Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures

There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n = 79) and men who underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P = .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was in group 2 (2.5 ± 0.14; P = .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively; P = .138), sperm motility (38.2% ± 2.69% and 38.7% ± 2.08%, respectively; P = .881), and morphology according to Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%, respectively; P = .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2 (14.9 ± 1.04; P = .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P = .9806), implantation rates (22.1% vs 17.3%; P = .5882), or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.     

A retrospective comparison of pregnancy outcome following conventional oocyte insemination vs intracytoplasmic sperm injection for isolated abnormalities in sperm morphology using strict criteria

Initial in vitro fertilization (IVF)-embryo transfer studies found poor fertilization and pregnancy rates following conventional fertilization of oocytes when using sperm with <4% normal morphology using strict criteria. Some consider today that sperm with only < or =5% normal morphology using strict criteria are associated with infertility. However, other studies have disputed the diagnostic potential of low strict morphology in identifying subnormal male fertility. Based on the original studies most IVF centers perform intracytoplasmic sperm injection (ICSI) when the sperm shows low morphology using strict criteria to allow selection of normal sperm. However, ICSI adds extra time for the embryologist and extra expense for the infertile couple. The present study retrospectively compared fertilization, pregnancy, and implantation rates according to the 2 methods of oocyte fertilization with sperm having normal morphology using strict criteria of < or =5% in women < or =39 years. All fresh embryo transfers were performed on day 3. There was a significantly higher fertilization rate with ICSI. However, there were significantly higher clinical and delivered pregnancy and implantation rates following conventional insemination. The rate of canceled transfers due to no available embryo was 1.9% with conventional insemination vs 1.5% for ICSI in women with adequate egg reserve. Hopefully, this retrospective study will generate interest in a prospective study.     

New method of evaluating sperm morphology with predictive value for human in vitro fertilization

A prospective study was planned to evaluate sperm morphology as a parameter to predict the fertilization outcome in an in vitro fertilization program. Couples applying to in vitro fertilization were admitted into this project when the sperm concentration was greater than 20 million per mL and motility greater than 30 per cent. Based on new strict criteria for evaluating normal sperm morphology, patients were divided prospectively into 2 groups. In group I (25 patients) normal sperm morphology was less than 14 per cent, and in group II (71 patients) normal sperm morphology was greater than 14 per cent, using a threshold established previously. Multiple regression analysis was used to evaluate different parameters: concentration, motility, and morphology against the dependent variables, fertilization, and cleavage. The only factor which was significantly correlated with fertilization and cleavage was normal sperm morphology (P less than 0.0001). The fertilization rate (per oocyte) and the cleavage rate were 49.4 per cent and 47.6 per cent in group I and 88.3 per cent and 87 per cent in group II (P less than 0.0001). The ongoing pregnancy rate per laparoscopy and per embryo transfer was 4 per cent and 5.5 per cent, respectively, in group I and 18.3 per cent and 18.5 per cent, respectively, in group II (no significant difference). This study demonstrates the value of analyzing sperm morphology using the criteria recommended in terms of predicting fertilization and perhaps pregnancy outcome. Patients can be better counseled and the probability of fertilization or no fertilization can be more accurately established. Furthermore a trend is shown in the pregnancy rate that may indicate the importance of the male genome in establishing a pregnancy.     

Increasing sperm concentration to adjust for subnormal sperm morphology did not adversely affect implantation after embryo transfer

Some sperm specimens contribute to infertility not by impairing the fertilization process but by causing embryo implantation defects. One hypothesis is that a toxic factor attached to the sperm is transferred to the zona pellucida by the supernumerary sperm and then subsequently to the embryo membrane. One abnormality, as manifested by subnormal hypoosmotic swelling test (HOST) scores, causes these problems even with the small number of sperm that attach to the zona pellucida under normal physiologic conditions. This study evaluated whether the technique used to increase the oocyte insemination concentration of sperm to adjust for subnormal morphology values using strict criteria may allow a higher concentration of this purported toxic factor to attach to the zona pellucida, thus resulting in the dissimilitude of normal fertilization rate but low implantation rate. A comparison of the pregnancy and implantation rate of embryos formed by insemination of this adjusted sperm concentration of < or = 200,000 sperm vs. those inseminated with the normal concentration of 25,000 sperm failed to demonstrate any differences. Thus, the technique of increasing sperm concentration to adjust for low sperm morphology to improve fertilization rates does not seem to adversely affect implantation rates as long as the HOST scores are normal.     

