精子DNA断裂指数对补救ICSI结局的影响及补救ICSI的临床价值  

Influence of the sperm DNA fragmentation index on the outcome of rescue ICSI and the clinical value of rescue ICSI

作　　者：陈其桂 李大文[1] 成俊萍[1] 薛林涛[1] 李金燕 CHEN Qigui;LI Dawen;CHENG Junping;XUE Lintao;LI Jinyan(Center for Reproductive Medicine and Genetics,People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021;Graduate School of Guilin Medical University,Guilin Guangxi 541004,China)

机构地区：[1]广西壮族自治区人民医院生殖医学与遗传中心,南宁530021 [2]桂林医学院研究生学院,广西桂林541004

出　　处：《中南大学学报（医学版）》2022年第1期63-71,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81360107);广西壮族自治区自然科学基金(2019GXNSFAA185056);广西壮族自治区卫生健康委员会科研项目(Z20170376);南宁市青秀区重点研发计划(2020030)。

摘　　要：目的:补救卵胞浆内单精子注射术(rescue intracytoplasmic sperm injection,R-ICSI)作为体外受精(in vitro fertilization,IVF)失败的补救方案,目前已广泛开展,但是未能明显提高受精率、临床妊娠率等。精子DNA断裂指数(DNA fragmentation index,DFI)与人工辅助生殖妊娠结局高度相关。本研究旨在探讨精子DFI对R-ICSI结局的影响及R-ICSI的临床价值。方法:回顾性分析2014年1月至2019年12月间在广西壮族自治区人民医院生殖医学与遗传中心IVF受精失败后行R-ICSI的140对不孕不育症夫妇,并将其分为完全受精失败(total fertilization failure,TFF)后行R-ICSI且DFI<30%(TFF+低DFI)组(n=63)、TFF后行R-ICSI且DFI≥30%(TFF+高DFI)组(n=16)、部分受精失败(partial fertilization failure,PFF)后行R-ICSI且DFI<30%(PFF+低DFI)组(n=52)、PFF后行R-ICSI且DFI≥30%(PFF+高DFI)组(n=9)。新鲜移植周期的胚胎来源均为R-ICSI。观察比较不同精子DFI在两种受精失败情况下患者的一般情况(不育年限、男方年龄、女方年龄、基础促卵泡素(follicle stimulating hormone,FSH)水平、基础黄体生成素(luteinizing hormone,LH)水平、窦卵泡个数、人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)日子宫内膜厚度、获卵数)和R-ICSI周期结局(受精率、正常受精率、卵裂率、优质胚胎率、种植率、临床妊娠率及活产率)。结果:TFF+低DFI组和TFF+高DFI组患者的一般情况和R-ICSI周期结局差异均无统计学意义(均P>0.05)。PFF+低DFI组和PFF+高DFI组患者的一般情况差异均无统计学意义(均P>0.05)。PFF+低DFI组受精率、正常受精率均高于PFF+高DFI组,差异均有统计学意义(分别为85.40%vs 72.41%,71.90%vs 58.62%;均P<0.05);但2组患者卵裂率、优质胚胎率、种植率、临床妊娠率及活产率差异均无统计学意义(均P>0.05)。TFF的R-ICSI周期共79个新鲜周期,57个新鲜移植周期,761个未受精卵,对584个M II期卵子行R-ICSI,受精率为83.22%,正常受精�Objective:As a remedy for the failure of in vitro fertilization(IVF),rescue intracytoplasmic sperm injection(R-ICSI)has been widely carried out,but it has failed to significantly improve the fertilization rate and clinical pregnancy rate.Sperm DNA fragmentation index(DFI)was highly correlated with pregnancy outcome of artificial assisted reproduction.This study aims to investigate the effect of the sperm DFI on the outcome of R-ICSI and the clinical value of R-ICSI.Methods:This retrospective analysis was conducted among 140 infertile couples receiving R-ICSI in from January 2014 to December 2019.The subjects were assigned into a total fertilization failure(TFF)+low DFI group(R-ICSI after TFF and DFI<30%)(n=63),a TFF+high DFI group(R-ICSI after TFF and DFI≥30%)(n=16),a partial fertilization failure(PFF)+low DFI group(R-ICSI after PFF and DFI<30%)(n=52),a PFF+high DFI group(RICSI after PFF and DFI≥30%)(n=9).All transferred embryos were come from R-ICSI.The general clinical data[infertility duration,male age,female age,basal serum level of follicle stimulating hormone(FSH),basal serum level of luteinizing hormone(LH),antral follicle count,endometrial thickness of human chorionic gonadotropin(HCG)day,and eggs]and R-ICSI cycle outcomes(fertilization rate,normal fertilization rate,cleavage rate,good embryo rate,implantation rate,clinical pregnancy rate and live birth rate)were analyzed.In addition,the effect of R-ICSI on the fertilization outcome of conventional IVF total fertilization failure and partial fertilization failure was explored.Results:There was no significant difference in the general clinical data and R-ICSI cycle outcome between the TFF+low DFI group and the TFF+high DFI group(all P>0.05).There was no significant difference in the general clinical data between the PFF+low DFI group and the PFF+high DFI group(all P>0.05).The fertilization rate and normal fertilization rate in the PFF+low DFI group were significantly higher than those in the PFF+high DFI group(85.40%vs 72.41%,71.90%vs 58.62%,respective

关 键 词：精子DNA断裂指数 补救卵胞浆内单精子注射术 完全受精失败 部分受精失败 结局 

分 类 号：R714.8[医药卫生—妇产科学]