精子DNA完整性与体外受精-胚胎移植临床结局的相关性研究

目的 探讨精子DNA完整性与精液参数及体外受精-胚胎移植（IVF-ET）/卵胞浆内单精子注射（ICSI）临床结局的关系.方法 选择2008年6月～2009年6月在解放军105医院生殖医学中心接受IVF/ICSI治疗的179对不育夫妇作为研究对象,采用吖啶橙试验（AOT）对116例实施IVF和63例实施ICSI治疗的男性患者进行精子DNA完整性分析,根据精子DNA碎片指数（DFI）将患者分为DFI≤30%组和DFI＞30%组,比较两组间精液参数、受精率、卵裂率、优胚率、胚胎冷冻率、着床率和临床妊娠率.结果 DFI ＞30%组精子畸形率显著高于≤30%组（P＜0.01）,但两组间精子密度、活动率、前向运动精子（a＋b）均无显著性差异（P＞0.05）;DFI＞30%组IVF和ICSI的优胚率、ICSI的胚胎着床率和临床妊娠率均显著低于DFI≤30%组（P＜0.01,P＜0.05）.结论 精子DNA完整性与精子形态密切相关,精子DNA损伤在IVF/ICSI过程中对胚胎质量有负面影响,并显著影响ICSI的胚胎着床率和妊娠率,建议行ICSI前应对精子DNA完整性进行评估.

The association of sperm DNA integrity with sperm parameters and clinical outcomes of in vitro fertilization-embryo transfer

Objective： To study the association of sperm DNA integrity with sperm parameters and pregnancy out-comes of in vitro fertilization （IVF）/intracytoplasmic sperm injection （ICSI）. Methods： A total of 179 patients underwent IVF/ICSI treatment （116 patients for IVF and 63 for ICSI） in the 105th Hospital of PLA from June, 2008 to June, 2009 and were enrolled in the study. The sperm DNA fragmentation index （DFI） was detected with acridine orange technique （AOT）. According to DFI, the patients were divided into DFI≤30% and DFI〉30% groups. The semen parameters and the outcomes of IVF/ICSI were compared between two groups. Results： There was no significant difference in sperm concentration, motility or progressive motility （a＋b） between two groups. The rate of abnormal sperm was significantly higher in DFI〉30% group than in DFI≤30% group （P〈0.01）. Both in IVF and ICSI treatments, high-quality embryo rate in DFI〉30% group was significantly lower than that in DFI≤30% group （P〈0.05）, while the fertilization rate and cleavage rate were similar in two groups. Men with DFI〉30% offered significantly lower embryo implantation rate and pregnancy rate in their partners in ICSI treatment than those with DFI≤30% did （P〈0.01 and P〈0.05, respectively）, while this discrepancy was not found in IVF treatment. Conclusions： The integrity of sperm DNA was positively correlated with abnormal sperm morphology that has an adverse effect on embryo quality and the outcomes of ICSI. It is suggested that the sperm DNA integrity should be detected before ICSI.