5例精子鞭毛多发形态异常患者的非整倍体率与卵胞质内单精子注射的临床结局研究

Sperm aneuploidy rate and intracytoplasmic sperm injection outcomes in five Chinese patients with multiple morphological abnormalities of sperm flagella

目的评估精子鞭毛多发形态异常(multiple morphological abnormalities of the sperm flagella,MMAF)患者的精子非整倍体率与卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)的临床结局关系。方法本研究在2017年1月至2018年6月期间共收集到来自郑州大学第二附属医院生殖中心的5例MMAF患者及10例精液参数正常的可育对照,通过巴氏染色和电子显微镜观察患者精子的形态及超微结构特征,采用荧光原位杂交技术(FISH)检测患者精子非整倍体率,最后对患者行ICSI助孕并观察其临床结局。结果患者精液中存在大量缺失的、短的、弯的、卷曲的和不规则的精子鞭毛,且鞭毛轴丝中央微管缺失;患者精子非整倍体率与正常相比差异无统计学意义(P>0.05);5对MMAF患者夫妇经过7个ICSI周期,均实现临床妊娠,其中活产3例,自然流产2例。结论MMAF患者精子鞭毛存在严重形态和超微结构异常,但患者较低的精子非整倍体率提示MMAF患者进行ICSI治疗具有较好的临床结局。

Objective To evaluate the relationship between sperm aneuploidy rate and clinical outcome of intracytoplasmic sperm injection(ICSI)in multiple morphological abnormalities of the sperm flagella(MMAF)patients.Methods A total of 5 MMAF patients and 10 normal fertile individuals with normal parameters from Reproductive Center of the Second Affiliated Hospital of Zhengzhou University were collected from January 2017 to June 2018.Papanicolaou staining,scanning electron microscopy and transmission electron microscopy were performed to observe the morphological characteristics of sperm.Fluorescence in situ hybridization(FISH)was used to detect the patients’sperm aneuploidy rate.Finally,ICSI was performed to observe the clinical outcome.Results The results of the light microscope and scanning electron microscope showed morphologically abnormal spermatozoa in the ejaculated semen of patients,including absent,short,bent,coiled,and irregular flagella,and the central pair complex was absent in flagellum axoneme using transmission electron microscopy.There was no significant increase in patients’sperm aneuploidy rate compared with normal control.Furthermore,in 7 ICSI cycles of 5 MMAF couples,all of them achieved clinical pregnancy,including 3 cases of live birth and 2 cases of spontaneous abortion.Conclusion There are serious morphological and ultrastructural abnormalities in the sperm flagella of MMAF patients.The low aneuploidy rates suggest that ICSI of MMAF patients will likely be of good prognosis for future pregnancies.