精子DNA碎片指数(DFI)与体外受精结局的多因素Logistic回归分析

目的 探讨精子DNA完整性与体外受精结局的关系。方法 回顾分析2011～2018年35岁以下卵巢储备功能良好并使用标准长方案的共3 576个体外受精(IVF)/补救性单精子卵浆内注射(R-ICSI)周期的资料,根据男方精子DNA碎片指数(DFI)检测值分为<20%,20%～30%,30%～40%和≥40%共四组,分析比较各组的女方平均年龄、体重指数、基础激素水平及IVF总受精率、R-ICSI周期的比例和R-ICSI受精率等指标,并且采用Logistic多因素回归模型分析体外受精结局与DFI之间的关系及找出相关的伴随因素。结果 四组的IVF/R-ICSI周期数分别为2 516,601,295和164个,女方平均年龄分别为31.88,31.72,31.56和31.18岁; 平均体重指数分别为21.72,21.74, 21.64和21.43 kg/m²; 血清平均基础卵泡刺激素(FSH)水平分别为6.10,6.24,6.15和5.86 U/L; R-ICSI周期的比例分别为11.8%,11.5%,16.9%和22.0%; IVF总受精率分别为74.4%,74.6%,70.0%和64.7%。其中女方年龄、体重指数和基础FSH水平组间比较差异均无统计学意义(均P>0.05)。而IVF总受精率随着DFI的升高呈现逐渐下降趋势(P<0.05),使用R-ICSI的周期数和卵子数占比则呈现逐渐上升的趋势(P<0.05)。用Logistic多因素回归模型分析发生低受精率相关风险因素中,精子DFI 的OR值为1.013(95%可信区间:1.004～1.023,P<0.05),提示精子DFI越高,发生受精率降低的风险逐渐升高。结论 精子DFI是常规体外受精过程中的一个重要的负面影响因素。

Multivariate Logistic Regression Analysis of Sperm DNA Fragment Index(DFI)and Outcome in Vitro Fertilization

Objective To investigate the relationship between sperm DNA integrity and outcome in vitro fertilization.MethodsThe data of 3 576 in vitro fertilization(IVF)/rescue intracytoplasmic sperm injection(R-ICSI)cycles with good ovarian reserve function under 35 years old from 2011 to 2018 were retrospectively analyzed.According to the malesperm DNA fragmentation index(DFI)detection values,the four groups were divided into < 20%,20%～30%,30%～40% and ≥40%.The average age,body weight index of women,basal hormone level in serum and IVF total fertilization rate,R-ICSIcycle ratio and RICSI in each group were analyzed and compared.Logistic multivariate regression model was used to analyze the relationship between IVF outcomesand DFI and find out the associated factors.Results Thenumber of IVF/R-ICSI cycles in the four groups were 2 516,601,295 and 164,respectively.The average age of the women were 31.88,31.72,31.56 and 31.18years,respectively.The average body mass index was 21.72,21.74,21.64 and21.43 kg/m²,respectively.The average level of serum basic follicle stimulating hormone(FSH)was 6.10,6.24,6.15 and 5.86 U/L,respectively.The proportion of RICSI cycles was 11.8%,11.5% and 16.9%,respectively,and the total fertilization rates of IVF were 74.4%,74.6%,70.0% and 64.7%,respectively.There was no significant difference in age,BMI and baseline FSH level between groups(P>0.05).The total fertilization rate of IVF decreased graduallywith the increase of DFI(P<0.05),while the cycle number and the proportion of eggs using R-ICSI increased gradually(P<0.05).The OR value of spermDFI was 1.013(95% confidence interval:1.004～1.023,P<0.05),which indicated that the higher the sperm DFI,the higher the risk of fertilization ratedecreasing.Conclusion Sperm DFI is an important negative factor in the process of conventional in vitro fertilization.