精子质量对不孕不育患者辅助生殖技术选择的指导作用

摘要

Objective To evaluate the guidance of sperm quality in choosing assisted reproductive technology for pa-tients with infertility. Methods We chose 201 infertile couples receiving conventional in vitro fertilization-embryo trans-plantation ( IVF-ET) , in whom, 126 couples ( IVF-ET group) succeeded ( the number of diodes accounted for≥30% of embryos) and 75 couples ( R-ICSI group) with unsuccessful IVF-ET ( the number of diodes accounted for <30% of em-bryos) received remedy intra-cytoplasmic sperm injection ( R-ICSI) . We compared the semen routine, sperm DNA integrity rate, sperm acrosome intact rate, acrosome reaction rate, rate of fertilization and good embryo rate of the two groups. Re-sults The normal morphology rate, sperm density and living rate of the IVF-ET group were higher than those in the R-ICSI group (all P<0. 05). The sperm DNA index (DFI) of the R-ICSI group was significant higher than that of the IVF-ET group (P<0. 05). No statistical differences were found in the acrosome intact rate and acrosome reaction rate between the two groups (all P>0. 05). The fertilization rate and good embryo rate of the R-ICSI group were lower than those of the IVF-ET group (all P<0. 05). Conclusion When the sperm density is less than 11. 07 × 106/mL, normal form rate is below 1. 4%, DFI is higher than 15. 9%, acrosome intact rate is below 77. 3% and the acrosome reaction rate is less than 15. 7%, we advise to use ICSI to assist reproduction.%目的：探讨精子质量对不孕不育患者辅助生殖技术选择的指导作用。方法选择201对行常规体外受精胚胎移植术( IVF-ET)的不孕不育夫妇,其中行IVF-ET成功(二极体的胚胎数量占胚胎总数≥30%)者126对(IVF-ET组),IVF-ET失败(二极体的胚胎数量占总胚胎数<30%)后行补救卵胞浆内单精子注射术(R-ICSI)75对( R-ICSI组)。比较两组精液常规、精子DNA完整率、精子顶体完整率、顶体反应率；体外受精后比较两组受精率、优胚胎率。结果 IVF-ET组精子密度、活力及正常形态率均高于R-ICSI组(P均<0.05)；R-ICSI组精子DNA断裂指数(DFI)明显高于IVF-ET组(P<0.05),顶体完整率、顶体反应率两组比较无统计学差异(P均>0.05)；R-IC-SI组受精率、优胚率低于IVF-ET组(P均<0.05)。结论当精子密度低于11.1×106/mL,正常形态率低于1.4%, DFI高于15.9%,顶体完整率低于77.3%,顶体反应率低于15.7%时建议直接行R-ICSI助孕。