精液优选对精子DNA碎片的影响及其对体外受精-胚胎移植妊娠结局的影响

The effect of semen optimization on the rate of sperm DNA fragmentation and its effect on pregnancy outcome of IVF-ET

目的评估密度梯度离心联合上游法改善精子DNA碎片(sperm DNA fragmentation)的效率及其对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法收集120份处理前后的精液,用精子染色质扩散法检测精子DNA碎片,评估其对100个新鲜移植患者妊娠结局的影响。结果优选后,男性不育组精子DNA碎片率(SDFI)由22.75(14.44,30.25)降至11.5(5.60,22.79),对照组则由20.86(15.00,26.81)降至7.5(3.63,15.44);妊娠组精子DNA碎片明显低于非妊娠组,ROC曲线下面积是0.667;高水平组(DFI≥20%)的妊娠率和出生率低于低水平组(DFI<20%),差异有统计学意义。结论密度梯度离心联合上游法可减少精子DNA碎片;优选后DNA碎片对IVF-ET妊娠结局具有预测价值,一旦超过阈值,虽可正常受精,但妊娠率和出生率下降。

Objective To investigate the method of effectively density gradient centrifugation combined with swim-up improves sperm nuclear integrity and determine whether the sperm chromatin dispersion test of sperm DNA fragmentation in raw or DGC-swim-up treated semen can influence the outcome of IVF. Method The DNA integrity of spermatozoa from 120 patients underwent IVF were analyzed by SCD before and after DGC and swim-up. The predictive value of the SDFI for IVF outcomes were assessed in a cohort of 100 patients who were underwent new embryo transfer. Result In male infertility group, DGC combined with swim-up decreased the SDFI from 22.75 （ 14.44,30.25 ） to 11.50 （5.60,22.79）, while the control group decreased the SDFI from 20.86 （ 15.00,26.81 ） to 7.50（3.63,15.44）, respectively （P 〈 0.05） ; SDFI after optimization in clinical pregnancy group was significantly lower than that of non-pregnant group. The area under the receiver operating characteristic curve was 0.667. The patients with low sperm DFI had a higher implantation rate and pregnancy rate compared with patients with high sperm DFI. Conclusions DGC and swim-up treated Sperm DNA fragmentation can predict the outcome of IVF. The effect of semen optimization on the rate of sperm DNA fragmentation is limited, once exceed, pregnancy rate and birth rate are decreased although fertilization is normal.