重度少精子症伴高碎片化精液精子和睾丸精子行ICSI助孕后临床结局分析

Clinical outcome analysis of ICSI assisted pregnancy using semen and testicular sperm from severe oligozoospermia patients with high sperm DNA fragmentation

目的评估高碎片化重度少精子症患者行卵泡浆内单精子注射(Intracytoplasmic sperm injection,ICSI)助孕治疗时使用精液精子和睾丸精子的临床结局。方法选择2017年4月至2018年4月南昌市生殖医院生殖男科门诊重度少精子症伴高碎片化精子行ICSI助孕的82例患者,按随机分组法随机分成睾丸精子组(治疗组)42例和精液精子组(对照组)40例,其中两组患者的年龄、不孕年限、精子浓度和精子碎片等一般情况比较无统计学差异(P>0.05),对两组不同取精方式行ICSI助孕后的受精率、优质胚胎率、流产率和抱婴率结局进行分析比较。结果治疗组睾丸精子碎片率比精液精子碎片明显低,两组对比受精率无统计学差异(P>0.05);优质胚胎数和可用胚胎总数治疗组较高(P<0.05);临床结局中治疗组临床妊娠率和抱婴率较高,而对照组流产率明显较治疗组高(P<0.05)。结论重度少精子症伴高碎片化精子患者使用睾丸精子行ICSI助孕后其受精率、优质胚胎率等方面要优于精液精子,临床可以选择睾丸精子行辅助生殖技术(assisted reproductive technology,ART),对临床上重度少精子症伴高碎片化精子患者提供较好的取精方式来获得更好的临床结局。

Objective To evaluate the clinical outcome of Intracytoplasmic sperm injection(ICSI)treatment using semen and testicular sperm from patients with highly fragmented severe oligozoospermia.Methods From April 2017 to April 2018,82 severe oligozoospermia patients with high fragmentary sperm were randomly divided into testicular sperm group(the treatment group,42 cases)and semen sperm group(the control group,40 cases).There were no significant differences in the age,infertility years,sperm concentration and sperm fragments between the two groups.Results The rate of testicular sperm fragments in the treatment group was significantly lower than that in the semen sperm group,and there was no significant difference in the fertilization rate between the two groups(P>0.05);the number of high-quality embryos and the total number of available embryos in the treatment group was higher(P<0.05);the clinical pregnancy rate and infant holding rate in the treatment group were higher,while the abortion rate in the control group was significantly higher than that in the treatment group(P<0.05).Conclusion the fertilization rate and high-quality embryo rate of ICSI assisted pregnancy using testicular sperm from severe oligozoospermia with high fragmentation sperm are better than those of semen sperm.Assisted reproductive technology(ART)can be used to select testicular sperm in clinic,which can provide a better way to get better clinical outcome for severe oligozoospermia with high fragmentation sperm.