精子DFI与精液常规、精子形态学的相关性及其对IVF-ET/ICSI结局的影响#br#

摘要：目的　分析精子DNA碎片指数（DFI）与精液常规、精子形态学及体外受精-胚胎移植（IVF-ET）/卵胞浆内单精子注射（ICSI）结局的关系，探讨精子DFI预测男性生育力及IVF-ET/ICSI结局的价值。方法　回顾性分析2420例男性不育患者精液检查数据，根据DFI值分为A组（DFI≤15%）、B组（15%＜DFI＜30%）、C组（DFI≥30%），分析精子DFI与精液常规、精子形态学相关性。检测117对IVF-ET/ICSI不孕夫妇中男性患者精子DFI，精液常规、精子形态学，根据DFI值分为IVF-1组（DFI≤15%）、IVF-2组（15%＜DFI＜30%）、IVF-3组（DFI≥30%），ICSI-1组（DFI≤15%）、ICSI-2组（15%＜DFI＜30%）、ICSI-3组（DFI≥30%），研究精子DFI对IVF-ET/ICSI结局的影响。结果　A、B、C组患者年龄、精子畸形率逐次升高，精子浓度、前向运动精子（PR）、精子活动率逐次降低（P＜0.01）；精子DFI与年龄、精子畸形率呈正相关，与精子浓度、PR、精子活动率呈负相关（P＜0.01）；与IVF-1组比较，IVF-3组精子浓度、PR降低；IVF-3组精子畸形率较IVF-2组升高；与ICSI-1组和ICSI-2组比较，ICSI-3组PR降低；ICSI-3组精子畸形率较ICSI-1组升高（P＜0.05）；IVF组和ICSI组中，各亚组受精率、卵裂率、优胚率及临床妊娠率差异均无统计学意义（P＞0.05）。结论　精子DFI可有效评估男性生育力。精子DFI对IVF/ICSI的临床结局没有预测价值，不建议将精子DFI检测作为选择辅助生殖技术方案检查项目。

Correlation analysis of sperm DFI,semen routine an sperm morphology and effection of sperm DFI on IVF-ET/ICSI outcome

Abstract: Objective　To analyze the relationship between sperm DNA fragmention index (DFI) and semen routine, sperm morphology and in vitro fertilization embryo transfer(IVF-ET) /intracytoplasmic sperm injection(ICSI) outcome, and to explore the predictive value of sperm DFI in evaluating male fertility and the outcome of IVF-ET/ICSI. Methods　Data of the sperm DFI, sperm routine and sperm morphology data of 2 420 male infertility patients, according to DFI level, the patients were divided into three groups: Group A, Group B(15%＜DFI＜30%), Group C (DFI≥30%), the correlation between sperm DFI and semen routine,malformation rate was analyzed. Sperm DFI,semen routine and sperm morphology was detected in male patients of 117 pairs of IVF-ET/ICSI infertile couples, then subdivided into IVF-1 group(DFI≤15%), IVF-2 group(15%＜DFI＜30%), IVF-3 group (DFI≥30%), ICSI-1 group(DFI≤15%), ICSI-2 group(15%＜DFI＜30%) and ICSI-3 group (DFI≥30%) according to DFI value. The effect of sperm DFI on the outcome of IVF-ET/ICSI was analyzed. Results　The age, sperm malformation rate of patients were successively increased in group A, group B and group C, while sperm concentration, PR and sperm motility rate was successively decreased (P＜0.01). The sperm DFI was positively correlated with patient age and sperm malformation rate, and the sperm DFI was negatively correlated with sperm concentration, PR and sperm motility rate (P＜0.01).Compared with IVF-1 group,the sperm concentration and PR were decreased in IVF-3 group. The sperm malformation rate was higher in IVF-3 group than that in IVF-2 group. Compared with ICSI-1 group and ICSI-2group, the PR was decreased in ICSI-3 group. The sperm malformation rate was higher in ICSI-3 group than that of ICSI-1 group (P＜0.05). There were no statistically significant differences in fertilization rate, cleavage rate, embryo rate and clinical pregnancy rate between IVF group or ICSI group，and between all subgroups (P＞0.05). Conclusion　Sperm DFI can be used to evaluate male fertility effectively. Sperm DFI has no predictive value for IVF-ET/ICSI clinical outcomes , DFI testing of sperm is not recommended as a test for assisted reproductive technology(ART) .