精子形态联合精子核DNA在试管婴儿周期治疗中的预测价值

Predictive value of sperm morphology combined with sperm nuclear DNA in IVF cycle therapy

目的 探讨精子形态联合精子DNA碎片率(DFI)对体外受精-胚胎移植临床结局的影响。方法 选取2020年1月~2021年8月在江西省九江市妇幼保健院生殖中心实施IVF-ET治疗的231例IVF新鲜治疗周期,取卵当日对精液标本进行精子形态及DNA完整性检测。依据精子形态分为正常组164例及畸形精子组67例,纳入精子DFI后分为A组(MNS≥4%且DFI<30%)、B组(MNS≥4%且DFI≥30%)、C组(MNS<4%且DFI<30%)和D组(MNS<4%且DFI≥30%),对比各组间受精率、2PN卵裂率、优胚率、临床妊娠率、早期流产率的差异;比较DFI与男方年龄、精液参数间的相关性。结果 正常形态组总受精率、2PN受精率显著高于畸形精子组(P<0.001),2PN卵裂率、优胚率、临床妊娠率、早期流产率在不同形态组间比较,差异均无统计学意义(均P>0.05);纳入精子DFI后,C、D两组的总受精率、2PN受精率显著低于A、B两组,D组2PN卵裂率显著低于A、C两组,B组、D组优质胚胎率显著低于A组、C组,B组临床妊娠率明显低于A组(P<0.0083);DFI与年龄及其他精液参数的相关性分析中,DFI与男性年龄呈显著正相关,与前向运动精子率呈显著负相关(P=0.002,0.001)。结论 精子核DNA联合精子形态评估能为IVF-ET的治疗结局带来更为高效准确的预测价值,值得在临床上推广应用;同时在IVF-ET的治疗中,也要关切男方年龄,避免高龄带来的诸多不利影响。

Objective To investigate the effect of sperm morphology combined with sperm DNA fragmentation index(sperm DNA fragmentation index,DFI)on clinical outcomes of in vitro fertilization and embryo transfer(in vitro fertilization and embryo transfe,IVF-ET).Methods A total of 231 IVF fresh cycles were selected from January 2020 to August 2021 in the reproductive center of our hospital,the sperm morphology and the integrity of sperm nuclear DNA were detected on the day of egg collection.According to the normal morphology sperm percentage is divided into 164cases of normal group and teratozoospermia group,after the inclusion of sperm DFI,they were divided into group A(MNS≥4%且DFI<30%),group B(MNS≥4%且DFI≥30%),group C(MNS<4%且DFI<30%),group D(MNS<4%且DFI≥30%).The differences of fertilization rates,zygote transgene rates,optimal embryo rates,clinical pregnancy rate,early abortion rate among the groups were compared.To compare the correlation of DFI with male and semen parameters.Results The total fertilization rate and two pronuclei(two pronucle,2PN)fertilization rate in normal sperm morphology group were significantly higher than those in teratozoospermia group(all P<0.001).There were no statistical differences in zygote transgene rates,optimal embryo rates,clinical pregnancy rate and early abortion rate between two groups(P>0.05).After the inclusion of sperm DFI,the fertilization rate and 2PN fertilization rate in group C and D were significantly lower than those in group A and B,the zygote transgene rate in group D was significantly lower than that in group A and C,the optimal embryo rates in group B and D was significantly lower than that in group A and C,and the clinical pregnancy rate in group B was significantly lower than that in group A(P<0.0083).In the correlation analysis of DFI with age and the other semen parameters,DFI was significantly positively correlated with male age,and significantly negatively correlated with forward motility sperm rate(P=0.002,0.001).Conclusion Sperm DNA combined with sperm morphology assessment can bring more efficient and accurate predictive value for the treatment outcome of IVF-ET,which is worthy of clinical promotion and application.At the same time,in the treatment of IVF,we should concern about the age of the man,to avoid the many adverse effects of advanced age.