Predictive value of selected sperm parameters for classical in vitro fertilization procedure of oocyte fertilization

A proportion of fertilized oocytes during classical in vitro fertilization (IVF) procedure was analysed depending on the following factors: number of mature oocytes, seminological criteria such as sperm morphology in raw semen and after its selection in a density gradient (six structural defects of a male gamete were taken into consideration), sperm concentration, motility parameters according to World Health Organization criteria and the functional tests: hypo-osmotic swelling assay and acrosomal reaction induced by calcium ionophore. Evaluation of DNA content in sperm by image cytometry and determination of malonyldialdehydes in seminal plasma were also performed. Seventy-nine semen samples from patients undergoing IVF were assessed. Apart from significant correlations obtained for selected semen parameters and proportion of fertilized eggs, logistic regression analysis showed that the best predictive factors for oocyte fertilization were normal morphology of sperm before and after gradient selection, grade B and C of sperm movement in raw semen, and DNA content after density gradient centrifugation, which all accounted for 76.7% of fertilization predictive value.     

Effects of leucocytospermia on semen parameters and outcomes of intracytoplasmic sperm injection

Leucocytes are present throughout the male reproductive tract but the clinical significance of leucocytic infiltration in the human ejaculate is controversial. The World Health Organization (WHO) defines leucocytospermia as the presence of peroxidase-positive leucocytes in concentrations of > or =1 x 10(6)/mL of semen. The goals of this study were to clarify the relationship between leucocytospermia and semen parameters including sperm concentration, progressive and total motility before and after semen preparation, and intracytoplasmic sperm injection (ICSI) outcomes, including fertilization, embryo development, embryo morphology, cleavage and pregnancy rates. We compared the semen parameters and ICSI outcome of 34 leucocytospermic and 36 non-leucocytospermic control couples who were undergoing ICSI because of male factor infertility including oligo and/or astheno and/or teratozoospermia. Semen parameters including progressive motility rate (1.5% vs. 3%) and sperm concentrations (12 vs. 29 million/mL) were significantly lower in the leucocytospermic group compared with the control group. Other semen parameters were not affected by the presence of leucocytes. ICSI outcome, including fertilization (82% vs. 87%) and embryo development rates (79% vs. 86%) were significantly lower in the leucocytospermic group compared with the control group although there were no statistical difference for embryo quality, embryo cleavage and pregnancy rates. These results indicate that some semen parameters and the outcome of ICSI were negatively affected by the presence of leucocytospermia.     

Intrauterine insemination in male factor subfertility: significance of sperm motility and morphology assessed by strict criteria

The study was conducted to evaluate the results of IUI treatment in a homogenous group with male factor infertility, and to assess the correlation of sperm variables, including sperm morphology by strict criteria, with pregnancy achievement after IUI. A total of 108 couples with no apparent female aetiology for infertility underwent 264 intrauterine insemination treatment cycles. A comparison was made between the sperm variables in two groups in which the achievement of pregnancy differed. The percentage of motile spermatozoa, degree of motility and normal morphology (by strict criteria) were significantly higher in the pregnant group compared with that of the nonpregnant group. A significant difference in pregnancy rates per couple after intrauterine insemination was demonstrated among three groups according to the percentage of sperm morphology, i.e. poor (< 4%), fair (4-14%) or good (> 14%) (11.1%; 36.1% and 50.0%, respectively). Intrauterine insemination is a valid mode of treatment in cases with male infertility, provided that normal morphology by strict criteria is higher than 4%.     

