异常形态精子对植入前胚胎发育和妊娠结局的影响

目的探讨异常形态精子(畸形率≥98%)对植入前胚胎发育及妊娠结局的影响。方法采用回顾性队列研究,分析2017年1~12月在唐都医院妇产科生殖医学中心行ART助孕的2419例患者临床资料,根据异常形态精子分为3组,即IVF对照组(畸形率≤96%,n=2129)、IVF实验组(畸形率≥98%,n=90)和ICSI实验组(畸形率≥98%,n=200)。比较3组间植入前受精失败率(受精率<30%)、正常受精率、可用胚胎率等胚胎发育参数和着床率、临床妊娠率、流产率及活产率等妊娠结局的差异。结果(1)胚胎发育结果:组间比较,IVF实验组受精失败率显著高于IVF对照组(P<0.05),ICSI实验组的受精失败率为0;ICSI实验组正常受精率显著高于IVF对照组和IVF实验组(P<0.05);IVF实验组可用胚胎率显著低于IVF对照组和ICSI实验组(P<0.05)。(2)妊娠结局:单因素分析结果显示,与IVF对照组、ICSI实验组相比,IVF实验组的着床率、临床妊娠率、流产发生率和活产率差异均有统计学意义(P<0.05);IVF对照组和ICSI实验组组间妊娠结局指标比较均无显著性差异(P>0.05)。(3)Logistic多因素分析显示:IVF实验组的受精失败风险显著高于IVF对照组(P=0.002),可用胚胎率、活产率显著低于IVF对照组(P=0.002);ICSI实验组的正常受精率显著高于IVF对照组(P=0.05)。结论对于活力正常、但异常形态精子率≥98%的患者,采用ICSI授精方式,能降低受精失败风险,提高正常受精率和可用胚胎率,同时提高妊娠率和活产率并降低流产发生率。

Influence of abnormal morphology sperm rate on pre-implantation embryo development and clinical outcomes

Objective:To explore the influence of abnormal morphology sperm rate on pre-implantation embryo development and clinical outcomes.Methods:A retrospective cohort study was used to analyze the clinical data of 2419 patients undergone ART treatment in the Reproductive Medicine Center of Tangdu Hospital from January to December 2017.According to the sperm morphology rate,the patients were divided into three groups:IVF control group(abnormal morphology sperm rate≤96%,n=2129),IVF experiment group(abnormal morphology sperm rate≥98%,n=90),ICSI experiment group(abnormal sperm rate≥98%,n=200).The pre-implantation embryo development parameters including fertilization failure rate(fertilization rate<30%),normal fertilization rate,available embryo rate and clinical outcomes including implantation rate,clinical pregnancy rate,abortion rate,birth rate were compared among the groups.Results:(1)Pre-implantation embryo development:the fertilization failure rate of IVF experiment group was significantly increased compare with IVF control group.The fertilization failure rate of the ICSI experiment group was 0.The normal fertilization rate of the ICSI experiment group was significantly higher than that of the IVF control group and the IVF experiment group(P<0.05).The available embryo rate of the IVF experiment group was significantly lower than that of the IVF control group and the ICSI experimental group(P<0.05).(2)Clinical outcomes:univariate analysis revealed that the implantation rate,clinical pregnancy rate,abortion rate,and birth rate in the IVF experiment group were significantly different with the IVF control group and the ICSI experiment group(P<0.05).There were no differences in the clinical outcomes parameters between the IVF control group and the ICSI experiment group(P>0.05).(3)Multivariate logistic regression models:the risk of fertilization failure in the IVF experiment group was significantly higher than that in the IVF control group(P=0.002),and the available embryo rate and live birth rate were significantly lower than those in the IVF control group(P=0.002).The normal fertilization rate in the ICSI experiment group was significantly higher than that of IVF control group(P=0.00).Conclusions:For the patients with normal motility and abnormal morphology sperm rate≥98%,utilization of ICSI reduces the risk of fertilization failure,increase normal fertility rate and available embryo rate,meantime increases pregnancy rate and birth rate,and reduces the incidence of abortion.