卵胞浆内单精子注射治疗畸形精子症的妊娠结局

【目的】 分析畸形精子症患者行卵胞浆内单精子注射(ICSI)后的妊娠结局?【方法】 回顾性分析因男性因素行ICSI治疗的445个新鲜取卵周期,根据精子形态学分析结果将研究对象分为:精子形态正常组(A组,正常形态率≥4%,n = 296),非极度畸形精子症组(B组,正常形态率≥1%且 0.05)?在3组中,极度畸形精子症组有最高的优质胚胎率(67.6% ,405/599),种植率(32.1%,53/165)和临床妊娠率(46.7%,35/75)?【结论】 ICSI可用于畸形精子症的治疗?按照WHO5标准评估,不同程度的精子畸形率对治疗结局影响较小,极度畸形精子症患者行ICSI后仍可获得较好的妊娠结局?

Teratozoospermia on Clinical Outcomes in Intracytoplasmic Sperm Injection Cycles

【Objective】 To evaluate the effect of teratozoospermia on the outcomes of intracytoplasmic sperm injection (ICSI). 【Methods】 A total of 445 ICSI cycles were reviewed retrospectively for the pregnancy outcome between October 2009 and July 2012 in our IVF center. ICSI cycles were classified into 3 groups based on sperm morphology according to the WHO Laboratory Manual for the Examination and Processing of Human Semen (2010, the 5th edition): Group A (normal sperm≥4%, n = 296); Group B (normal sperm≥1% and <4%, n = 74); Group C, severe teratozoospermia (normal sperm <1%, n = 75). The observational outcomes included oocyte maturation rate, fertilization rate, cleavage rate, implantation rate, clinical pregnancy rate, ectopic pregnancy rate, multiple pregnancy rate and miscarriage rate. 【Results】 The oocyte maturation rate of group A, B, and C were 85.7% (3367/3927), 82.7% (645/762), and 85.9% (773/900), the fertilization rates of group A, B, and C were 75.5% (2543/3367), 81.1% (523/645), and 80.1%(619/773), respectively, and the corresponding clinical pregnancy rates were 44.9% (133/296), 41.9% (31/74), and 46.7% (35/75). There was no statistical difference in the oocyte maturation rate, the cleavage rate, the high quality embryo rate, the implantation rate, the clinical pregnancy rate, the ectopic pregnancy rate, and the miscarriage rate among the three groups. However, the high-quality embryo rate (67.6%, 405/599), the implantation rate (32.1%, 53/165) and the pregnancy rate (46.7%, 35/75) were observed in group C with the most severe teratozoospermia. 【Conclusion】 ICSI is a method of choice in patients with teratozoospermia. The percentage of morphologically normal sperm is not statistically correlated with clinical outcomes. Sperms selected for ICSI allowed excellent outcomes even in the samples with severe teratozoospermia.