精子核成熟度与体外受精结局的相关性分析  

Correlation of sperm nuclear maturity with the outcomes of in vitro fertilization

作　　者：李洁[1] 戎春浩[1] 胡巨伟 周黎明[1] LI Jie;RONG Chun-hao;HU Ju-wei;ZHOU Li-ming(Reproductive Medicine Center,Ningbo Women and Children’s Hospital,Ningbo,Zhejiang 315012,China)

机构地区：[1]宁波市妇女儿童医院生殖医学中心,浙江宁波315012

出　　处：《中华男科学杂志》2021年第12期1075-1080,共6页National Journal of Andrology

基　　金：浙江省医药卫生科技计划项目(2019RC268);宁波市医疗卫生品牌学科(PPXK2018-06);浙江省病理生理学技术研究重点实验室开放基金(202102)。

摘　　要：目的:探讨精子核成熟度与体外受精(IVF)结局的相关性。方法:回顾性分析2018年9月至2020年5月于宁波市妇女儿童医院生殖中心进行IVF治疗的1393个周期的临床资料,根据精子高DNA可染性(HDS)分为精子核成熟组(HDS≤10%)与精子核未熟组(HDS>10%),比较两组间患者体外受精、胚胎发育及临床结局等指标的差异并分析其与HDS的相关性。结果:精子核成熟组的受精率与正常受精率高于未熟组,受精失败率低于未熟组,差异均有统计学意义(P<0.05),卵裂率、优胚率、囊胚形成率、临床妊娠率、流产率和活产率在两组间均无显著差异(P>0.05)。单因素Logistic回归分析结果显示,HDS与受精率、正常受精率和囊胚形成率均呈负相关(P<0.05),与受精失败率呈正相关(P<0.05),与卵裂率、优胚率、临床妊娠率、流产率和活产率均无显著相关性(P>0.05)。采用多因素Logistic回归分析校正相关混杂因素后,HDS与受精率呈负相关(OR=0.945,95%CI=0.918~0.972,P<0.05),与受精失败率呈正相关(OR=1.043,95%CI=1.010~1.078,P<0.05),与正常受精率、卵裂率、优胚率、囊胚形成率、临床妊娠率、流产率和活产率均无显著相关性(P>0.05)。结论:精子核成熟度对IVF患者的受精率和受精失败率具有显著影响。在IVF临床实施过程中,考虑精子核成熟度指标,有助于更全面地进行精液评估、反映男性生育力与指导IVF临床决策。Objective:To investigate the correlation between sperm nuclear maturity and the outcomes of in vitro fertilization(IVF).Methods:We retrospectively analyzed the clinical data on 1393 cycles of IVF in our center from September 2018 to May 2020.According to the high DNA stainability(HDS)of sperm,we divided the patients into a mature(HDS≤10%)and an immature sperm nucleus group(HDS>10%),compared the results of IVF,embryonic development and clinical outcomes between the two groups,and analyzed their correlation with HDS.Results:The rates of fertilization and normal fertilization were significantly higher and that of fertilization failure remarkably lower in the mature than in the immature sperm nuclear group(P<0.05).There were no statistically significant differences between the two groups in the rates of cleavage,high-quality embryo,blastocyst formation,clinical pregnancy,miscarriage and live birth(P>0.05).Univariate logistic regression analysis showed that HDS was correlated negatively with the rates of fertilization,normal fertilization and blastocyst formation(P<0.05),positively with fertilization failure(P<0.05),but not significantly with the rates of cleavage,high-quality embryo,clinical pregnancy,miscarriage and live birth(P>0.05).After adjusting for confounding factors by multivariate logistic regression analysis,HDS was found correlated negatively with the fertilization rate(OR=0.945,95%CI:0.918 to 0.972,P<0.05),positively with fertilization failure(OR=1.043,95%CI:1.010 to-1.078,P<0.05),but not significantly with the rates of normal fertilization,cleavage,high-quality embryo,blastocyst formation,clinical pregnancy,miscarriage and live birth(P>0.05).Conclusion:Sperm nuclear maturity significantly affects the rates of fertilization and fertilization failure in IVF patients.Taking sperm nuclear maturity indicators in consideration in the process of IVF may contribute to comprehensive evaluation of semen and male fertility and guide clinical decision-making.

关 键 词：精子核成熟度 高DNA可染性 体外受精 胚胎发育 临床结局 

分 类 号：R321.1[医药卫生—人体解剖和组织胚胎学]