浮游器筛选后精子超微结构变化和IVF-ET结局分析:一项随机对照试验  

Influence of optimal selection of planktonic apparatus on sperm ultrastructure and IVF-ET outcome analysis:a randomized controlled trail

作　　者：曹晓敏[1] 刘丽[1] 邸建永[1] 刘烨 张美姿 徐凤琴[1] Cao Xiaomin;Liu Li;Di Jianyong;Liu Ye;Zhang Meizi;Xu Fengqin(Department of Reproductive Medicine,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院生殖医学科,300192

出　　处：《中华生殖与避孕杂志》2021年第7期610-617,共8页Chinese Journal of Reproduction and Contraception

基　　金：天津市第一中心医院院内春风科研基金(院CF201810)。

摘　　要：目的寻找体外受精(in vitro fertilization,IVF)过程中合适的精液处理方法。方法本研究采用前瞻性随机对照双盲设计,选取300例因女性因素且男性生育力检查未见异常行IVF-胚胎移植(embryo transfer,ET)助孕的不孕夫妇为研究对象,纳入的患者通过计算机产生随机数进行随机化分组,分为浮游组(新型无损伤精子筛选技术,FY组,n=100)、密度梯度组(DG组,n=100)和上游组(SU组,n=100)。收集三组患者受精后剩余的精子观察精子超微结构,并比较三组优选后精子DNA碎片指数(DNA fragment index,DFI)及IVF-ET治疗过程中的受精率、卵裂率、优质胚胎率及妊娠率等指标之间的差异。结果FY组精子DFI显著低于DG组和SU组(3.22%±2.73%比8.31%±2.14%比6.43%±2.56%),差异有统计学意义(P=0.02),FY组的精子头、尾部质膜完整率明显高于其他两组(92.0%±24.2%比80.2%±29.5%比73.2%±30.1%和93.9%±1.2%比80.1%±1.1%比74.9%±1.2%),差异具有统计学意义(P=0.01,P=0.03)。FY组的优质胚胎率、囊胚形成率明显高于DG组和SU组[44.14%(452/1024)比32.30%(292/904)比32.46%(296/912)和54.40%(396/728)比43.52%(302/694)比46.34%(330/712)],差异均具有统计学意义(P均<0.001)。新鲜周期FY组的妊娠率和植入率明显高于DG组和SU组[57.14%(24/42)比33.33%(16/48)比35.56%(16/45)和50.00%(30/60)比27.45%(14/51)比28.26%(13/46)],差异具有统计学意义(P=0.04,P=0.02)。复苏周期FY组的妊娠率和植入率明显高于DG组和SU组[52.38%(22/42)比31.25%(10/32)比37.14%(13/35)和52.38%(22/42)比29.41%(10/34)比30.56%(11/36)],差异具有统计学意义(P=0.03,P=0.02)。结论浮游法可减少对精子造成的物理损伤,提高精子质膜的完整率,降低精子DFI,改善辅助生殖技术结局。Objective To find a suitable semen treatment method in in vitro fertilization(IVF).Methods A prospective randomized double-blind design was performed,300 infertile couples with female factors and no abnormal fertility test were selected for IVF-embryo transfer(ET),the patients were randomly divided into float group(FY group,n=100),density gradient group(DG group,n=100)and upstream group(SU group,n=100).The remaining sperm after fertilization were collected from three groups,and sections of electron microscope were prepared.The ultrastructure of sperm was observed by transmission electron microscope.The differences among the three groups of selected sperm DNA fragment index(DFI)and fertilization rate,cleavage rate,high-quality embryo rate and pregnancy rate during IVF-ET were compared.Results The sperm DFI of the three groups after treatment was statistically different(P=0.02),and the sperm DFI of the FY group was significantly lower than that of DG group and SU group(3.22%±2.73%vs.8.31%±2.14%vs.6.43%±2.56%).The rates of sperm head and tail plasma membrane integrity rate in FY group were significantly higher than those in the other two groups(92.0%±24.2%vs.80.2%±29.5%vs.73.2%±30.1%and 93.9%±1.2%vs.80.1%±1.1%vs.74.9%±1.2%),and the differences were statistically significant(P=0.01,P=0.03).The high-quality embryo rate and the blastocyst formation rate of FY group were significantly higher than those of DG group and SU group[44.14%(452/1024)vs.32.30%(292/904)vs.32.46%(296/912)and 54.40%(396/728)vs.43.52%(302/694)vs.46.34%(330/712)],and the differences were statistically significant(all P<0.001).The pregnancy rate and the implantation rate in the fresh cycle FY group were significantly higher than those in DG and SU groups[57.14%(24/42)vs.33.33%(16/48)vs.35.56%(16/45)and 50.00%(30/60)vs.27.45%(14/51)vs.28.26%(13/46)],and the differences were statistically significant(P=0.04,P=0.02).The pregnancy rate and implantation rate in the resuscitation cycle FY group were significantly higher than those in the DG and SU

关 键 词：密度梯度法 上游法 精子超微结构 受精 体外 胚胎移植 精子优选 浮游法 

分 类 号：R714.8[医药卫生—妇产科学]