特殊类型畸精子症行卵细胞胞质内单精子注射的治疗结局分析  

Intracytoplasmic sperm injection for patients with special types of teratozoospermia:Analysis of outcomes

作　　者：孙军培 房建正 孙雪萍 杨晓玉 SUN Jun-pei;FANG Jian-zheng;SUN Xue-ping;YANG Xiao-yu(Center of Reproductive Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China;Center of Reproductive Medicine,Jiangsu Province People's Hospital/The First Affiliated Hospi-tal of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]蚌埠医学院第一附属医院生殖医学中心,安徽蚌埠233000 [2]江苏省人民医院/南京医科大学第一附属医院生殖医学中心,江苏南京210029

出　　处：《中华男科学杂志》2023年第1期43-48,共6页National Journal of Andrology

基　　金：国家自然科学基金(82271638);蚌埠市科技创新指导类项目(20210336)。

摘　　要：目的:特殊类型畸精子症是男性不育中罕见病和单基因遗传疾病,本文探讨其卵细胞胞质内单精子注射(ICSI)的治疗结局。方法:回顾性分析2011年1月至2021年1月于江苏省人民医院生殖医学中心实施ICSI治疗的特殊类型畸精子症患者,根据精子形态分为三组(圆头精子症、无头精子症和精子鞭毛多发形态异常),三组患者基因检测均发现致病或可能致病的基因突变。比较三组患者间的临床和实验室数据(年龄、BMI、精子参数、成熟卵子数、受精率、优质胚胎率、临床妊娠率、活产率和自然流产率)差异。结果:三组共34对患者夫妇,三组患者间年龄,BMI,MII卵子数差别无统计学意义(P>0.05),圆头精子症的精子浓度和精子活力显著高于其他两组(P<0.01),圆头精子症组的受精率显著低于其他两组(P<0.01)。三组共34个取卵周期,其中4个取卵周期未形成可移植胚胎,形成可移植胚胎的30个取卵周期在第一个胚胎移植周期中获得22例临床妊娠,最终活产20例,自然流产2例。无头精子症和精子鞭毛多发形态异常两组的临床妊娠率和活产率显著高于圆头精子症组(P<0.01),三组间自然流产率没有统计学差异(P>0.05)。结论:圆头精子症患者实施人工卵母细胞激活依然有部分患者完全不受精或受精率低下。精子鞭毛多发形态异常和无头精子症患者可以通过ICSI取得相对较好的妊娠结局。Objective:To investigate the outcomes of intracytoplasmic sperm injection(ICSI)in the treatment of special types of teratozoospermia such as globozoospermia,acephalic spermatozoa syndrome(ASS)and multiple morphological abnormalities of sperm flagella(MMAF).Methods:We retrospectively analyzed the clinical data on 7 cases of globozoospermia(group A),6 cases of ASS(group B)and 21 cases of MMAF(group C)treated by ICSI from January 2011 to January 2021,all confirmed with pathogenic or likely pathogenic gene variations.We compared the age,body mass index(BMI),sperm parameters,number of mature oocytes,and rates of fertilization,high-quality embryos,clinical pregnancy,live birth and spontaneous abortion among the three groups of patients.Results:There were no statistically significant differences in the age,BMI and number of metaphaseⅡ(MⅡ)oocytes among the three groups(P>0.05).Sperm concentration and motility were dramatically higher(P<0.01)while the rates of fertilization,clinical pregnancy and live birth remarkably lower in group A than in B and C(P<0.01).No statistically significant difference was observed in the spontaneous abortion rate among the three groups(P>0.05).Conclusion:ICSI can achieve relatively satisfactory outcomes of clinical pregnancy in patients with ASS or MMAF,but only a low fertilization rate or no fertilization at all in those with globozoospermia even if treated by artificial oocyte activation.

关 键 词：畸精子症 圆头精子症 无头精子症 精子鞭毛多发形态异常 卵细胞胞质内单精子注射 

分 类 号：R698.2[医药卫生—泌尿科学]