精子形态与体外受精胚胎移植临床妊娠结局的关系

目的:当前精子形态对体外受精(IVF)的影响尚存争议,本研究旨在评估正常形态精子百分率在体外受精-胚胎移植(IVF-ET)中的应用价值。方法:选择生殖遗传中心659对IVF-ET治疗夫妇,按正常形态精子百分率分为4组,A组(2%)112个周期,B组(≥2%~4%)180个周期,C组(≥4%~5%)74个周期,D组(≥5%)293个周期。比较各组间的受精率、正常受精率、卵裂率、优胚率以及新鲜移植周期的生化妊娠率、临床妊娠率、流产率及活产率等指标。结果:4组间的受精率、正常受精率和可移植胚胎率有差异。C组(71.90%)和D组(72.89%)的受精率均显著高于A组(57.97%)和B组(63.29%)(P均0.05),C组与D组间、A组和B组间均无显著差异(P均0.05)。D组的正常受精率(57.16%)显著高于A组(46.52%)和B组(50.89%)(P均0.05),C组正常受精率(54.67%)显著高于A组(P0.05),其余组间无显著差异(P均0.05)。D组的可移植胚胎率(55.62%)显著高于B组(45.75%)(P0.05),其余组间均无显著差异(P均0.05)。D组的无可移植胚胎患者比例(8.87%)显著低于A组(20.54%)和B组(18.89%)(P均0.05),C组(12.16%)与其余组间均无显著差异(P均0.05)。各组间新鲜移植周期的生化妊娠率、临床妊娠率、种植率、流产率和活产率均无显著差异(P均0.05)。结论:正常形态精子百分率对IVF-ET的受精率及胚胎形成有一定影响,用于评估IVF受精结局时,5%临界值略优于4%。     

Prediction of unexpectedly poor fertilization and pregnancy outcome using the strict criteria for sperm morphology before and after sperm separation in IVF-ET

This study was performed to investigate if unexpectedly poor fertilization and in-vitro fertilization (IVF) outcome could be predicted using sperm morphology as diagnosed by the strict criteria. Sperm morphology was assessed in 137 IVF-ET cycles with at least three oocytes collected. The lowest amount of normal forms was 5% in 137 samples, indicating there were no patients belonging to 'poor prognosis' (<5% normal forms). Treatment using intracytoplasmic sperm injection (ICSI) was also excluded. Before sperm separation by the swim-up method, sperm morphology demonstrated a significant correlation with the fertilization rate (p < 0.0001). The fertilization rate (80.5%) in 110 'normal' samples (>14% normal forms) was significantly higher (p < 0.01) than that (55.4%) in 27 samples with 'good prognosis' (those with 5--14% normal forms). No embryo was available for transfer (ET) in 4 (3.6%) of 110 'normal' cycles and in 3 (11.1%) of 27 'good prognosis' cycles (not significant). Fresh ET was intentionally cancelled to avoid severe ovarian hyperstimulation syndrome (OHSS) in six of 110 'normal' cycles as well as in one of 27 'good prognosis' cycles. The pregnancy rate per ET was 31.0% (31/100) in the former group, while it was 26.1% (6/23) in the latter group. There was no difference between the two groups. In the post swim-up evaluation of sperm characteristics, morphology was significantly correlated with the fertilization rate in IVF-ET (p < 0.05) while other sperm parameters were not. When the cut off level for the post swim-up sperm morphology was set at 25%, there was a significant difference in the fertilization rates between patients (78.6%) with post-swim-up >25% and those (55.0%) with post-swim-up < or =25% (p < 0.01). Taken together, a relative indication for ICSI using sperm morphology before and after swim-up was established. Category A includes < or =14% normal forms in the ejaculate and post-swim-up < or =25%, while Category B includes < or =14% in the ejaculate and post-swim-up >25%. There was a significant difference in the fertilization rates between patients (47.2%) in Category A and those (60.2%) in Category B (p < 0.05). The clinical pregnancy rate was 11.1% for patients in Category A compared with 35.7% for patients in Category B. However, there was no significant difference between the two categories. These results indicate that the strict criteria provide a reliable estimation of the fertilizing ability of human spermatozoa. ICSI might be considered in Category A patients to avoid poor fertilization and pregnancy outcome.     

Evaluation of sperm morphology using Kruger's strict criteria.

Prospective and retrospective studies were conducted to evaluate sperm morphology using strict criteria for predicting fertilization capacity in males. Severely impaired male fertility potential was measured by a result of less than or equal to 4% (denotes percentage sperm having normal morphology) and scores of greater than 14% indicated normal fertilization potential. There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of less than or equal to 4% vs. those with 14% or greater (chi 2 analysis): the prospective study showed a 41% pregnancy rate in less than or equal to 4% group vs. 29% rate in greater than 14% group (p = 0.44 NS); the retrospective analysis showed a 50% pregnancy rate in the group with less than or equal to 4% morphology scores vs. 67% in greater than 14% group (p = 0.45 NS). When only the men with normal motile density (greater than 10 x 10(6)/ml) were evaluated, a statistical difference was found in the retrospective study between the group with morphology results greater than 14% (93%) vs. the group less than or equal to 4% (40%). However, the 56% success rate in the men with less than 10 x 10(6)/ml sperm and normal morphology less than or equal to 4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria.     

