梯度离心后精子形态对人工授精妊娠结局的影响  

The influence of sperm morphology before and after processing with gradient centrifugation on the outcome of intrarauterine insemination

作　　者：朱立华[1] 肖新燕[1] 常玉婷[1] 

机构地区：[1]山东省聊城市第二人民医院生殖医学科,山东临清252600

出　　处：《中国优生与遗传杂志》2015年第4期126-128,93,共4页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨精液处理后精子形态对人工授精结局的影响。方法回顾性分析289例共651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(World Health Organization)人类精液检验与处理实验手册第五版标准,比较处理后精子形态<4%和≥4%时促排卵方案、周期数对临床妊娠率的影响。结果当处理后精子形态<4%时,NC、HMG、FSH+HMG和LE+HMG的周期妊娠率分别为5.5%、12.1%、12.1%和10.6,各组之间差异不显著(P>0.05);当处理后精子形态≥4%时,NC、HMG、FSH+HMG和LE+HMG的周期妊娠率分别为8.0%、15.2%、18.5%和16.9%,且FSH+HMG和LE+HMG与NC相比存在显著差异(P<0.05),HMG周期妊娠率较NC有所提高。精子形态<4%组,第1,2及≥3周期,周期妊娠率分别为13.0%,8.9%,0.0%,且≥3周期与1,2周期相比差异显著(P<0.05);精子形态≥4%时,第1,2及≥3周期,周期妊娠率分别为18.9%,15.3%,13.5%,且各组之间无显著差异(P>0.05),当≥3周期时精子形态<4%和精子形态≥4%两组周期妊娠率分别为0.0%和13.5%,差异显著(P<0.05)。结论当男性患者精子形态<4%时,治疗方案应采用自然周期,且周期数不宜超过2个周期,如未孕,应尽快转入IVF/ICSI治疗;精子形态≥4%时,可考虑选用促排卵治疗,行3个及以上人工授精治疗周期。Objective：The aim of this study was to access the influence of sperm morphology after processing on the intrarauterine insemination（IUI）. Methods：The retrospective study included 289 infertile couples who underwent 651 cycles. The semen samples were processed with gradient centrifugation.Sperm morphology was analysed strictly according to the fifth edition of the WHO（World Health Organization）laboratory manual for the examination and processing of hunman semen. The clinical pregnancy rates were compared according to ovulation induction methods and IUI cycles between the two groups that sperm morphology 4% and ≥4% after processing. Results：After processing the pregnancy rates per cycle of NC,HMG,FSH＋HMG and LE＋HMG were 5.5%,12.1%,12.1% and 10.6% in patients with4% normal forms without statistical diference（P〉0.05）;But the pregnancy rates per cycle of NC,HMG,FSH＋HMG and LE＋HMG were 8.0%,15.2%,18.5%,and 16.9% in patients with≥4% normal forms after processing,Statistically significant difference in pregnancy rates per cycle was observed among NC and FSH＋HMG,LE＋HMG methods（P〉0.05）,The pregnancy rates per cycle of HMG method was higher than NC. The pregnancy rates per cycle of the first IUI cycle,the second IUI cycle and ≥ the third IUI cycle were 13.0%,8.9% and 0.0%,Statistically significant difference was observed among ≥ the third IUI cycle and the first IUI cycle,the second IUI cycle（P〈0.05）;After processing the pregnancy rates per cycle of the first IUI cycle,the second IUI cycle and ≥ the third IUI cycle were 18.9%,15.3% and 13.5% without statistical diference（P〈0.05）;The pregnancy rates per cycle of the two groups that sperm morphology 4% and ≥4% after processing were 0.0% and 13.5% when the IUI cycle was ≥ the third IUI cycle with statistical diference（P〈0.05）. Conclusion：NC should be treated in patients with 4% normal forms after processing less than two cycles,IVF and ICSI treatment should be performed in time after twice failure. Ovulati

关 键 词：人工授精 精子形态 促排卵 周期妊娠率 

分 类 号：R714.8[医药卫生—妇产科学]