精子畸形率对体外受精-胚胎移植治疗结局的影响

目的回顾性分析我中心接受常规体外受精（IVF）及卵胞浆内单精子注射（ICSI）治疗中，男方精子畸形率对受精率、胚胎质量及临床结局的影响。方法选取本中心2008年9月至2010年5月接受IVF的344对及ICSI的178对夫妇，分为常规IVF组和ICSI组，组内按照男方精子畸形率分为正常形态组（IVF266／ICSI76）和畸精子症组（IVF78／ICSI102）。受精后分别统计IVF及ICSI两组内畸精子症组和正常形态组正常受精率、优质胚胎率、种植率、临床妊娠率及流产率的差别。结果在IVF中，畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为64．32％／60．09％、33．78％／37．02％、42．03％／54．62％及12．5％／4．23％。两组间受精率无显著性差别，畸精子症组的临床妊娠率显著性低于正常形态组，而早期流产率显著高于正常形态组（P〈0．05）；ICSI组中，畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为68．01％／64．59％、32．26％／33．78％、43．75％／52．63％及4．76％／5％。畸精子症患者的临床妊娠率较正常组显著性降低（P〈0．05）。将两种受精方式的畸精子症组间比较，IVF的患者早孕流产率显著高于ICSI者（P〈0.05）。结论常规IVF中畸精子症不影响正常受精。对于畸精症子患者，其临床妊娠率均较精子形态正常组低，但是采用ICSI治疗可以显著降低早孕流产率。‘

Effect of teratozoospermia on the results of in vitro fertilization-embryo transfer

Objective： To evaluate the effect of teratozoospermia on embryo quality and clinical outcome of in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI）. Methods： Three hundred and forty four couples treated with IVF and 178 with ICSI during the period of Sepr t. 2008 to May 2010 in our centre were sub-grouped into normal sperm morphology group or teratozoospermia group （abnormal sperm morphology rate≥96%）. The rates of normal fertility, goodquality embryo, implantation, clinical pregnancy and miscarriage in each group were analyzed with software SPSS13.0. Results： There were no significant differences in the rates of normal fertilization rate, good-quality embryo rate, and implantation rate between IVF and ICSI groups. In IVF group, the clinical pregnancy rate was significantly lower and the miscarriage rate significantly higher in teratozoospermia than those of normal morphology group （42.03% vs. 54.62% and 12.5% vs. 4.23%, respectively） （P〈0. 05）. In ICSI group, teratozoospermia group had a significantly lower clinical pregnancy rate compared with normal sperm morphology group （43.75% vs. 52.63%） （P〈0. 05）, but there was no significant difference in miscarriage rates （4. 76% vs. 5.00%） between the two groups. For patients with teratozoospermla, lvr and ICSI protocols showed similar outcomes in the fertilization rate, good-quality embryo rate or clinical pregnancy rate, but IVF approach resulted in a significantly higher miscarriage rate than that of ICSI （12.5% vs. 4.76%） （P〈0.05）. Conclusions： In conventional IVF or ICSI treatment, teratozoospermia did not affect the normal fertilization but significantly decreased the clinical pregnancy rate, but ICSI approach significantly reduced the occurrence of early miscarriage （P〈0.05）.