Seminal characteristics and sexual behavior in men of different age groups： is there an aging effect？

Aim： To assess the seminal characteristics as well as the sexual behavior of men of various age groups to establish the presence of an aging effect on those characteristics. Methods： Semen samples were collected from men （n = 792） undergoing in vitro fertilization or intrauterine insemination in cases of female factor infertility only. Samples were collected using a seminal collection device at intercourse and evaluated manually according to World Health Organization （WHO） standards. Men were divided into four groups according to their ages： （i） 20-30, （ii） 31-40, （iii） 41-50 and （iv） 51-60 years, and their seminal characteristics and responses to a sexual behavior questionnaire were compared. Results： The data showed statistically significant differences in the seminal characteristics tested, most notably in the sperm concentration, motility, grade of motility, hypo-osmotic swelling and normal sperm morphology. Furthermore, the decline in normal sperm morphology with age was more pronounced when using strict criteria rather than WHO standards. There were also differences in total sperm count, total motile sperm and total functional sperm fraction （assessed by both WHO and strict criteria）. Significant differences were also observed in the sexual behavior patterns in older men in terms of the number of years they have been trying to conceive, sexual frequency and sexual satisfaction. Conclusion： The data clearly illustrate an aging effect on semen characteristics and sexual behavior in men as they age. It is suggested that the aging effect be taken into consideration when proposing normal standard values for semen characteristics in routine semen analysis as outlined by WHO standards.     

Sperm chromatin structure assay （SCSA）： a tool in diagnosis and treatment of infertility

Diagnosis of male infertility has mainly been based on the World Health Organization (WHO) manual-based semen parameter's concentration, motility and morphology. It has, however, become apparent that none of these parameters are reliable markers for evaluation of the fertility potential of a couple. A search for better markers has led to an increased focus on sperm chromatin integrity testing in fertility work-up and assisted reproductive techniques. During the last couple of decades, numerous sperm DNA integrity tests have been developed. These are claimed to be characterized by a lower intraindividual variation, less intralaboratory and interlaboratory variation and thus less subjective than the conventional sperm analysis. However, not all the sperm chromatin integrity tests have yet been shown to be of clinical value. So far, the test that has been found to have the most stable clinical threshold values in relation to fertility is the sperm chromatin structure assay (SCSA), a flow cytometric test that measures the susceptibility of sperm DNA to acid-induced DNA denaturation in situ. Sperm DNA fragmentation as measured by SCSA has shown to be an independent predictor of successful pregnancy in first pregnancy planners as well as in couples undergoing intrauterine insemination, and can be used as a tool in investigation, counseling and treatment of involuntary childlessness. More conflicting data exist regarding the role of sperm DNA fragmentation in relation to fertilization, pre-embryo development and pregnancy outcome in in vitro fertilization and intracytoplasmic sperm injection (ICSI).     

精子形态变化对体外受精率的影响

目的:通过对ICSI和IVF受精率的统计,比较精子形态中的精子正常形态率、头部畸形率、畸形精子指数(TZI)和精子畸形指数(SDI)对受精结果的影响。方法:用Krger's严格标准法分别计算每组样本的精子正常形态率、头部畸形率、TZI和SDI值,与受精率进行比较。结果:①IVF组和ICSI组的受精率,与精子正常形态率、头部畸形率、TZI、SDI均无相关性。②IVF组和ICSI组中SDI>1.6和SDI<1.6的受精率、优质胚胎率和临床妊娠率差异均无统计学意义(P>0.05)。③IVF组和ICSI组中精子正常形态率≤15%与精子正常形态率>15%的二组间受精率、优质胚胎率和临床妊娠率的差异均无统计学意义(P>0.05)。结论:精子形态在体外受精时对受精率无影响,不能用精子形态来直接评价体外受精的结果。     

Association between sperm cell chromatin condensation, morphology based on strict criteria, and fertilization, cleavage and pregnancy rates in an IVF program

