Y染色体多态性对精液质量、精子功能及IVF/ICSI-ET妊娠结局的影响

The effects of Y chromosome polymorphism on sperm quality,sperm function and IVF/ICSI-ET outcome

目的探讨Y染色体多态性对精液质量、精子功能、辅助生殖妊娠结局以及出生后代的影响。方法回顾分析济宁医学院附属医院生殖医学中心2016年6月至2019年12月因男方因素行IVF/ICSI-ET的207例Y染色体多态性患者(包括50例46,XY,Y≥18;51例46,XY,Y≤21;36例46,X,Yqs;30例46,XYq-;40例,46,XYp+)作为实验组,染色体正常组135例男性纳入对照组。对比以上两组精子质量、精子功能指标(诸如顶体酶、精子顶体完整性、精子核蛋白组检测型、精子-透明质酸结合率等)以及妊娠结局和出生后代指标。结果实验组与对照组男、女方患者的平均年龄、不孕年限、窦卵泡数,女方基础FSH和LH,HCG日E_(2)水平和子宫内膜厚度比较无统计学意义(P>0.05)。实验组中207例Y染色体多态性患者与对照组相比,实验组患者精液质量、精子功能指标差异有统计学意义。在IVF治疗周期组中,实验组的受精率,优质胚胎率,着床率、临床妊娠率小于对照组,生化妊娠率大于对照组,差异有统计学意义,卵裂率与对照组相比差异无统计学意义,ICSI治疗周期中,实验组的受精率,优质胚胎率,着床率、生化妊娠率、临床妊娠率与对照组相比差异无统计学意义。与对照组相比,实验组的早产率、出生体重、双胎妊娠率、男婴比例、出生缺陷率差异无统计学意义。实验组的流产率高于对照组,差异有统计学意义。结论Y染色体多态性对男性生育以及ART妊娠结局的发育有一定影响。ICSI受精可以改善一部分患者的妊娠结局。

Objective To evaluate the effects Y chromosome polymorphism on spermatogenesis,sperm function,sperm quality and IVF/ICSI-ET outcome.Methods A retrospective analysis was carried out in 207 infertile couples with Y chromosome polymorphism(including 50 cases of 46,XY,Y≥18,51 cases of 46,XY Y≤21,36 cases of 46,X,Yqs;30 cases of 46,X,Yq-;40 cases of 46,X,Yp+)who underwent IVF or ICSI treatments from June 2016 to December 2019.Other 135 men with normal chromosome and natural history of fertility was set as the control group.Sperm function and outcomes of IVF/ICSI-ET treatment were comparatively analyzed between the experience group and the control group.Results There were no significant differences between the experimental group and the control group in the average age and years of infertility,the count of the antral follicle,E_(2) level on HCG day,basic FSH,basic LH,intimal thickness on HCG day in women male and female patients.However,there were significant differences in semen quality and sperm function between the two groups.The clinical pregnancy rate of embryo rate,implantation rate and high quality embryo rate in the control group were lower than those in the control group.The differences were statistically significant in the IVF treatment cycle group and the biochemical pregnancy rate was higher than that in the control group.There was no significant difference in cleavage rate between the two groups in the 1 CSI treatment cycle group.There were no significant differences in the pregnancy rate of heavy twins,the proportion of male babies and the rate of birth defects between two groups.The abortion rate in the experimental group was higher than that in the control group,and the difference was statistically significant.Conclusion Y chromosome polymorphism may have adverse effects on male fertility and IVF-ET outcome.ICSI may improve these patient’s outcome of IVF-ET treatment.