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组).将不明原因不孕组25例患者通过超排卵获取的成熟卵母细胞随机分为2组,分别行常规IVF(A1组)和卵胞质内单精子注射术(intracytoplasmic sperm injection,ICSI)受精(A2组);单纯女方输卵管因素组(B组)采用常规IVF.将2组男方的精子利用废卵分别进行精-卵结合实验和透明带诱发精子顶体反应实验.观察A组与B组平均精卵结合数和透明带诱发精子顶体反应情况,分析透明带诱发精子顶体反应率与受精率的关系.比较不明原因不孕组通过2种方式受精后的受精率、优胚率及妊娠率.结果:A组平均精卵结合数(78.29±16.31)和透明带诱发精子顶体反应率[(55.87±27.69)%]明显低于B组的平均精卵结合数(94.63±6.72)及透明带诱发精子顶体反应率[(82.53±17.99)%],差异具有统计学意义(P＜0.01);A1组的受精率(49.32%)明显低于B组(64.42%)和A2组(71.33%),差异具有统计学意义(P＜0.01);而A1组的优胚率(44.44%),与A2组(56.86%)及B组的优胚率(53.81%)相比,差异无统计学意义(P＞0.05);A2组的受精率及优胚率与B组比较,差异也无统计学意义(P＞0.05);A组的妊娠率(36%)与B组(40%)相比,差异无统计学意义(P＞0.05);A1组的受精率与透明带诱发精子顶体反应率具有明显的相关性,有统计学意义(r=0.932,P＜0.01).结论:对于不明原因不孕患者,精卵结合及透明带诱发精子顶体反应是有重要意义的精子功能检测实验.不明原因不孕患者的卵子采用half-ICSI,可有效地避免受精完全失败导致的无胚胎移植,从而获得较理想的妊娠结局.%Objective To 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.Methods We 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 25patients with unexplained infertility were randomly divided into 2 groups with conventional in vitro fertilization (IVF) ( Group Al ) and intracytoplasmic sperm injection (ICSI) fertilization ( Group A2).The pure female tubal factor group (Group B) had conventional IVF.We conducted spermZP binding and ZP-induced acrosome reaction experiments with 2 groups of men's sperms separately.We conpared 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.Results The 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 ).Conclusion ZP 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.
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