Summary. In this study, a total of 95 ejaculates from infertile patients were investigated morphologically according to Kruger's strict criteria and 78 of the 95 ejaculates were stained for chromatin condensation with acidic aniline blue. Patients were divided into two groups based on the percentage of morphologically normal spermatozoa as follows: Men with normal sperm morphology <14% (Group I), and men with normal morphology >14% (Group 2). The relationship between percentage of normal sperm morphology and fertilization, cleavage and pregnancy rate was analysed. The rates were 33.7%, 57.1% and 0.0% respectively, in the first group. The corresponding values for the second group were 76.1%, 68.2% and 32.1%. The fertilization and pregnancy rates correlate significantly with morphologically normal spermatozoa.
In regard to the percentage of morphologically normal spermatozoa stained with aniline blue, patients were divided into two groups: patients with 0–20% stained spermatozoa (Group I) and those with >20% (Group 2). Fertilization and pregnancy rates were higher in the first group than in the second group (79.9%, 52.8% vs. 58.8%, 29.5%).
The results demonstrate that chromatin condensation visualized by aniline blue staining is a good predictor for IVF outcome and should be considered besides morphology by sperm assessment for patients undergoing IVF treatment.—     

Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection

PURPOSE: We tested the hypothesis that spinal cord injury and/or anejaculation affects the outcome of intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: From November 1993 to October 1998 we obtained and prospectively reviewed data on 34 ICSI cycles using electroejaculated sperm, 620 male factor infertility ICSI cycles using normal ejaculated sperm and 120 cases of obstructive azoospermia, in which microsurgical epididymal aspiration and testicular sperm extraction-ICSI were done in 93 and 27, respectively. RESULTS: A total of 34 ICSI cycles were performed in 17 couples with male infertility due to anejaculation secondary to spinal cord injury in 10 patients and retroperitoneal lymph node dissection in 5, and idiopathic in 2. In all 17 couples at least 3 previous intrauterine insemination cycles had failed. After electroejaculation 11 men had oligozoospermia and 6 normal sperm density. Median sperm retrieval volume plus or minus standard deviation was 1.9 +/- 1.9 ml., median sperm concentration 70.7 +/- 60.2 x 106 sperm per ml., median motility 10.7% +/- 10.8% and median forward progression 2.3 +/- 0.5 (scale 1 to 4). In the anejaculation group ICSI resulted in a median fertilization of 60% +/- 28%, 15% pregnancies per cycle and 29% pregnancies per couple. In the control group of 620 ICSI cycles from ejaculated specimens obtained from male patients with infertility median fertilization was 58% +/- 26%, and there were 39% pregnancies per cycle and 47% pregnancies per couple. The rate of pregnancies per embryo transfer and per couple was higher in the control than in the electroejaculation-ICSI group (p <0.05). However, there was no statistically significant difference in the fertilization rate. CONCLUSIONS: ICSI or in vitro fertilization is a viable alternative for patients with anejaculation in whom intrauterine insemination failed. While the fertilization rate is similar in these couples, the pregnancy rate is significantly lower than that achieved with ejaculated specimens from patients with severe male factor infertility. ICSI is a viable alternative for a patient with anejaculation in whom intrauterine insemination or in vitro fertilization failed.     

精浆piRNA对精子DNA完整性及辅助生殖技术结局的影响

目的通过检测男性不育症患者精浆中存在的睾丸特异piRNA与精子DNA损伤程度的关系,探讨其对精子DNA完整性及辅助生殖技术(ART)结局的影响。方法分析149例男性不育症患者精液质量及精子DNA完整性;按精子DNA碎片指数(DFI)将不育症患者分为:A组(DFI≤15%)、B组(15%DFI30%)、C组(DFI≥30%),采用实时荧光定量聚合酶链式反应(Q-PCR)检测各组患者精浆中piRNA-013423和piRNA-023386的表达量,比较各组患者受精率、卵裂率、优胚率、生化妊娠率及临床妊娠率的差异。结果与A、B组比较,C组的精子密度、前向活动精子、精子活动率、正常形态率均明显下降(P0.05),A、B两组比较,B组精子活动率下降(P0.05)。A、B、C三组中,C组患者piRNA-013423、piRNA-023386表达均低于A、B组(P0.01);C组患者受精率、卵裂率、优胚率、生化妊娠率及临床妊娠率均低于A、B组(P0.01)。结论男性不育症患者存在精子DNA不同程度的损伤,精浆中piRNA的水平与精子DNA完整性有关,DNA完整性差的患者精浆piRNA表达降低,且影响ART临床结局。提示piRNA可能通过某些信号通路调控精子DNA损伤,但具体机制需要下一步深入研究探讨。     

