目的:探讨改良直接上游法在常规体外受精(IVF)中的应用价值.方法:487个拟行常规IVF周期中,获卵数均不少于8个.将同一来源卵随机分成实验组和对照组,实验组采取改良直接上游法处理精液,对照组则采用常规上游法处理.比较两组受精及胚胎发育情况,检测两组受精后3小时氧化损伤相关的脂质过氧化水平.结果:实验组精液与对照组相比,精液密度显著降低(22.7±12.6 vs 28.3±17.8,P＜0.01),但活率差异无统计学意义(82.3±13.1 vs80.9±12.5,P＞0.05).两组受精率、早补救发生比率、卵裂率、优质胚胎率比较,差异均无统计学意义(73.96％ vs 71.82％,6.16％vs 6.16％,98.92％ vs 98.63％,56.67％ys 57.21％,P＞0.05),两组种植率、临床妊娠率、流产率比较,差异也无统计学意义(32.49％ vs 30.44％,9.38％vs 10.83％,P＞0.05).实验组与对照组丙二醛(MDA)水平比较差异有统计学意义( 12.23±3.24 vs 18.51±3.55,P＜0.05).实验组也未增加污染几率.结论:改良直接上游法用于常规ⅣF周期,是一种简单、有效的精液处理方法.%Objective:To study the application of modified direct swim-up technique in In vitro fertilization (IVF). Methods:In 487 cycles which planned to receive conventional IVF, the enrolled cycle's recovery oo-cytes were more than 8, and then the oocytes were randomly and equally divided into two groups. The standard swim-up technique was used in control group, whereas the modified swim-up technique was used in study group. The condition of fertilization and embryo development were compared in two groups. The lip-id peroxidation (LPO) level which related to oxidative damage was detected 3 hours after fertilization in two groups. Results: The sperm concentration decreased significantly (22. 7 ± 12.6 vs 28. 3 ± 17. 8 in study group,P<0.01), but sperm motility showed no significant difference in two groups (82. 3 ±13.1 vs 80. 9 ± 12.5,P>0. 05). There were no significant difference between study group and control group in fertilization rate, occurrence of early rescue ICSI, cleavage rate, good embryo rate, implantation rate, and abortion rate (73.96% VS 71.82%, 6.16% vs 6.16%, 98.92% vs 98.63%, 56.67% vs 57.21%, 32.49% vs 30. 44%, 9. 38% vs 10. 83%, P>0.05 ). Malondialdehyde (MDA) level in study group was significant lower than that in control group(12.23 ±3. 24 vs 18.51 ±3. 55, P<0. 05). The direct swim-up technique did not increase the occurrence of contamination. Conclusions:The modified direct swim-up technique is a simple, effective sperm preparation protocol in routine IVF cycles.
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