精子DNA完整性对冻融胚胎移植周期妊娠结局的影响

Effect of sperm DNA integrity on pregnancy outcome in frozen-thawed embryo transfer cycle

目的探讨男性精子DNA完整性对行ART助孕患者冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2016年8月至2017年12月在江苏省苏北人民医院生殖中心接受IVF/ICSI助孕的667对不孕夫妇FET周期的临床资料。男性患者进入周期前均采用精子染色质结构分析法(SCSA)染色后通过流式细胞仪来检测男性精子DNA完整性,并观察精子DNA碎片率(DFI)对妊娠结局的影响。根据不同精子DFI水平将研究对象分为两组:低DFI水平组(低DFI组:DFI≤30%,439个周期)和高DFI水平组(高DFI组:DFI>30%,228个周期);再根据不同受精方式分为两个亚组:常规IVF组及ICSI组,比较不同水平的精子DFI及不同受精方式对FET周期妊娠结局的影响。结果纳入研究的667对不孕夫妇中临床妊娠334例,总妊娠率50.07%。低DFI组、高DFI组患者的一般资料比较均无统计学差异(P>0.05),但低DFI组的受精率显著高于高DFI组(P<0.05)。低DFI组的临床妊娠率显著高于高DFI组(54.21%vs.42.11%)(P<0.05),流产率则显著低于高DFI组(16.81%vs.27.08%)(P<0.05)。低DFI组中IVF组和ICSI组的临床妊娠率(52.63%vs.58.62%)、流产率(15.88%vs.19.12%)比较均无显著性差异(P>0.05);高DFI组中IVF组的临床妊娠率显著低于ICSI组(33.33%vs.48.48%),流产率则显著高于ICSI组(40.63%vs.20.31%)(P均<0.05)。结论精子DFI水平影响不孕患者的受精率;随着精子DFI水平增高,其整体临床妊娠率下降,流产率增加。低DFI水平的不孕夫妇可选择常规IVF或ICSI助孕;但对于高DFI水平的不孕夫妇,选择ICSI助孕方式可能对改善妊娠结局有益。

Objective:To investigate the effects of sperm DNA fragments on the pregnancy outcome of the frozen embryo transfer cycle in ART patients.Methods:The clinical data of 667 infertile couples who received IVF/ICSI in the Reproductive Center of Northern Jiangsu People’s Hospital from August 2016 to December 2017 were retrospectively analyzed.Sperm chromatin structure analysis(SCSA)was used in all male patients before entering the cycle.The sperm DNA integrity was measured by flow cytometry.The effect of sperm DNA fragmentation rate(DFI)on pregnancy outcome was observed.The couples were divided into two groups according to the sperm DFI value:low DFI group(DFI≤30%)(n=439)and high DFI group(DFI>30%)(n=228).Then the couples were subdivided into two subgroups according to different fertilization methods:conventional IVF group and ICSI group.The effect of sperm DFI level and the fertilization method on the pregnancy outcome of frozen embryo transfer cycle were compared.Results:Of the 667 infertile couples included in the study,334 were clinically pregnant,with a total pregnancy rate of 50.07%.The general clinical data was not significantly different between the low DFI group and high DFI group.However,the fertilization rate of low DFI group was significantly higher than that in the high DFI group(P<0.05).The clinical pregnancy rate was significantly higher(54.21%vs.42.11%),but the abortion rate(16.81%vs.27.08%)was significantly lower in low DFI group compared with high DFI group(P<0.05).In the high DFI group,the clinical pregnancy rate of IVF group was significantly lower than that of ICSI group(33.33%vs.48.48%),but the abortion rate was significantly higher than that of ICSI group(40.63%vs.20.31%)(P<0.05).Conclusions:The sperm DFI level affects the fertilization rate of infertile patients.The overall clinical pregnancy rate decreases and the abortion rate increases along with the increase of sperm DFI level.The infertile couples with low DFI level can choose routine IVF or ICSI for assisted pregnancy,but infertile couples with high DFI levels should choose ICSI,which may be beneficial for improving pregnancy outcomes.