The outcome of clinical pregnancies following intracytoplasmic sperm injection is not affected by semen quality

Summary.  The objective of this study was to investigate the impact of severe oligoasthenoteratozoospermia (OAT) on pregnancy outcome. For this purpose 279 consecutive intracytoplasmic sperm injection (ICSI) cycles were retrospectively evaluated and compared to 436 consecutive IVF cycles performed during the same time frame. Group A ( n = 62) included ICSI patients with severe OAT; group B ( n = 217) included patients who underwent ICSI for other indications; and group C ( n = 436) included couples who underwent standard IVF. The mean age of female patients and mean number of embryos transferred were comparable in all groups. No difference was observed regarding implantation, clinical pregnancy, delivery and miscarriage rates between all three groups, but fertilization rate was significantly lower in group A than in groups B and C. It is concluded that couples undergoing ICSI with severe male infertility (OAT) have a slightly reduced fertilization rate but their chances of delivery and pregnancy loss are similar to those of other patients undergoing clinical ICSI and IVF with non-male infertility.     

Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility

This study was performed to predict pregnancy by intrauterine insemination (IUI) using computer-aided sperm analysis (CASA) estimates and strict criteria in patients with male factor infertility. IUI was performed in 682 cycles on 160 male factor infertile patients. Semen examinations were carried out by CASA and strict criteria before and after sperm preparation using continuous-step density gradient centrifugation. Receiver operating characteristics (ROC) curves were constructed for assessment of the effectiveness of each individual parameter in predicting pregnancy by IUI. A clinically acceptable threshold was calculated when sensitivity plus specificity were maximum. The average cycle of IUI performed was 4.3 +/- 2.4. Pregnancy rate per cycle and per patient were 7.2% (49/682) and 28.1% (45/160), respectively. Using ROC curve, it was shown that normal sperm morphology assessed by the strict criteria before sperm separation and five parameters after sperm separation including rapid, progressive motility, average path velocity (VAP), curvilinear velocity (VCL), and straight line velocity (VSL) were able to predict pregnancy by IUI. Correlation between sperm parameters and pregnancy outcome was examined by the logistic regression model. In a multivariate analysis normal morphology before sperm separation >or=15.5% [odds ratio (OR) = 2.2, p = 0.02], rapid after sperm separation >or=25.5% [OR = 3.9, p = 0.029], and VCL after sperm separation >or=102.65 microm/sec [OR = 3.2, p = 0.002] were the parameters of predictive value for pregnancy outcome. Adjustment of the model for female age, female infertility factors, and the methods of ovulation induction did not change this finding, and the final model still had the same covariates. Pregnancy rates per cycle according to the number (0, 1, 2 and 3) of variables satisfied with the three parameters were 0% (0/110), 1.6% (3/183), 9.7% (21/217) and 15.1% (23/151), respectively. Three semen parameters including normal morphology before sperm separation, rapid and VCL after sperm separation were identified as predictors of pregnancy by IUI. These variables would be helpful when counselling patients before they make the decision to proceed with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-ET.     

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。     

Morphology of seminal and swim-up spermatozoa and the outcome of in vitro fertilization and embryo transfer

Tubal infertility was treated by in vitro fertilization-embryo transfer (IVF-ET) in 112 couples. Twenty-eight pregnancies were obtained in 140 treatment cycles. Couples are accepted for treatment in our IVF-ET programme if previous semen samples fulfil the inclusion criteria: ejaculate volume greater than 1.5 ml, concentration of spermatozoa greater than 15 x 10(6) ml-1, greater than 40% motile spermatozoa, and greater than 25% spermatozoa with normal morphology. In order to determine to which extent IVF-ET treatment results are influenced by sperm morphology, within this selected group of patients, we have retrospectively analysed the data from both original semen samples and swim-up preparations. The sperm morphology was not related to the outcome of treatment in terms of fertilization (ovum cleavage rate), early embryo development, or pregnancy. Nor was any relationship detected between early embryo development or pregnancy and the degree of improvement in morphology resulting from the swim-up procedure. However, if improvement in morphology by swim-up was high, ovum cleavage rate was low. Sperm morphology within the limits set by our inclusion criteria could not predict the outcome of IVF-ET treatment. It is further concluded that the presence of abnormal spermatozoa at the site of fertilization may be without harm if only the number of normal sperms is high enough.