体外受精周期低受精与精子相关参数的多因素分析

Multivariate analysis of IVF low fertilization and sperm parameters

目的探讨体外受精(IVF)周期低受精的发生与精子参数的相关性。方法选取2017年6月—2018年10月于保定市妇幼保健院生殖医学科行IVF助孕的患者264例。根据受精5~6 h拆卵后第二极体的出现与否,分为低受精组(受精率<30%)和正常受精组(受精率≥30%),比较两组患者的基本资料和精子参数。采用二分类Logistic回归分析相关性。采用受试者工作特征曲线(ROC)的曲线下面积(AUC)分析预测价值。结果低受精组头部缺陷精子率、精子畸形指数和自发顶体反应(AR)高于正常受精组(P<0.05)。经二分类Logistic回归分析,头部缺陷精子率[OR=1.132(95%CI:1.058,1.211)]、精子畸形指数[OR=24.826(95%CI:3.186,193.439)]和自发AR[OR=1.268(95%CI:1.174,1.369)]均为IVF周期低受精的影响因素(P<0.05)。各因素的AUC比较,回归方程的预测价值最大[AUC=0.854(95%CI:0.805,0.894)]。结论头部缺陷精子率、精子畸形指数及自发AR与IVF低受精的发生相关,当回归方程预测值(P)>-1.461时,建议患者选择卵质内单精子注射助孕。

Objective To investigate the correlation between the occurrence of low fertilization in in vitro fertilization(IVF)cycles and sperm parameters.Methods This retrospective analysis was conducted among 264 infertile cases receiving of in vitro fertilization procedures in our Reproductive Medicine Center from June 2017 to October 2018.According to the presence or absence of two polar bodies after 5 to 6 hours of fertilization,they were divided into low fertilization group(fertilization rate<30%)(n=63)and normal fertilization group(fertilization rate≥30%)(n=201).The basic data and sperm parameters of the two groups were compared.The correlation was analyzed by binary logistic regression.The area under the curve(AUC)of Receiver Operating Characteristic Curves(ROC)was used to analyze the predictive value.Results Compared with the normal fertilization group,the head defected sperm rate(%H),sperm deformity index(SDI)and acrosome reaction rate(AR)in the low fertilization rate group were higher(P<0.05).By binary logistic regression analysis,the correlation between three indicators and low fertility rate of IVF was determined:%H(OR=1.132),SDI(OR=24.826),AR(OR=1.268)and established a regression equation that predicts the occurrence of low fertilization rate:LogitP=-19.234+0.124%H+3.212SDI+0.237AR(P<0.05).Through ROC analysis,the regression equation with three parameters is compared with a single parameter,which has the greatest predictive value[AUC=0.854,(95%CI:0.805,0.894)],the cut-off value is-1.461,the sensitivity was 85.71%and the specificity was 71.14%.Conclusion H%,SDI and AR were associated with the low fertilization rate of IVF.The predicted value of low fertilization rate(P)was calculated according to the logistic regression equation.When the predicted value of regression equation is>-1.461,patients were advised to choose ICSI to help pregnancy.