精子DNA碎片率在体外受精-胚胎移植中对冻融囊胚移植结局的影响

Impact of sperm DNA fragmentation on the outcome of frozen-thawed blastocyst transfer in in vitro fertilization and embryo transfer

目的:研究精子DNA碎片率对冻融囊胚移植结局的影响。方法:回顾性分析2015年1月至2018年1月在南方医科大学附属佛山市妇幼保健院生殖中心行常规IVF-ET治疗的不孕患者共308例。根据男方精子DNA碎片率水平分为3组:正常组(DFI≤15%,114例),中度碎片化组(15%<DFI≤30%,103例),高度碎片化组(DFI>30%,91例)。比较3组胚胎发育情况及临床结局。结果:正常组、中度碎片化组的囊胚形成率与高度碎片化组相比,差异有统计学意义(68.9%、66.2%vs 58.3%,P<0.05);正常组、中度碎片化组的可利用囊胚率与高度碎片化组相比,差异无统计学意义(88.1%、84.0%vs81.2%,P>0.05);3组之间优质囊胚率差异有统计学意义(80.3%、68.8%vs59.7%,P<0.05)。高度碎片化组的种植率显著低于正常组及中度碎片化组(30.4%vs43.1%、41.0%,P<0.05);正常组及中度碎片化组的临床妊娠率显著高于高度碎片化组(43.2%、40.2%vs33.6%,P<0.05);高度碎片化组流产率明显高于正常组及中度碎片化组(16.2%vs10.0%、9.8%,P<0.05)。结论:DFI显著升高时,会显著降低囊胚培养的囊胚形成率、可利用囊胚率及优质囊胚率,降低冻融囊胚移植后的临床妊娠率和种植率,增加冻融囊胚移植后的流产率。

Objective: To study the impact of sperm DNA fragmentation(DF) on the outcome of frozen-thawed blastocyst transfer in in vitro fertilization and embryo transfer(IVF-ET). Methods: We retrospectively analyzed 308 cases of routine IVF-ET performed at our Center of Reproductive Medicine from January 2016 to January 2018. According to the sperm DNA fragmentation index(DFI), we divided the patients into a normal DFI(DFI ≤ 15%, n = 114), a moderate DFI(15% < DFI ≤ 30%, n = 103), and a high DFI group(DFI > 30 %, n = 91), and compared the development of embryos and clinical outcomes among the three groups. Results: The blastocyst formation rate was remarkably higher in the normal and moderate DFI groups than in the high DFI group(68.9% and 66.2% vs 58.3%, P < 0.05) but the percentage of available blastocysts exhibited no statistically significant difference between the former two and the latter group(88.1% and 84.0% vs 81.2%, P > 0.05). There were statistically significant differences among the normal, moderate and high DFI groups in the percentage of high-quality blastocysts(80.3% vs 68.8% vs 59.7%, P < 0.05). The implantation rate was dramatically lower in the high DFI group than in the normal and moderate DFI groups(30.4% vs 43.1% and 41.0%, P < 0.05), and so was the clinical pregnancy rate(33.6% vs 43.2% and 40.2%, P < 0.05), but the abortion rate markedly higher in the former than in the latter two groups(16.2% vs 10.0% and 9.8%, P < 0.05). Conclusion: High sperm DFI can not only significantly reduce the rates of blastocyst formation, available blastocysts and high-quality blastocysts, but also decrease the rates of implantation and clinical pregnancy and increase that of abortion after frozen-thawed blastocyst transfer.