精子DNA碎片对IVF-ET胚胎发育和临床结局的影响

The Effect of Sperm DNA Fragmentation Index on the Embryo Development and Clinical Outcomes of IVF-ET

目的:探讨精子DNA完整性对体外受精-胚胎移植(IVF-ET)胚胎发育及临床结局的影响。方法:选择190对不孕症夫妇为研究对象,采用密度梯度洗涤及上游法处理精子,检测处理前后的DNA碎片指数(DFI)。通过受试者工作特征(ROC)曲线,根据DFI预测IVF-ET受精率的阈值将患者分为高DFI组和低DFI组。比较两组精液参数及体外受精/卵胞浆内单精子注射(IVF/ICSI)的助孕情况和妊娠结局。结果:(1)DFI预测IVF受精的AUC为0.559(95%CI 0.501~0.617),最大约登指数对应阈值为25%。患者分为高DFI组[≥25%,59对夫妇(IVF 24对,ICSI 35对)]和低DFI组[<25%,131对夫妇(IVF101对,ICSI 30对)]。经过密度梯度洗涤及上游后精子DFI显著降低(17.9%vs 1.9%,P<0.01)。(2)无论IVF还是ICSI周期,两组前向运动精子比例的差异均有统计学意义[(39.7±17.3)%vs(21.8±19.1)%,P<0.01;(28.5±18.3)%vs(13.6±10.9)%,P<0.01]。在IVF周期中,低DFI组受精率[(84.0±15.9)%]明显高于高DFI组[(76.3±16.4)%],差异有统计学意义(P<0.05),而在ICSI周期中,两组受精率差异无统计学意义[(73.8±19.9)%vs(76.2±20.1)%,P>0.05]。(3)两组的卵裂率、优质胚胎率、囊胚形成率、种植率、临床妊娠率、早期流产率、持续妊娠率差异均无统计学意义(P>0.05)。结论:高DFI患者的精子活力明显降低,密度梯度洗涤及上游后可显著降低精子DFI。高DFI患者可通过ICSI提高受精率,但是DFI对于IVF/ICSI胚胎发育以及临床结局没有预测价值。

Objective:To investigate the influence of the DNA integrity of sperm on the embryonic development and clinical outcomes of in vitro fertilization-embryo transfer(IVF-ET).Methods:190 couples underwent IVF-ET were included.Sperms used for IVF or ICSI were processed through density gradient centrifugation(DGC)and swim-up.Sperm DFI before and after processed were examined.The couples were grouped to analyze the correlation between the sperm DFI and the laboratory and clinical outcomes of IVF and ICSI.Results:(1)Comparison of ROC curve of DFI for fertilization rate revealed that the best DFI cut-off value was 25%,AUC=0.559(95%CI 0.501-0.617).After DGC and swim up,the sperm DFI was decreased remarkably(17.9%vs 1.9%,P<0.01).(2)Significant difference in progressive motility was found between high(≥25%)and low(<25%)DFI groups after IVF or ICSI[(39.7±17.3)%vs(21.8±19.1)%,P<0.01;(28.5±18.3)%vs(13.6±10.9)%,P<0.01].In IVF cycle,the fertilization rate was obviously lower in the high DFI group[(84.0±15.9)%vs(76.3±16.4)%,P<0.05].But no significant change was found in the ICSI cycle[(73.8±19.9)%vs(76.2±20.1)%,P>0.05].(3)No statistic difference was detected between the low-and high-DFI groups in other embryonic development and clinical outcomes either in the IVF or the ICSI cycles.Conclusions:DFI was negatively correlative with sperm motility.ICSI can improve the fertilization rate of high-DFI.DFI did not provide independent information regarding embryo development or clinical outcomes for infertile patients who received IVF/ICSI.