精子形态可否预测精子其他参数和受精结局

摘要

Objective To investigate the influence of sperm morphology on sperm function and fertilization outcomes of in vitro fertilization (IVF), and explore its prediction value in choosing treatment methods on assisted reproductive technology(ART).Methods This study retrospectively analyzed 1951 cycles of infertile couples treated with conventional IVF, ICSI or rescue ICSI(RICSI) from June 2012 to February 2015, and according to 4% as the lower reference limits of sperm normal morphology provided by WHO laboratory manual for the Examination and processing of human semen (5th Edition), the cycles were divided into three groups: 470 cycles with values<1.0% in A group; 562 cycles with values≥1.0% and <4% in B group; and 919 cycles with values≥4.0% in C group.Results There were extremely significant differences in sperm concentration, total motility, progressive motility and DNA integrity among three groups (P<0.01), but no significant difference in acrosin activity. There were positive correlations between sperm normal morphology and other parameters. Meanwhile, the percentage of IVF was 72.3%, 86.7% and 96.8%, and the percentage of ICSI was 27.7%, 13.3% and 3.2%, respectively, there were statistically significant differences in treatment methods (P<0.01). the percentage of RICSI decreased by sperm normal morphology. Fertilization rate (67.0%, 70.0% and 79.6%) had extremely significant difference only in conventional IVF group(P<0.01), and with the increase in sperm normal morphology, fertilization rate increased; there was no consistent trend in embryo quality among different insemination ways.Conclusion There is positive correlation between sperm normal morphology and most semen parameters, and sperm morphology influences IVF fertilization rate, which is some valuable indicatior to select IVF or ICSI on ART treatment.%目的：探讨精子形态在辅助生殖治疗中对选择授精方法时有否预测价值和意义。方法回顾性分析2012年6月至2015年2月接受辅助生殖治疗的1951周期患者精液资料，根据《WHO人类精液检查与处理实验室手册》（第五版）精子正常形态率参考值下限为4%，将患者的精子正常形态率分成3组：A组＜1.0%470周期，B组1%~4%562周期，C组≥4%919周期，分别采用常规体外受精（IVF）或卵胞浆内单精子注射（ICSI）以及IVF受精失败后补救ICSI（RICSI）授精方式，比较3组精子正常形态与其他精液参数相关性，与授精方式、受精率、优质胚胎率的关系。结果除了顶体酶外，精子浓度、活力、前向运动率、DNA完整率在3组形态间都差异极显著（P＜0.01），而且它们与精子正常形态呈显著的正相关；授精方式上3组的IVF比例分别是72.3%、86.7%、96.8%，ICSI组27.7%、13.3%、3.2%，3组间授精方式差异极显著（P＜0.01），RICSI比例也随着精子正常形态率升高而降低；受精结局上，只有IVF组3组形态间受精率（67.0%、70.0%和79.6%）差异极显著（P＜0.01），且和精子正常形态率趋势一致；胚胎质量反映在不同授精方式上趋势各有不同。结论精子正常形态与其他大部分的精液参数有正相关性，影响IVF的受精率，故在辅助生殖治疗中对授精方式选择有一定指导意义。