精子DNA碎片指数对卵胞质内单精子显微注射周期助孕结局的影响  

Effect of sperm DNA fragment index on the outcome of intracytoplasmic sperm injection cycles

作　　者：吴春香[1] 刁飞扬[1] 杨晓玉[1] 刘嘉茵[1] Wu Chunxiang;Diao Feiyang;Yang Xiaoyu;Liu Jiayin(Reproductive Medicine Center of First Affiliated Hospital,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院生殖医学科,210029

出　　处：《中华生殖与避孕杂志》2020年第9期729-733,共5页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发项目(2016YFC100020,2016YFC100073);江苏省临床生殖医学中心(YXZXB2016001)。

摘　　要：目的比较精子DNA碎片指数(DFI)对因男方因素行卵胞质内单精子显微注射(ICSI)周期临床和实验室指标的影响,探讨DFI与临床助孕结局的关系。方法回顾性队列研究分析2016年1月至2017年12月期间于南京医科大学第一附属医院生殖医学科因男方因素进行ICSI助孕的387个周期的临床资料。所有周期均为首次进行ICSI助孕,选用拮抗剂灵活方案促排卵。根据精子DFI的检测结果将所有周期分成3组,A组:精子核DNA完整性良好(DFI≤15%,167个周期),B组:精子核DNA完整性中等(15%<DFI<30%,145个周期),C组:精子核DNA完整性差(DFI≥30%,75个周期)。分别比较3组的基线资料和正常受精率、卵裂率、可移植胚胎率、优质胚胎率和单次取卵周期的累积活产率。结果3组间女方的年龄、体质量指数(BMI)、抗苗勒管激素(AMH)、卵泡刺激素(FSH)及基础窦卵泡数(AFC)差异均无统计学意义(P>0.05),C组的男方年龄[(32.56±5.70)岁]高于A组[(30.27±4.04)岁,P=0.002]和B组[(30.22±4.81)岁,P=0.003]。A组ICSI的正常受精率(86.7%)和可移植胚胎率(88.3%)均显著高于B组(83.8%,P=0.0245;84.9%,P=0.0121)和C组(82.1%,P=0.0056;84.4%,P=0.0227),但优质胚胎率和流产率组间差异均无统计学意义(P>0.05)。C组的累积活产率(74.7%)较A组和B组下降(82.0%、78.6%),但差异无统计学意义(P>0.05)。结论精子DFI是评估男性生育力的一个重要指标,男方年龄增高可能会导致DFI升高。精子DNA损伤可能会影响胚胎发育及辅助生殖的结局,DFI≥30%可能降低ICSI周期的累积活产率,但还需更大样本的研究。Objective To explore the relationship between sperm DNA fragmentation index(DFI)and clinical outcomes of intracytoplasmic sperm injection(ICSI)cycles due to male factors.Methods We used a retrospective cohort to analyze the clinical data of 387 ICSI cycles in Reproductive Medicine Center of First Affiliated Hospital,Nanjing Medical University from January 2016 to December 2017.All patients were undergoing their first ICSI cycle,using a flexible antagonist protocol.Patients were divided into three groups according to sperm DFI,including group A,DFI≤15%(n=167),group B,15%<DFI<30%(n=145)and group C,DFI≥30%(n=75).Laboratory and clinical outcomes were compared among the three groups.Results There were no significant differences in maternal age,body mass index(BMI),anti-Müllerian hormone(AMH),follicle-stimulating hormone(FSH)and antral follicle count(AFC)among the three groups(P>0.05).The males in group C[(32.56±5.70)years]were older than those in group A and group B[(30.27±4.04)years,P=0.002;(30.22±4.81)years,P=0.003].The fertilization rate(86.7%)and the rate of transplantable embryos(88.3%)in group A were significantly increased compared with group B(83.8%,P=0.0245;84.9%,P=0.0121)and group C(82.1%,P=0.0056;84.4%,P=0.0227).There was no significant difference in good-quality embryo rate and abortion rate(P>0.05).The cumulative live birth rate was decreased in group C(74.7%)compared with group B(78.6%)and group A(82.0%),but there was no statistical difference(P>0.05).Conclusion Sperm DFI is an important indicator for assessing male fertility,it may affect embryonic development and assisted reproductive outcomes.An increase in the age of the man may lead to an increase in DFI.DFI≥30%may reduce the cumulative live birth rate of ICSI,but a larger sample study is still needed.

关 键 词：精子DNA碎片指数 累积活产率 卵胞质内单精子注射 精子DNA完整性 受精率 可移植胚胎率 

分 类 号：R714.8[医药卫生—妇产科学]