正常形态前向运动精子总数对早期观察受精失败的预测价值

Predictive value of total number of normal morphological and progressive motility sperm in early fertilization failure

目的探究正常形态前向运动精子总数(TNNPS)对早期观察受精失败的预测价值。方法回顾性分析2013年1月1日至2016年3月31日在本中心行早期观察治疗的2 768个周期,根据TNNPS不同将所有周期分为4组,分别为A组:TNNPS≤2.76×10~6;B组:2.76×10~6<TNNPS≤7.21×10~6;C组:7.21×10~6<TNNPS≤16.31×10~6;D组:16.31<TNNPS≤149.61×10~6;另外再将TNNPS≤3.0×10~6的周期分为6组,分别为Ⅰ组:TNNPS≤0.5×10~6;Ⅱ组:0.5×10~6<TNNPS≤1.0×10~6;Ⅲ组:1.0×10~6<TNNPS≤1.5×10~6;Ⅳ组:1.5×10~6<TNNPS≤2.0×10~6;Ⅴ组:2.0×10~6<TNNPS≤2.5×10~6;Ⅵ组:2.5×10~6<TNNPS≤3.0×10~6,比较各不同组间的女方年龄、男方年龄、不育年限、平均获卵数、女方体重指数(BMI)及受精失败率之间的差异。利用多因素Logistic回归分析女方年龄、男方年龄、不育年限、平均获卵数、女方BMI及TNNPS≤1.0×10~6对受精失败的影响。结果 A^D组、Ⅰ~Ⅵ组各组间女方年龄、男方年龄、不育年限、平均获卵数及女方BMI均无显著性差异(P>0.05)。所有周期中,A组的受精失败率显著高于另外3组(P<0.05);TNNPS≤3.0×10~6的周期分组中,Ⅰ、Ⅱ组受精失败率显著高于其余4组(P<0.05)。多因素Logistic回归分析显示TNNPS≤1.0×10~6[OR=25.422,95%CI(17.702-36.508)]对于预测受精失败具有统计学意义(P<0.05)。结论行早期观察治疗的患者中TNNPS≤1.0×10~6的人群受精失败的风险较高。TNNPS对早期观察受精失败有一定的预测价值。

Objective ： To investigate the predictive value of total number of normal morphological and progressive motility sperm（TNNPS）in early observed fertilization failure.Methods ： The data of 2 768 cycles with early fertilization in our center from January 1,2013 to March 31,2016 were retrospectively analyzed. All the cycles were divided into 4 groups according to TNNPS：TNNPS≤2.76×10 6 in group A;2.76× 10 6 〈TNNPS≤7.21×10 6 in group B;7.21×10 6 〈TNNPS≤16.31× 10 6 in group C;16.31〈TNNPS≤149.61×10 6 in group D. The cycles with TNNPS≤3.0×10 6 were subdivided into 6 groups：TNNPS≤0.5×10 6 in groupⅠ;0.5×10 6 〈TNNPS≤1.0×10 6 in group Ⅱ;1.0×10 6 〈TNNPS≤1.5×10 6 in group Ⅲ;1.5×10 6 〈TNNPS≤2.0× 10 6 in group Ⅳ;2.0×10 6 〈TNNPS≤2.5× 10 6 in groupⅤ;2.5×10 6 〈TNNPS≤3.0×10 6 in group Ⅵ. The difference of female age,male age, infertility years,average number of oocytes retrieved,female BMI,fertilization failure rate were compared among the groups. Logistic regression were used to determine the influence of female age,male age,infertility years,average number of oocytes retrieved,female BMI and TNNPS≤1.0×10 6 on fertilization failure.Results ： There were no significant differences in female age,male age,infertility years,average number of oocytes retrieved and female BMI among group A-D and group Ⅰ-Ⅵ（ P 〉0.05）. However,the fertilization failure rate of group A was significantly higher than that in group B,C and D（ P 〈0.05）. The fertilization failure rate of groupⅠand group Ⅱ were significantly higher than those in group Ⅲ,Ⅳ,Ⅴ and Ⅵ（ P 〈0.05）. The logistic regression results showed that TNNPS≤1.0×10 6 [ OR =25.422,95% CI （17.702-36.508）] was statistically significant for predicting the fertilization failure.Conclusions ： The risk of early fertilization failure in patients with TNNPS≤1.0×10 6 is significantly higher. TNNPS has certain predictive value for early fertilization failure.