短时受精中不同受精结局组间精子-透明质酸结合率及妊娠率的比较

Comparison of sperm-hyaluronan binding rate and pregnancy rate between different fertilization outcome groups in short-term in vitro fertilization

目的探讨精子-透明质酸结合率对受精能力的预测以及妊娠的影响。方法回顾性分析2016年1月—6月期间本中心正常受精的短时体外受精(IVF)患者1 630例作为对照组(短时IVF组),因短时受精失败行补救卵胞质内单精子注射(ICSI)的130例作为研究组(R-ICSI组),检测并分析两组精液的精子-透明质酸结合率、浓度、前向运动率、正常形态率、胚胎质量以及妊娠结局。结果 (1)女方年龄、不孕年限、总Gn用量、Gn使用时间以及获卵数组间均无统计学差异(P>0.05);(2)R-ICSI组的精子-透明质酸结合率[(63.8±17.4)%]显著低于短时IVF组[(71.8±13.6)%](P<0.01),并同时伴有精子浓度和正常形态率的明显下降(P<0.05),但其均值却仍然高于精液常规参数的正常参考值;(3)R-ICSI组的正常受精率(70.8%)、总受精率(76.2%)及优质胚胎率(50.0%)均显著低于短时IVF组(76.01%,85.0%,59.0%)(P<0.01);(4)R-ICSI组平均移植胚胎数(2.0±0.2)显著高于短时IVF组(1.9±0.3)(P<0.01),但种植率(36.6%)却仍然低于短时IVF组(49.0%)(P<0.05);R-ICSI组临床妊娠率低于短时IVF组,胚胎停育率高于短时IVF组,但两者之间的差异并无统计学意义(P>0.05)。结论精子-透明质酸结合率对IVF有一定的预测作用,结合常规参数,精子-透明质酸结合率低于63.8%时,受精失败风险增加,但其对于妊娠的影响还有待于进一步研究。

Objective To detect the prediction of sperm-hyaluronan binding rate for fertilization and infhience of pregnancy. Methods A retrospective analysis from January to June in 2016 was performed on patients who took short-term fertilization for the first time in our center. All the patients were divided into two groups, one was control group which took conventional in vitro fertilization （IVF） including 1 630 patients, the other was experimental group including 130 patients which took rescue intracytoplasmic sperm injection （R-ICSI）. The rate of sperm-hyahironan binding, concentration, forward movement rate, normal morphology rate, embryo quality and pregnancy outcome were compared. Results 1） There were no differences in female age, infertility duration, total dosage of Gn used, duration of Gn used and number of oocytes retrieved between the two groups （P〉0.05）. 2） The rate of sperm-hyaluronan binding in R-ICSI group [（63.8 ＋ 17.4）%] was significantly lower than that in Control group [（71.8±13.6）%] （P〈0.01）, accompanied with a sharp decline in sperm density and normal morphology rate at the same time （P〈0.05）, but the mean value of sperm concentration and normal morphology rate were still higher than the normal reference value of semen parameters. 3 ） The normal fertilization rate （70.8%）, total fertilization rate （%.2%） and optimal embryo rate （50.0%） in R-ICSI group were significantly lower than those in control group （%.0%, 85.0%, 59.0%） （P〈0.01）. 4） Though the average number of embryo transfer in R-ICSI group （2.0 ±0.2） was significantly higher than control group （1.9 ±0.3） （P〈0.01）, the implantation rate （36.6%） was still lower than it （49.0%） （P〈0.05）. There were no statistical differences of clinical pregnancy rate and termination of embryo developing between the two groups （P〉0.05）. Conclusion The rate of sperm-hyaluronan binding has a certain effect on the prediction of IVF. Combined with the conventional semen parameters, the risk of fertilization failure is increasing, when the sperm-hyaluronan binding rate is lower than 63.8%, but its effect on the pregnancy is still need further study.