论文部分内容阅读
目的探讨精子形态在辅助生殖治疗中对选择授精方法时有否预测价值和意义。方法回顾性分析2012年6月至2015年2月接受辅助生殖治疗的1 951周期患者精液资料,根据《WHO人类精液检查与处理实验室手册》(第五版)精子正常形态率参考值下限为4%,将患者的精子正常形态率分成3组:A组<1.0%470周期,B组1%~4%562周期,C组≥4%919周期,分别采用常规体外受精(IVF)或卵胞浆内单精子注射(ICSI)以及IVF受精失败后补救ICSI(RICSI)授精方式,比较3组精子正常形态与其他精液参数相关性,与授精方式、受精率、优质胚胎率的关系。结果除了顶体酶外,精子浓度、活力、前向运动率、DNA完整率在3组形态间都差异极显著(P<0.01),而且它们与精子正常形态呈显著的正相关;授精方式上3组的IVF比例分别是72.3%、86.7%、96.8%,ICSI组27.7%、13.3%、3.2%,3组间授精方式差异极显著(P<0.01),RICSI比例也随着精子正常形态率升高而降低;受精结局上,只有IVF组3组形态间受精率(67.0%、70.0%和79.6%)差异极显著(P<0.01),且和精子正常形态率趋势一致;胚胎质量反映在不同授精方式上趋势各有不同。结论精子正常形态与其他大部分的精液参数有正相关性,影响IVF的受精率,故在辅助生殖治疗中对授精方式选择有一定指导意义。
Objective To investigate whether sperm morphology has predictive value and significance in the selection of insemination methods in assisted reproductive therapy. Methods A total of 1 951 cycles of semen from June 2012 to February 2015 were retrospectively analyzed. According to the WHO sperm normal laboratory examination and treatment manual (5th edition), the lower limit of normal sperm reference rate was 4%. The normal sperm morphology of patients were divided into three groups: group A <1.0% 470 cycles, group B 1% ~ 4% 562 cycles, group C ≥ 4% 919 cycles, respectively, using routine in vitro fertilization Intracytoplasmic sperm injection (ICSI) and ICSI (RICSI) fertilization after failed IVF fertilization were performed. The correlation between normal sperm morphology and other semen parameters was compared between three groups, and the relationship between fertilization rate, fertilization rate and quality embryo rate. Results In addition to acrosin, sperm concentration, vitality, forward motility and DNA integrity were significantly different among the three groups (P <0.01), and they were positively correlated with the normal morphology of spermatozoa. The rates of IVF in the three groups were significantly different (72.3%, 86.7%, 96.8%, 27.7%, 13.3% and 3.2%, respectively) in the ICSI group (P <0.01) (P <0.01). The fertilization results showed that there was significant difference (P <0.01) between the fertilization rate and the normal morphological rate of the sperm in the IVF group (67.0%, 70.0% and 79.6% Different insemination on the trend of different. Conclusion The normal morphology of sperm has positive correlation with most other semen parameters and affects the fertilization rate of IVF. Therefore, it is instructive to choose the mode of insemination in assisted reproductive therapy.