不同精液优化方法精子回收率的差异及对妊娠结局的影响  

Sperm recovery rate in different semen optimization methods and its effect on pregnancy outcome

作　　者：张凤凤 赵敏 张明忠 覃瑶琴 谷琦琦 易晓榕 解为全 刘春雷 Zhang Fengfeng;Zhao Min;Zhang Mingzhong;Qin Yaoqin;Gu Qiqi;Yi Xiaorong;Xie Weiquan;Liu Chunlei(The Reproductive Medicine Center,Central Hospital of Enshi Autonomous Prefecture-Enshi Clinical College of Wuhan University,Enshi 445000,Hubei,China)

机构地区：[1]湖北省恩施土家族苗族自治州中心医院-武汉大学恩施临床学院生殖医学中心,湖北恩施445000

出　　处：《中国男科学杂志》2024年第5期63-67,共5页Chinese Journal of Andrology

基　　金：恩施州科技局指导性项目(JCY2019000004)。

摘　　要：目的探讨密度梯度离心法和上游法在夫精宫腔内人工授精(intrauterine insemination,IUI)中精液参数、精子回收率的差异和对妊娠结局的影响。方法将精液常规参数正常男性和少弱精子症患者分别随机分两组,一组进行密度梯度离心法优化精液,一组进行上游法优化精液。结果精液常规参数正常男性密度梯度离心法优化后精子浓度为(53.68±16.31)×10~6/mL、PR为(85.10±7.83)%、精子回收率为(13.67±6.86)%和前向运动精子回收率为(30.35±15.80)%,明显高于上游法优化后相应参数(49.85±15.25)×10~6/mL、(82.35±9.52)%、(11.88±4.92)%和(25.43±11.05)%,差异具有统计学意义;而临床妊娠率、活产率上游法高于密度梯度离心法。少弱精子症患者密度梯度离心法优化精液后精子PR为(74.26±13.11)%、精子回收率为(15.88±7.57)%、前向运动精子回收率为(46.70±29.47)%,均高于上游法优化后相应参数(67.34±14.73)%、(10.50±4.58)%和(35.49±21.05)%,差异有统计学意义;而上游法临床妊娠率、活产率均高于密度梯度离心法。人工授精影响因素二元Logistic回归分析优化后精子PR和20×10~6≤处理后前向运动精子总数(total progressively motile sperm cell count,TPMC)<30×10~6可独立预测妊娠结局(P<0.05)。结论密度梯度离心法精子回收率、前向运动精子回收率均明显高于上游法,但是此两项指标不是临床妊娠结局的预测指标,应根据中心实际情况结合患者精液情况选择合适的精液优化方法。Objective To investigate the difference of semen parameters and sperm recovery rate between density gradient centrifugation and upstream method in intrauterine insemination(IUI)and its effect on pregnancy outcome.Methods Semen samples from patients with normal semen and patients with oligospermia were randomly divided into two groups,respectively.Semen samples in one group were treated by density gradient centrifugation,and semen samples in the other group treated by upstream method.Results For the patients with normal semen parameters,their sperm concentration(53.68±16.31)10~6/mL,PR(85.10±7.83)%,sperm recovery rate(13.67±6.86)%and forward motility sperm recovery rate(30.35±15.80)%after density gradient centrifugation treatment were all significantly higher than those after upstream centrifugation treatment(49.85±15.25)×10~6/mL;(82.35±9.52)%;(11.88±4.92)%;(25.43±11.05)%,and the differences were statistically significant.However,their clinical pregnancy rate and the live birth rate after upstream method treatment were higher than those after density gradient centrifugation treatment.For the patients with oligospermia,their sperm PR(74.26±13.11)%,sperm recovery rate(15.88±7.57)%and forward motility sperm recovery rate(46.70±29.47)%after density centrifuge method treatment were all higher than those after upstream method treatment(67.34±14.73)%;(10.50±4.58)%;(35.49±21.05)%,and the differences were statistically significant.However,their pregnancy rate and the live birth rate after upstream method treatment were higher than those after density gradient centrifugation treatment.Binary Logistic regression analysis of influencing factors for artificial insemination showed that the sperm PR after optimized and the 20×10~6≤TPMC<30×10~6 were independently predictor for the outcome of pregnancy(P<0.05).Conclusion The sperm recovery rate and the forward movement sperm recovery rate of density gradient centrifugation method are significantly higher than those of the upstream method,but they are not the pred

关 键 词：离心法 密度梯度 授精 人工 精液分析 妊娠结局 

分 类 号：R321.1[医药卫生—人体解剖和组织胚胎学] R321-33[医药卫生—基础医学]