梯度离心前后精子形态对人工授精妊娠结局的影响  

Influence of sperm morphology after semen processing by gradient centrifugation on the outcome of intrauterine insemination

作　　者：朱立华[1] 许玉刚[1] 孙秀芬[1] 肖新燕[1] 

机构地区：[1]聊城市第二人民医院生殖医学科,山东临清252600

出　　处：《中华男科学杂志》2014年第10期907-911,共5页National Journal of Andrology

摘　　要：目的:探讨精液处理前后精子形态学变化及其对人工授精结局的影响。方法:回顾性分析185对共228个人工授精周期,精液经密度梯度离心法处理,形态学分析严格按照WHO《人类精液检查与处理实验室手册》第5版标准,比较处理前后精子形态<4%和≥4%两组对妊娠结局的影响以及其对女性年龄和不孕年限各组的影响。结果:处理前精子形态<4%组,周期妊娠率为14.6%(14/96),处理前精子形态≥4%组,周期妊娠率为12.8%(17/132),无统计学差异(P>0.05);处理后精子形态<4%组,周期妊娠率为8.7%(6/69),处理后精子形态≥4%组,周期妊娠率为15.7%(25/159),无统计学差异(P>0.05)。处理前精子形态<4%和≥4%两组在不同女性年龄和不孕年限各组间无差异(P>0.05);处理后精子形态<4%和≥4%两组,当女性年龄>35岁时,妊娠率分别为0(0/39)、14.3%(6/42),差异显著(P<0.05);当女性不孕年限>5年时,妊娠率分别为0(0/38)、14.0%(6/43),差异有显著性(P<0.05)。结论:当处理后精子形态<4%,女性年龄>35岁或女性不孕年限>5年时妊娠率明显降低,应及时行IVF或ICSI治疗。Objective： To access the influence of sperm morphology before and after semen processing on the outcome of intrauterine insemination（ IUI）. Methods： This retrospective study included 185 infertile couples who underwent 228 cycles of IUI.The semen samples were processed by gradient centrifugation and sperm morphology analysis was based on the strict criteria of the WHO Laboratory Manual for the Examination and Processing of Human Semen（ 5th Ed）. The outcomes of IUI were compared between those with morphologically normal sperm（ MNS） 4% and ≥4% before and after semen processing as well as among the women of different age and duration of infertility. Results： There were no statistically significant differences in the pregnancy rate per cycle between the MNS 4% and MNS≥4% groups before semen processing（ 14. 6% [14 /96]vs 12. 9% [17 /132],P 〉0. 05） and after semen processing（ 8. 7% [6 /69]vs 15. 7% [25 /159],P 〉0. 05）. The sperm morphology showed no significant influence on the pregnancy rate in the women of different age and infertility duration before processing（ P 〉0. 05）. After semen processing,the pregnancy rate in the women aged 35 years was markedly lower in the MNS 4% than in the MNS≥4% group（ 0% [0 /39]vs 14. 3% [6 /42],P〈 0. 05）,so was it in those with infertility duration 5 years（ 0% [0 /38] vs 14. 0% [6 /43],P 〈0. 05）. Conclusion： With morphologically normal sperm 4% after semen processing by gradient centrifugation,the pregnancy rate of IUI significantly decreases in females aged 35 years or with infertility duration 5 years,in which case,IVF or ICSI treatment should be considered.

关 键 词：人工授精 精子形态 妊娠率 不孕年限 

分 类 号：R714.8[医药卫生—妇产科学]