极度少弱精子症、无精子症与精液正常患者辅助生殖助孕结局的配对病例对照研究

A Paired Case-control Study of Assisted Reproduction and Assisted Pregnancy Outcomes in Patients with Extreme Asthenospermia, Azoospermia and Normal Semen

目的研究极度少弱精子症患者、无精子症手术取精患者与精液正常患者的辅助生殖助孕结局。方法采用回顾性病例配对研究,病例来源于2014年5月至2022年12月在宁夏医科大学总医院生殖医学中心接受辅助生殖技术助孕的患者,选择首次进入周期的新鲜胚胎移植周期,根据男方术前精液检查筛选出极度少弱精子症患者215例为极度少弱精子症组,无精子症手术取精患者134例为无精子症手术取精组。根据研究组中夫妇双方的年龄、体质量指数(BMI)及女方的卵巢储备功能、促排卵情况等参数,选择在同一时期、首次进入周期并新鲜胚胎移植的精液分析参数正常的夫妇,按照1∶2的比例进行配对,分别筛选出430例、268例为对照组,配对比较分析极度少弱精子症组与对照组、无精子症(附睾、睾丸抽吸取精)组与对照组两组的一般情况、获卵数、MII卵率、正常受精率、正常卵裂率、优质胚胎率、囊胚培养形成率、植入率、临床妊娠率、活产率、单胎率、双胎率、单胎早产率、流产率、异位妊娠率及男女性别比例等。结果极度少弱精子症组与对照组、无精子症手术取精组与对照组的一般资料比较结果显示,男女双方患者的平均年龄、BMI、窦卵泡数(AFC)、女方基础性激素水平、抗缪勒管激素(AMH)、Gn使用总量及天数、HCG日子宫内膜厚度及E2水平比较,极度少弱精子症组、无精子症手术取精组与对照组差异均无统计学意义(P均>0.05),极度少弱精子症组、无精子症手术取精组的不孕年限均长于其对照组(P均<0.05)。极度少弱精子症组、无精子症手术取精组中MII卵率基本相近,正常受精率、正常卵裂率及优质胚胎率均高于对照组(P均<0.05),囊胚培养形成率低于对照组。极度少弱精子症组、无精子症手术取精组的植入率、活产率均高于其对照组,且在无精子症手术取精组中临床妊娠率高于对照组(P均<0.05),其余单胎率、双胎率、单胎早产率、流产率、异位妊娠率及男女性别比例等结果差异均无统计学意义(P均>0.05)。结论在首次新鲜胚胎移植周期中,男性精液常规分析中精子数量和活力及精液来源不影响辅助生殖助孕的临床妊娠结局。

Objective To investigate the outcome of assisted reproduction in patients with extreme asthenos-permia,azoospermia and normal semen by the paired case-control study.Methods A retrospective case-matching study was conducted,patients who received assisted reproductive technology in the Reproductive Medicine Center,General Hospital of Ningxia Medical University from May 2014 to December 2022 were selected for the first time to enter the cycle of fresh transplantation.According to the preoperative semen examination of the male partner,215 patients with severe oligospermia and asthenospermia were screened as the severe oligospermia and asthenospermia group,and 134 patients with azoospermia undergoing surgical sperm retrieval were screened as the azoospermia surgical sperm retrieval group.Based on the age,BMI,ovarian reserve function,and ovulation stimulation status of both partners in the severe oligospermia and asthenospermia group and the azoospermia surgical sperm retrieval group,in the patients with azoospermia(134 cases),according to the age,BMI,ovarian reserve function,ovulation promotion and other parameters of the couple,the couple who entered the cycle for the first time,and the fresh transplant cycle with normal semen analysis parameters were selected in the same period.In this study,430 cases and 268 cases were selected as the control group through 1∶2 matching,respectively.The general conditions,number of eggs obtained,MII egg rate,normal fertilization rate,normal rupture rate,good embryo rate,blastocyst formation rate,implantation rate,clinical pregnancy rate,live birth rate,single birth rate,twin birth rate,single premature birth rate,abortion rate,ectopic pregnancy rate and gender ratio were compared between the extreme asthenospermia group and the normal parameter group,the azoospermia group(epididymis and testicular extraction)and the normal semen parameter group,respectively.Results The average age,BMI,antral follicle number(AFC),female basal hormone level,AMH,total amount and days of Gn use,endometrium thickness and E2 level on HCG day were no significant difference(P all>0.05).The infertility years of the two study groups were longer than that of the control group,and the difference was statistically significant(P all<0.05).In the laboratory results of the two study groups,the MII egg rate was similar,the normal fertilization rate,normal cleavage rate and high-quality embryo rate were higher than the control group,there were statistical differences(P all<0.05),and the blastocyst culture formation rate was lower than the control group.The implantation rate,clinical pregnancy rate and live birth rate of the two groups were higher than that of the control group,and the clinical pregnancy rate of the azoospermia group was higher than that of the control group and the difference was statistically significant(P all<0.05),The other results of single birth rate,twin birth rate,premature birth rate of single birth,abortion rate,ectopic pregnancy rate and male to female sex ratio were not statistically different(P all>0.05).Conclusion In the first fresh embryo transfer cycle,the number and motility of sperm and the source of semen in the routine analysis of male semen parameters do not affect the clinical pregnancy outcome of assisted reproduction.