无创胚胎染色体筛查在男性严重少弱畸精子症不育患者的临床应用  

Non⁃invasive chromosome screening for male infertility patients with severe oligo⁃astheno⁃teratozoospermia

作　　者：孙琴 许娟娟 冯雨明 马汝钧 陈莉 姚兵 SUN Qin;XU Juan-juan;FENG Yu-ming;MA Ru-jun;CHEN Li;YAO Bing(Department of Reproductive Medicine,Jinling School of Clinical Medicine,Nanjing Medical University,Nanjing,Jiangsu 210002,China)

机构地区：[1]南京医科大学金陵临床医学院/东部战区总医院生殖医学科,江苏南京210002

出　　处：《中华男科学杂志》2022年第1期14-19,共6页National Journal of Andrology

基　　金：国家自然科学基金面上项目(81973965);江苏省自然科学基金面上项目(BK20191230)。

摘　　要：目的:探讨无创胚胎染色体筛查技术(NICS)对男性严重少弱畸精子症辅助生殖妊娠结局的应用价值。方法:随机选取2017年1月至2020年12月因男方严重少弱畸形精症行辅助生殖助孕的男性不育患者共计170例,接受NICS治疗的85对夫妻作为试验组,接受卵胞质内单精子注射(ICSI)85对夫妇作为对照组,比较两组女方年龄、女方体重质量指数(BMI)、抗苗勒氏管激素(AMH)、基础窦卵泡计数(AFC)、不孕年限、男方年龄、精子浓度、前向运动精子百分率、正常形态精子百分率、精子DNA碎片化指数(DFI)、获卵数、正常受精数、优质囊胚数、临床妊娠率、流产率的差异。结果:NICS组与ICSI组相比,女方年龄、女方BMI、AMH、AFC、不孕年限、男方年龄、精子浓度、前向运动精子百分率、正常形态精子百分率、精子DFI、获卵数、正常受精数、优质囊胚数均无统计学差异(P均>0.05),NICS组明确诊断率88.24%,检测胚胎染色体整倍体率48.56%,NICS组挑选整倍体胚胎移植后临床妊娠率高于ICSI组(66.28%vs 51.09%)、而流产率低于ICSI对照组(12.28%vs 29.79%),差异均有统计学意义(P<0.05)。结论:对于男性严重少弱畸形精子症不育患者,NICS技术可以提高临床妊娠率、降低流产风险。Objective:To explore the value of non⁃invasive embryo chromosome screening(NICS)in improving the outcomes of clinical pregnancy after assisted reproduction in men with severe oligo⁃astheno⁃teratozoospermia(OAT).Methods:We randomly selected 170 cases of assisted reproduction due to severe OAT from January 2017 to December 2020,85 undergoing NICS treatmentand the other 85 receiving intracytoplasmic sperm injection(ICSI).We made comparisons between the two groups in the female age,body mass index(BMI),anti⁃Müllerian hormone level(AMH),basal antral follicle count(AFC),infertility duration,male age,sperm concentration,percentages of progressively motile sperm(PMS)and morphologically normal sperm(MNS),sperm DNA fragmentation index(DFI),numbers of oocytes retrieved and high⁃quality blastocysts,and rates of normal fertilization,clinical pregnancy and abor⁃tion.Results:No statistically significant differences were observed between the two groups in the female age,female BMI,AMH,AFC,infertility duration,male age,sperm concentration,percentages of PMS and MNS,sperm DFI,numbers of oocytes retrieved and high⁃quality blastocysts,or normal fertilization rate(P>0.05).The rate of definite diagnosis was 88.24%,and that of embryo chro⁃mosome euploidy was 48.56%in the NICS group.The rate of clinical pregnancy after selected euploid embryo transfer was significantly higher in the NICS than in the ICSI group(66.28%vs 51.09%,P<0.05),while that of abortion remarkably lower in the former than in the latter(12.28%vs 29.79%,P<0.05).Conclusion:For male infertility patients with severe OAT,NICS technology can improve the rate of clinical pregnancy and reduce the risk of abortion.

关 键 词：不育症 男性 无创胚胎染色体筛查 卵细胞胞质内单精子注射 临床妊娠率 

分 类 号：R698[医药卫生—泌尿科学]