精子鞭毛形态多发畸形患者行卵细胞质内单精子注射治疗的结局分析  

Impact of multiple morphological anomalies of the flagella on the outcomes of intracytoplasmic sperm injection for males with infertility

作　　者：陈杰[1] 袁贺佳 崔元庆[1] 闫伟[1] 连花瑜 刘晓妍[1] 张伟[1] 刘雪梅[1] 郝翠芳[1] 王雄[1] Chen Jie;Yuan Hejia;Cui Yuanqing;Yan Wei;Lian Huayu;Liu Xiaoyan;Zhang Wei;Liu Xuemei;Hao Cuifang;Wang Xiong(Department of Reproductive Medicine,Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院生殖医学科,264000

出　　处：《中华医学杂志》2018年第36期2914-2919,共6页National Medical Journal of China

基　　金：山东省自然科学基金（ZR2017LH012）;山东省医药卫生科技发展计划（2016WS0704）

摘　　要：目的分析精子鞭毛形态多发畸形（MMAF）相关的重度弱精子症患者行卵细胞质内单精子注射（ICSI）助孕治疗的临床结局。方法回顾性分析烟台毓璜顶医院生殖医学科自2011年1月至2016年12月收治的15例MMAF患者的临床数据，行低渗法选择“活”精子行ICSI治疗，匹配同一治疗时间30例因梗阻性无精子症（OA）行ICSI的患者。比较两组患者夫妇双方年龄、体质指数（BMI）、不育年限、获卵数、ICSI卵子数、受精率、卵裂率、可移植胚胎率、优质胚胎率、胚胎种植率、临床妊娠率、早期流产率、单胎率及双胎率差异。结果15例MMAF患者经过27个ICSI周期，均实现临床妊娠，其中活产11例，自然流产2例，持续妊娠2例。MMAF组与OA对照组在男、女方年龄、BMI、获卵数、ICSI卵子数等基本情况差异无统计学意义（P〉0．05），但在不育年限上的差异有统计学意义（P〈0．001）；MMAF组与OA对照组的ICSI受精率（92．0％比91．6％）、卵裂率（95．4％比96．5％）、优质胚胎率（56．5％比57．5％）、优质囊胚率（23／61比35／94）、胚胎种植率（20／48比35／75）、早期流产率（4／19比8／36）、临床妊娠率（15／27比28／50）、单胎率（10／13比20／25）和双胎率（3／13比5／25）差异均无统计学意义（均P〉0．05）。结论MMAF可能不影响ICSI治疗结局，但遗传缺陷也可以通过ICSI传递，是否选择胚胎植入前遗传学诊断（PGD）应在充分遗传咨询的情况下遵从患者夫妇意愿。Objective To evalute the clinical outcomes of intracytoplasmic sperm injection（ICSI） for infertility male with severe asthenospermia induced by multiple morphological anomalies of the flagella （MMAF）. Methods The clinical data of 15 patient with MMAF were retrospectively analyzed, who underwent ICSI treatment using hyponotic swelling test the ＂live＂ sperm in the Department of Reproductive Medicine of Yantai Yuhuangding Hospital from January 2011 to December 2016. Another 30 obstructive azoospermia （OA）patients are matched strictly who also accepted ICSI in the same treatment time. The two groups were compared in the couples＇ age, the body mass index （BMI）, the duration of infertility, the retrieved oocytes,the number of ICSI oocytes, and the rates of fertilization, cleavage, transferrable embryos, good embryos, embryos implanted, clinical pregncncy, early abortion, singleton and twins. Results After 27 cycles of ICS1, all of the MMAF patients achieved clinical pregnancy, including 11 cases of live birth, 2 cases of spontaneous abortion, and 2 cases of pregnancy maintenance. There were no significant difference between MMAF and OA groups in the couples＇age and BMI, or the numbers of retrieved oocytes and ICSI oocytes（P 〉 0. 05 ）, but the differences in the infertility duration had statistical meaning（P 〈 0. 001 ）. No statistical differences were observed among groups in ICSI fertility rate（92. 0% vs 91.6% ）, clesvage rate （95.4% vs 96. 5% ）, high-quality embryonic rate（56. 5% vs 57.5% ）, good blastocyst rate（23/61 vs 35/ 94 ）, embryo implantation rate （20/48 vs 35/75 ）, early abortion rate （4/19 vs 8/36 ） , clinical pregncncy rate （ 15/27 vs 28/50 ）, singleton rate （ 10/13 vs 20/25 ） and twinning rate （ 3/13 vs 5/25 ） （ P 〉 0. 05 ）. Conclusions MMAF may not affect ICSI treatment outcomes, but genetic defects can be transmitted through ICSI. The affected couples should be informed of the necessity of prenatal genetic diagnosis before embr

关 键 词：鞭毛 男性不育 弱精子症 临床结局 

分 类 号：R698.2[医药卫生—泌尿科学]