不同卵子质量下精子DNA碎片对体外受精临床结局的影响

Influence of sperm DNA fragmentation on clinical outcome of in vitro fertilization with different oocyte quality

目的探讨不同卵子质量下精子DNA碎片对体外受精(IVF)临床结局的影响。方法回顾性分析2018年9月至2019年12月在金华市人民医院生殖医学中心接受IVF治疗的896组不孕不育夫妇。促排卵方案根据女方卵巢储备功能制定,正常行促性腺激素释放激素激动剂(GnRH-a)长方案(LP,593例),下降行GnRH-a短方案(SP,303例)。根据LP/SP中精子DNA碎片指数(DFI)分为正常组(DFI<10%,300例/150例)、轻度组(10%≤SDFI<20%,206例/104例)和重度组(DFI≥20%,87例/49例),分别比较三组的临床结局。结果在LP中,三组间的受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率和异位妊娠率差异均无统计学意义(P>0.05),重度组的早期流产率比正常组和轻度组高,但三组间差异无统计学意义(P>0.05)。在SP中,三组间的受精率、卵裂率、优质胚胎率和异位妊娠率比较,差异无统计学意义(P>0.05)。胚胎种植率和临床妊娠率三组间比较,差异具有统计学意义(P<0.05),重度组的胚胎种植率显著低于正常组(P<0.0167),轻度组和重度组的临床妊娠率也分别显著低于正常组(P<0.0167)。早期流产率三组间差异虽然有统计学意义(P<0.05),但两两之间比较,差异无统计学意义(P>0.0167)。结论DFI对IVF临床结局有不利影响,尤其是卵巢储备功能下降的治疗周期,卵子质量可能在DFI对IVF影响中起决定作用。

Objective To explore the influence of sperm DNA fragmentation on clinical outcome of in vitro fertilization(IVF)with different oocyte quality.Methods 896 infertile couples who received IVF treatment in the Center of Reproductive Medicine in Jinhua People′s Hospital from September 2018 to December 2019 were retrospectively analyzed.If ovarian reserve was normal,we used the long protocol of gonadotropin-releasing hormone agonist(GnRH-a)(LP,593 cases),otherwise used the short protocol of GnRH-a(SP,303 cases).According to the SPERM DNA fragmentation index(DFI)in LP/SP,the cases were divided into normal group(DFI<10%,300 cases/150 cases),mild group(10%≤SDFI<20%,206 cases/104 cases)and severe group(DFI≥20%,87 cases/49 cases),and the clinical outcomes of the three groups were compared respectively.Results In LP,there were no statistically significant differences in fertilization rate,cleavage rate,high quality embryo rate,embryo implantation rate,clinical pregnancy rate and ectopic pregnancy rate among the three groups(P>0.05).The early abortion rate of the severe group was higher than that of the normal group and the mild group,but there was no statistically significant difference among the three groups(P>0.05).In SP,there were no statistically significant differences in fertilization rate,cleavage rate,high quality embryo rate and ectopic pregnancy rate among the three groups(P>0.05).The difference between the three groups was statistically significant(P<0.05),the embryo implantation rate of the severe group was significantly lower than that of the normal group(P<0.0167),and the clinical pregnancy rate of the mild group and the severe group was also significantly lower than that of the normal group(P<0.0167).Although there was a statistically significant difference in the early abortion rate among the three groups(P<0.05),there was no statistically significant difference between the three groups(P>0.0167).Conclusions DFI has negative effect on IVF clinical outcome,especially in the treatment cycle with reduced ovarian reserve.Oocyte quality may play a decisive role in the effect of DFI on IVF.