诊断学理论与实践

诊断学理论与实践 ›› 2017, Vol. 16 ›› Issue (03): 270-272.doi: 10.16150/j.1671-2870.2017.03.007

• 论著 • 上一篇    下一篇

精子形态、顶体区大小与IVF受精率的关系

黄文强, 范宇平, 胡烨, 杨阳, 江宁东, 黄媚媛, 潘家坪, 滕晓明   

  1. 同济大学附属第一妇婴保健院生殖医学中心,上海 200040
  • 收稿日期:2017-04-25 出版日期:2017-06-25 发布日期:2017-06-25
  • 通讯作者: 滕晓明 E-mail: tengxiaoming@hotmail.com

Correlation of sperm morphology and acrosome index with fertility rate of in vitro fertilization and embryo transfer

HUANG Wenqiang, FAN Yuping, HU Ye, YANG Yang, JIANG Ningdong, HUANG Meiyuan, PAN Jiaping, TENG Xiaoming   

  1. Center of Reproductive Medicine, The First Maternity and Infant Hospital Affiliated to Tongji University School of Medicine, Shanghai 200040, China
  • Received:2017-04-25 Online:2017-06-25 Published:2017-06-25

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摘要： 目的: 观察精子形态学参数对体外受精-胚胎移植(in vitro fertilization and embryo transfer, IVF-ET)受精率的影响,探讨精子形态学参数的临床意义。方法: 回顾性分析2016年4月至2016年9月在同济大学附属第一妇婴保健院生殖中心行IVF-ET的824对夫妇,筛选其中经女方妇科检查后明确为输卵管因素,术前女方控制性促排方案为短效长方案,排除取卵失败,获卵数在6~15枚,排除术日补救卵细胞质内单精子显微注射 (intracytoplasmic sperm injection,ICSI)及短时受精的样本。男方术前精液行2次以上常规参数检查,前向运动精子总数均在500万以上,并排除男方感染、遗传及其他因素,入组观察对象136对。以男女双方年龄、精子正常形态率、精子浓度、前向运动精子百分比、头部畸形率、尾部畸形率和精子顶体区占精子头部的百分比作为自变量,受精率作为应变量,行Logistic回归分析。结果: 入组男方年龄为(34.12±4.30)岁(27~46岁),女方年龄为(32.32±4.14)岁(25~43岁),不育年限为(2.77±1.34)年(1~8年)。精子头部畸形率与受精率呈负相关(P=0.035);而精子顶体区占精子头部的百分比与受精率呈正相关(P=0.046);其他自变量与受精率间无统计学相关性。结论: 精子头部畸形率和顶体区大小对IVF受精率存在影响,因此临床分析精子形态学报告不应只关注正常形态率,而应进一步对各种精子畸形进行分类以作出准确判断。

关键词: 体外受精, 精子形态学参数, 诊断

Abstract: Objectives: To investigate the influence of morphological parameters of sperm on fertility rate of in vitro fertilization and embryo transfer (IVF-ET) and discuss the clinical significance of sperm morphological parameters. Methods: Data form 824 couples underwent IVF-ET in our IVF center during April, 2016 to September, 2016 were analyzed retrospectively. Inclusion criteria were female infertility due to female tubal factors and the method of controlled ovulation induction was short-term long protocol. Number of retrieved oocyte was 6 to 15. Failure of oocyte retrieval, rescue ICSI and short co-incubation of gametes were excluded. Male inclusion criteria were total number of progressive motile sperm more than 5 million in two CASA tests, and patients with genetic and infectious factors were excluded. Altogether 136 couples were enrolled. Sperm morphology test was performed according to WHO 5th edition manual and acrosome index was calculated by image software. Logistic regression analysis was performed for statistical analysis. Results: The mean age of enrolled male patients was (34.12±4.30) years (ranging from 27-46 years) and female patients was( 32.32±4.14 ) years (ranging from 25-43 years). Their mean infertility time was(2.77±1.34) years (ranging from 1-8 years). The rate of sperm head abnormality was in significant negative correlation with fertility rate(P=0.035), and acrosome index had a significant positive correlation with fertility rate (P=0.046), whereas other CASA and morphological parameters had no correlation with fertility rate. Conclusions: The rate of sperm head abnormality and acrosome index may adversely affect the fertility rate of IVF. Therefore, the morphological tests should not only focus on normal morphology rate, but also should pay attention to the classification of various sperm anomalies for obtaining a better prediction of IVF outcome.

Key words: In vitro fertilization, Sperm morphological parameters, Diagnosis

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