不明原因不孕患者精子的精-卵相互作用实验及体外受精临床结局的研究

目的:研究不明原因不孕患者的精子功能,并进一步探讨不明原因不孕患者体外受精(in vitro fertilization,IVF)方式对临床结局的影响.方法:选择2009年7月至2010年1月在中南大学湘雅医院生殖医学中心行IVF治疗的55例患者,根据不孕的原因将患者分为不明原因不孕组(A组)和单纯女方输卵管因素组(B...

Sperm-oocyte interaction and in vitro fertilization clinical outcomes in patients with unexplained infertility

ObjectiveTo determine the sperm-zona pellucida (ZP) binding and ZP-induced acrosome reaction in patients with unexplained infertility, and to discuss the relationship between ZP-induced acrosome reaction and fertilization rate.MethodsWe compared the fertilization rate and good embryo rate in patients with unexplained infertility after fertilization in 2 ways. Based on the causes of infertility, patients were divided into an unexplained infertility group (Group A) and a pure female tubal factor group (Group B). Oocytes which were obtained by super ovulation from 25 patients with unexplained infertility were randomly divided into 2 groups with conventional in vitro fertilization (IVF) (Group A1) and intracytoplasmic sperm injection (ICSI) fertilization (Group A2). The pure female tubal factor group (Group B) had conventional IVF. We conducted sperm-ZP binding and ZP-induced acrosome reaction experiments with 2 groups of men’s sperms separately. We compared the number of sperm-egg binding and ZP-induced acrosome reaction rate and discussed the relationship between the ZP-induced acrosome reaction and fertilization rate, and also the fertilization rate, good embryo rate and pregnancy rate in patients with unexplained infertility after fertilization in 2 ways .ResultsThe average number of sperm-egg binding (78.29±16.31) and the ZP-induced acrosome reaction rate (55.87±27.69) % in Group A were lower than those of Group B ［94.63±6.72,（82.53±17.99）%］. The difference between the average number of sperm-egg binding and the ZP-induced acrosome reaction was significant (P<0.01). The fertilization rate of Group A1 was significantly lower than that of Group B and Group A2 （P<0.01）. But there was no significant difference in the good embryo rate among the 3 groups. There was no significant difference between Group A2 and B in fertilization rate and good embryo rate （P＞0.05）. There was no significant difference in pregnancy rate between Group A and B （P＞0.05）. Fertilization rate and the rate of acrosome reaction had marked positive correlation with statistical significance (r=0.932, P<0.01) .ConclusionZP binding and ZP-induced acrosome reaction are very important experiments in sperm function test for patients with unexplained infertility. It can not only effectively avoid no embryo transferring due to complete failure of fertilization but also get a desirable outcome of pregnancy using half-ICSI fertilization in patients with unexplained infertility.