精子功能指标在辅助生殖助孕方式选择中的作用

目的评估精子功能参数对精子常规体外受精能力的预测价值,探寻有效选择受精方式的新指标。方法回顾性分析2017年1月至2019年12月于我院首次行体外受精-胚胎移植(IVF-ET)短时受精的429个周期的临床资料,根据受精结局不同分为2组:受精失败或受精率<30%的患者为早补救卵胞浆内单精子注射(R-ICSI)组(n=98);受精率≥30%的为短时IVF组(n=331)。比较两组患者精子前向运动(PR)、精子浓度、精子正常形态率、顶体酶活性、顶体反应(AR)、酪氨酸磷酸化(TP)及透明质酸结合试验(HBA)等指标;采用Logistic回归分析影响受精的独立危险因素,并绘制受试者工作曲线(ROC曲线)评估各项危险因素对IVF受精率的预测价值。结果两组患者精子的正常形态率、顶体酶活性、自发AR和TP比较均无显著性差异(P>0.05);R-ICSI组患者的精子浓度、PR、诱发顶体反应(IAR)和HBA均显著低于短时IVF组(P<0.05)。Logistic回归分析显示,精子PR、IAR和HBA为IVF受精率的独立危险因素;ROC曲线显示精子PR、IAR、HBA和联合预测新变量(Pre-1)的曲线下面积(AUC)分别为0.66、0.62、0.64和0.70。结论精子功能指标中IAR和HBA是影响IVF受精率的独立危险因素,其对辅助生殖助孕方式的选择有一定指导意义。

Effect of sperm function parameters on selection of assisted reproductive methods

Objective:To evaluate the value of sperm function parameters to predict fertilization rate in vitro,and explore new indicators for selecting fertilization method.Methods:The clinical data of 429 IVF cycles initially performed in Shenzhen People’s Hospital from 2017 to 2019 were retrospectively analyzed.The cycles were divided into two groups according to the outcome of fertilization:early rescue ICSI(R-ICSI)group(n=98)for patients with fertilization failure or fertilization rate<30%;short-term IVF group(n=331)for patients with fertilization rate≥30%.The sperm progressive rate(PR),sperm concentration,sperm normal morphology rate,acrosin activity,acrosome reaction(AR),tyrosine phosphorylation(TP)and sperm hyaluronic acid binding assay(HBA)were compared between the two groups.Logistic regression analysis was used to analyze the independent risk factors of IVF fertilization.The receiver operating curve(ROC curve)was drawn to evaluate the predictive value of risk factors for IVF fertilization rate.Results:There were no significant differences in sperm normal morphology rate,acrosin activity,spontaneous AR and TP between the R-ICSI group and the short-term IVF group(P>0.05).The sperm concentration,PR,induced acrosome reaction(IAR)and HBA in the R-ICSI group were significantly lower than those in short-term IVF group(P<0.05).Logistic regression analysis showed that sperm PR,IAR and HBA were the independent risk factors of IVF fertilization rate.Furthermore,ROC curve showed that the area under the curve(AUC)of PR,IAR,HBA and new combination variable(Pre-1)were 0.66,0.62,0.64 and 0.70.Conclusions:Among the sperm function parameters,IAR and HBA are independent risk factors for IVF fertilization rate,which have certain guiding significance for selecting assisted reproduction method.