精子DNA碎片对体外受精-胚胎移植妊娠结局及胚胎发育的影响  

Impact of sperm DNA fragmentation index on embryonic development and live birth outcome of in vitro fertilization-embryo transfer

作　　者：黄旋[1] 王岑岑 王慧[1] 姚兵[1] 陈莉[1] HUANG Xuan;WANG Cen-cen;WANG Hui;YAO Bing;CHEN Li(Department of Reproductive Medicine,Jinling Hospital Affiliated to Nanjing University/General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China)

机构地区：[1]南京大学附属金陵医院/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》2024年第8期722-729,共8页National Journal of Andrology

基　　金：东部战区总医院临床研究专项(22LCYY-QH12)。

摘　　要：目的:分析精子DNA碎片指数(DFI)对体外受精-新鲜胚胎移植(IVF-ET)助孕及活产结局的影响。方法:选取2015年6月至2020年12月因女方因素首次行IVF并进行新鲜胚胎移植的患者共947例,根据DFI分为低、中、高3组:DFI<15%、15≤DFI≤30%和30%<DFI,比较3组双方基础数据,女方包括年龄、体质量指数(BMI)、基础生殖激素、AMH等;男方包括年龄、BMI、精液参数;超促排卵参数;处理前和处理后IVF精液参数;促排卵结局、胚胎质量及妊娠结局。结果:不同DFI水平间相比,双方年龄在3组间均有显著性差异,15≤DFI≤30%和30%<DFI组双方年龄显著大于DFI<15%组;基础状态精液参数中前向运动精子百分率、非前向运动精子百分率、不活动精子百分率,以及IVF处理前精子总活率、前向运动精子百分率在3组间也均有显著差异(P<0.01);中和高DFI组中基础精子正常形态率、IVF处理前精子浓度、精子总数和处理后精子浓度均显著低于低DFI组;30%<DFI组无论是精液处理前还是精液处理后精子总数均显著低于其他两组(P<0.01)。此外,中和高DFI组受精率显著低于低DFI组,其他临床数据包括促排卵参数、胚胎质量、妊娠结局组间均无显著差异。结论:高DFI水平对精子活率产生显著影响,IVF精液处理后DFI水平与精子浓度、精子总数、受精率均呈显著负相关,对胚胎质量及妊娠结局无影响。Objective:To investigate the effects of sperm DNA fragmentation index(DFI)on embryonic development and live birth outcomes of in vitro fertilization-fresh embryo transfer(IVF-ET).Methods:We selected 947 cases of IVF-ET due to female factors from June 2015 to December 2020 and,according to the DFI,divided them into a low-(DFI<15%),a medium-(15≤DFI≤30%)and a high-DFI(30%<DFI)group.We obtained the female factors(including age,body mass index[BMI],and baseline levels of sexual hormones and anti-Müllerian hormone[AMH]),male factors(including age,BMI,and semen parameters),parameters of superovulation induction,semen parameters before and after IVF treatment,outcome of ovulation induction,embryo quality and pregnancy outcome,and compared them among the three groups.Results:The patients in the medium-and high-DFI groups had a significantly older age than those in the low-DFI group.There were statistically significant differences among the three groups in the baseline percentages of progressively motile sperm,non-progressively motile sperm and immotile sperm,and total sperm motility and progressive sperm motility before IVF(P<0.01).The baseline percentage of morphologically normal sperm,sperm concentration and total sperm count before IVF treatment,and sperm concentration after IVF treatment were significantly lower in the medium-and high-DFI groups than in the low-DFI group,and so was the total sperm count in the high-DFI than in the low-and medium-DFI groups either before or after semen treatment(P<0.01).The fertilization rate was also markedly lower in the medium-and high-DFI than in the low-DFI group,but no statistically significant differences were observed in ovulation induction parameters,embryo quality and pregnancy outcome among the three groups.Conclusion:High DFI significantly affects sperm motility.The DFI level after semen treatment is negatively correlated with sperm concentration,total sperm count and fertilization rate,but does not affect embryo quality and pregnancy outcome.

关 键 词：体外受精-胚胎移植 精子DNA碎片指数 精液参数 胚胎发育 妊娠结局 

分 类 号：R446.19[医药卫生—诊断学]