不孕相关因素,不能确定为half-ICSI或ICSI指征。

Objective To analyze the influence factors of fertilization rate of conventional in vitro fertilization（IVF） in half intra-cytoplasmic sperm injection（half-ICSI） cycles. Methods A total of 180 half-ICSI cycles of 180 barren patients treated with half-ICSI from August 2010 to August 2012 in reproductive center of West China Second University Hospital, Sichuan University,were chosen as study objects. According to conventional IVF fertilization rate, the 180 half-ICSI cycles were divided into low fertilization rate group,including 46 cycles in which ICSI fertilization rate was over 50% and conventional IVF fertilization rate was equal or less than 25% and another 134 cycles in which ICSI and conventional IVF fertilization rate were both over 50% were enrolled into high fertilization rate group. The relative factors including 9 female factors（age, duration of infertility, etc. ） and 8 male factors（sperm concentration, ratio of progressive sperm, etc. ） were analyzed retrospectively, and made single factor analyze of these 17 factors. According to clinical experiences and single factor analyze result, the sperm concentration, progressive sperm percentage and normal morphology sperm percentage, ratio of asthenozoospermia and teratozoosperrnia males, which remained statistical significance of conventional IVF fertilization rate in these 17 factors were analyzed by multivariate unconditional logistic regression analysis. Results The mean sperm concentration, progressive sperm percentage and normal morphology sperm percentage of low fertilization rate group were lower than those of high fertilization rate group, while the ratio of asthenozoospermia and teratozoospermia males were higher than those of high [ertilization rate group, and the differences were statistically significant（P^0.05）. There were no significant differences between two groups of half-ICSI cycles in 9 female factors including age, duration of infertility, constituent ratio of primary or secondary infertility, rate of artificial insemination by husband （AIH） treatment history, incidence rate of endometriosis（EMS） and polycystic ovary syndrome（PCOS）, spontaneous abortion rate, female ratio of age^35 years old and duration of infertility^3 years; and other 3 male factors including total sperm number, ratio of oligospermia and teratozoospermia in which sperms were totally malformation（P〉0.05）. （2）The multivariate unconditional logistic regression analysis showed that the independent risk factor of conventional IVF fertilization rate in half-ICSI cycles was asthenozoospermia（OR = 6. 476, 95%CI： 1. 621-25. 877,P〈0.05）. Conclusions The risk of fertilization failure of conventional IVF in half-ICSI cycles may be increased in patients with asthenozoospermia. Males with teratozoospermia or femalesI related infertility factors are not valid indications for half-ICSI or ICSI therapy.