常规精液检查及优化处理后的精液参数对常规IVF受精结局的预测价值  

Predictive value of semen parameters in routine semen analysis and after optimal selection in fertilization outcome of conventional IVF

作　　者：孙青 李观贵 熊风 成金泉 万才云 彭月婷 黄菊 曾勇 

机构地区：[1]深圳中山泌尿外科医院生殖中心,深圳市围着床期生殖免疫重点实验室,深圳518045 [2]深圳中山生殖与遗传研究所,深圳518045

出　　处：《生殖医学杂志》2016年第9期787-793,共7页Journal of Reproductive Medicine

基　　金：深圳市科创委基础研究项目(JCYJ20150402165325174);深圳市卫计委科技计划项目(201402156)

摘　　要：目的分析促排卵前常规精液检查及取卵当日处理后的精液参数对常规体外受精(IVF)结局的预测作用和影响。方法回顾性分析2011年1月至2014年12月期间2 647个常规IVF治疗周期。根据受精率是否低于50%,将患者分为低受精率组(受精率<50%,n=157)和正常受精率组(受精率≥50%,n=2 490)。比较两组患者间的基础资料、精液参数、胚胎发育、胚胎种植率以及临床妊娠情况。采用多因素logistic回归和受试者工作特征曲线(ROC)分析促排卵前常规精液检查及取卵当日的各种单一或综合精液参数指标对IVF低受精率的预测能力。结果除不育年限(P<0.05)外,两组间的基础资料包括女方年龄、男方年龄、女方BMI、获卵数、移植胚胎数和男性不育原因构成比均无统计学差异(P>0.05)。相比于正常受精率组,低受精率组的卵裂率(90.69%vs.95.98%)、优质胚胎率(40.54%vs.50.89%)、胚胎种植率(18.91%vs.31.86%)以及临床妊娠率(35.67%vs.57.15%)均显著降低(P<0.05)。两组间各项精液参数的差异均有统计学意义(P<0.05)。多因素logistic回归分析显示促排卵前常规精液检查指标中正常形态精子百分率(aOR0.935;95%CI:0.898-0.974)和正常形态前向运动精子总数(aOR0.299;95%CI:0.143-0.623),以及取卵日优化处理后的活动精子百分率(aOR0.972;95%CI:0.957-0.988)对预测低受精率的发生具有统计学意义。ROC分析结果显示常规精液检查中的正常形态前向运动精子总数和优化处理后的活动精子百分率的曲线下面积均为0.636,大于正常形态精子百分率的曲线下面积0.604。结论精液常规检查中的正常形态前向运动精子总数和优化处理后的活动精子百分率可作为预测常规IVF低受精率的指标。Objective： To investigate the predictive value of semen parameters in routine semen analysis and after optimal selection on the day of ovum pickup （OPU） in fertilization outcome in patients undergone conventional IVF （clVF）. Methods： The data of 2 647 cIVF cycles from January 2011 to December 2014 were retrospectively analyzed. The cycles were divided into two groups：low fertilization rate （FR） group （〈50%,n=157） and normal FR group （≥50% ,n=2 490）. Baseline characteristics,semen parameters in routine semen analysis low FR. Results： No significant differences were found in female age, male age, female BMI, number of oocytes retrieved, number of embryos transferred,and constituent ratio of male infertile factors （P〈0.05）, except infertility years （P〈0.05） between the two groups. However,the cleavage rate （90.69% vs. 95.98%）, good quality embryo rate （40.5% vs. 50.89%）,implantation rat （18.91% vs. 31.86%） and clinical pregnancy rate （35.67% vs 57.15 %） in low FR group were significantly lower than those in normal FR group （P〈0.05）. Moreover, all the semen parameters showed significant differences between the two groups. Analysis of logistic regression demonstrated that normal morphology sperm rate （NMSR） （aOR 0.935;95% CI：0.898-0.974） and total normal progressive sperm count （TNPS） （aOR 0.299;95% CI： 0.143 0.623） in routine semen analysis and the motile sperm rate （MSR） （aOR 0.972;95% CI.0.957 - 0. 988） after optimal selection on the OPU day had significance for predicting the occurrence of low FR. Furthermore, ROC results showed that the area under the curve （AUC） of TNPS in routine semen analysis and MSR after optimal selection were all 0. 6367 which is larger than that of NMSR in routine semen analysis （AUG 0. 604）. Conclusions： TNPS in routine semen analysis and MSR after optimal selection may be as index for predicting the occurrence of low fertilization in cIVF.

关 键 词：常规IVF 活动精子百分率 活动精子总数 受精率 

分 类 号：R[医药卫生]