精液体外优化对精子DNA以及IVF-ET妊娠结局的影响

Changes of sperm DNA fragmentation before and after processed and it′s effects on outcomes of IVF-ET

目的探讨人工助孕前精液经体外优化制备技术处理后精子DNA的损伤以及对体外授精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)结局的影响。方法收集107例行IVF助孕患者的精液,按照WHO标准对处理前精液行精液常规分析,采用精子染色质扩散试验(sperm chromatin dispersion,SCD)检测处理前和处理后精子DNA碎片率,并收集IVF实验室及临床结局。根据处理前精子DNA碎片率将患者分为两组:精子DNA碎片率≤20%的患者为A组,精子DNA碎片率>20%的患者为B组。结果优化处理后精子DNA碎片率显著低于处理前精子DNA碎片率(3.49±3.38%vs18.69±10.89%,P<0.001);处理前和处理后精子DNA碎片率均与精子总活动率、前向运动率及受精率有显著负相关关系(Spearman相关系数:-0.508、-0.629、-0.283、-0.299、-0.399、-0.329,P<0.05)与男方年龄、精液量、精子浓度、正常形态率及卵裂率无显著相关关系;B组处理后精子DNA碎片率高于A组,差别有统计学意义(P<0.05);B组的精子总活动率、前向运动率和受精率均低于A组,差别有统计学意义(P<0.05);两组男方年龄、女方年龄、不孕年限、获卵数、精液量、精子浓度、正常形态率、卵裂率、种植率和妊娠率之间的差异均无统计学意义(P>0.05)。结论精液经过优化处理(密度梯度离心加上游法)可以显著降低精子DNA碎片率,精子DNA碎片率高与精子活力低下密切相关,并会降低受精率,但对种植率、妊娠率等临床结局没有显著影响。

Objective：To investigate the changes of sperm DNA fragmentation index（DFI）before and after density gradient centrifugation（DCG）and swim-up in In Vitro Fertilization-Embryo Transfer（IVF-ET）,and analyze the effects of sperm DFI on outcomes of IVF-ET. Methods：A total of 107 IVF-ET patients′ spermatozoa were collected and processed through DCG and swim-up. Conventional semen analysis was according WHO standard before processed. Sperm DFI was analyzed by sperm chromatin dispersion（SCD）before and after processed and outcomes of IVF-ET were collected. The patients were divided into two groups upon the size of DFI before processed：Group A（DFI≤20%）,Group B（DFI〉20%）. Results：Sperm DFI was decreased significantly after DGC and swim-up（3.49±3.38% vs 18.69±10.89%,P〈0.001）. There were significantly negative correlation between sperm DFI before and after processed and sperm vitality/sperm progressive motility/fertilization rate（Spearman correlation coefficient：-0.508,-0.629,-0.283,-0.299,-0.399,-0.329,P〈0.05）,but there were no significant correlation with male age/semen volume,density,normal morphology/ cleavage rate. Compared with group A,sperm vitality and sperm progressive motility as well as fertilization rate were reduced in group B（P〈0.05）. However,the difference between two groups of male age/female age/infertility age/number of retrieved oocytes/semen volume,density,normal morphology/cleavage rate/ implantation rate/ pregnancy rate had no statistical significance（P〉0.05）. Conclusions：DGC and swim-up can reduce sperm DFI remarkably. Sperm progressive motility is most related to sperm DFI. The increase of sperm DFI will lower fertilization rate,but for implantation rate and pregnancy rate were not significantly affected.