不同精子来源质量冷冻方式与妊娠结局的关联性分析

Correlation analysis of freezing methods with different sperm sources and pregnancy outcomes

目的探讨冷冻微量精子相关参数与体外受精周期实验室及临床结局的关系。方法回顾性分析2016年1月至2020年12月在生殖医学科行稀少精子冷冻复苏后卵胞浆内单精子显微注射(ICSI)的118个周期相关资料。根据冷冻精子的冷冻方法分为微量冷冻组、传统常规冷冻组;按精子来源分为丈夫射精组、附睾穿刺组、睾丸穿刺组;根据精子质量分为Ⅰ型、Ⅱ型、Ⅲ型严重少弱组。分别比较各组之间一般资料、实验室及临床结局等;采用多因素二元Logistic回归分析冷冻精子相关参数对临床结局的影响。结果①一般资料:按冷冻精子的冷冻方法、精子来源和精子质量分组,女方的年龄、体质量指数、不孕年限、基础促卵泡素(FSH)、抗苗勒氏管激素(AMH)、Gn天数、Gn总量、人绒毛膜促性腺激素(HCG)日雌二醇(E_(2))水平、获卵数、MⅡ卵数各组之间差异均无统计学意义(P>0.05);②实验室指标及临床结局:微量冷冻组与传统常规冷冻组两组组间胚胎利用率、临床妊娠率之间差异均无统计学意义(P>0.05),2PN率(P=0.002)、2PN卵裂率(P=0.036)、优胚率(P=0.002)差异均有统计学意义。丈夫射精组、附睾穿刺组和睾丸穿刺组组间比较,2PN率、临床妊娠率差异均无统计学意义(P>0.05);2PN卵裂率(P<0.001)、胚胎利用率(P=0.048)、优胚率(P=0.002)差异均有统计学意义。Ⅰ型、Ⅱ型和Ⅲ型严重少弱组3组间比较,2PN率、胚胎利用率、优胚率之间差异均无统计学意义(P>0.05);2PN卵裂率(P<0.001)、种植率(P=0.005)、临床妊娠率(P=0.048)差异均有统计学意义;③多因素二元Logistic回归分析结果显示,Ⅲ型严重少弱精组相对Ⅰ型严重少弱精组是低临床妊娠率危险因素[OR:0.259,95%CI、0.075~0.887]。结论微量冷冻和常规冷冻可获得相似临床妊娠率,精子来源不影响临床妊娠率,极严重少弱精可能降低临床妊娠率,但还需要扩大样本量进一步证实。

Objective To investigate the relationship between the technical parameters of frozen micro-sperm and the clinical outcomes of in vitro fertilization(IVF)cycle.Methods A total of 118 cycles related to intracytoplasmic sperm microinjection(ICSI)after cryoresuscitation of rare spermatozoa during Jan.2016 and Dec.2020 were retrospectively analyzed.The cycles were divided into micro freezing group and conventional freezing group according to the method of freezing;husband ejaculation group,epididymal puncture group and testicular puncture group according to the source of sperm;types Ⅰ,Ⅱ and Ⅲ severe asthenia groups according to the quality of sperm.The general data,laboratory and clinical outcomes were compared.The effects of related parameters on the clinical outcomes were analyzed with multivariate binary Logistic regression.Results①General data:there were no significant differences in the age,body mass index(BMI),years of infertility,basal follicle stimulating hormone(FSH),anti-Mullerian hormone(AMH),Gn days,total dosage of Gn,E_(2) level on hCG day,number of oocytes retrieved,and number of M Ⅱ eggs among the groups when the cycles were grouped according to freezing method,sperm source and sperm quality.②Laboratory parameters and clinical outcomes:there were no significant differences in the transferable embryo rate or clinical pregnancy rate between the micro freezing and conventional freezing groups,but there were differences in the 2PN rate(P=0.002),2PN cleavage rate(P=0.036),and the high quality embryo rate(P=0.002)(P<0.05).There were no significant differences in 2PN rate or clinical pregnancy rate among husband ejaculation,epididymal puncture and testicular puncture groups,but there were differences in 2PN cleavage rate(P<0.001),transferable embryo rate(P=0.048)and high quality embryo rate(P=0.002).There were no significant differences in 2PN rate,transferable embryo rate,and high quality embryo rate among the severe oligoasthenia types Ⅰ,Ⅱ,and Ⅲ,but there were significant differences in 2PN cleavage rate(P<0.001),implantation rate(P=0.005),and clinical pregnancy rate(P=0.048)among the three groups.③The multivariate binary Logistic regression analysis showed that the relative risk of a poor outcome was 0.287 in type Ⅲ versus type Ⅰ severe oligoasthenospermia groups(OR=0.259,95%CI:0.075-0.887,P<0.05).Conclusion Similar clinical pregnancy rates can be obtained by micro freezing and conventional freezing.The source of sperm does not affect the clinical pregnancy rate.A lower clinical pregnancy rate may be caused by very severe oligoasthenoteratozoospermia,and further confirmation with an expanded sample size is needed.