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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (05) : 530 -534. doi: 10.3877/cma.j.issn.1673-5250.2016.05.008

所属专题： 文献；

论著

部分卵母细胞胞浆内单精子注射周期中影响其常规体外受精受精率的相关因素分析
邓唐1, 李尚为1,†()   
  1. 1. 610041　成都，四川大学华西第二医院辅助生殖中心、出生缺陷与相关妇儿疾病教育部重点实验室
  • 收稿日期:2016-06-11 修回日期:2016-09-03 出版日期:2016-10-01
  • 通信作者: 李尚为

Analysis of the influence factors of fertilization rate in half intra-cytoplasmic sperm injection cycles

Tang Deng1, Shangwei Li1,†()   

  1. 1. Department of Assisted Reproduction Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2016-06-11 Revised:2016-09-03 Published:2016-10-01
  • Corresponding author: Shangwei Li
  • About author:
    Corresponding author:Li Shangwei,Email:
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邓唐, 李尚为. 部分卵母细胞胞浆内单精子注射周期中影响其常规体外受精受精率的相关因素分析[J]. 中华妇幼临床医学杂志(电子版), 2016, 12(05): 530-534.

Tang Deng, Shangwei Li. Analysis of the influence factors of fertilization rate in half intra-cytoplasmic sperm injection cycles[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 530-534.

目的

探讨部分卵母细胞胞浆内单精子注射(half-ICSI)周期中，影响该周期常规体外受精(IVF)受精率的相关因素。

方法

选择2010年8月至2012年8月，于四川大学华西第二医院生殖医学中心接受half-ICSI助孕的180例不孕患者的共计180个half-ICSI周期为研究对象。按照常规IVF受精率高低，将ICSI受精率>50%且常规IVF受精率≤25%的46个周期，纳入低受精率组；ICSI受精率>50%且常规IVF受精率>50%的134个周期，纳入高受精率组。回顾性分析可能影响常规IVF受精率的因素，包括女方年龄及不孕年限等9项，以及涉及男方的包括精子浓度和前向运动精子百分率等8项，并对这17项因素进行单因素分析。根据临床经验及上述单因素分析结果，将精子浓度、前向运动精子百分率、弱精子症、畸形精子症及正常形态精子百分率等5项影响常规IVF受精率的相关因素，进行多因素非条件logistic回归分析，了解其独立危险因素。

结果

①低受精率组男方精子浓度、前向运动精子百分率及正常形态精子百分率均较高受精率组低，而弱精子症和畸形精子症患者所占比例，则较高受精率组高，且差异均有统计学意义(P<0.05)。两组女方9项因素，包括年龄、不孕年限、不孕类型构成比、既往夫精人工授精(AIH)助孕率、子宫内膜异位症(EMS)发生率、多囊卵巢综合征(PCOS)发生率、自然流产率，以及年龄≥35岁者所占比例、不孕年限≥3年者所占比例比较，以及男方其他3项因素，包括精子总数、少精子症患者所占比例及精子全部畸形患者所占比例比较，差异均无统计学意义(P>0.05)。②多因素非条件logistic回归分析结果显示，影响half-ICSI周期常规IVF受精率的独立危险因素为男方弱精子症(OR＝6.476, 95%CI：1.621～25.877，P<0.05)。

结论

男方弱精子症可能增加half-ICSI周期常规IVF受精失败风险，而男方畸形精子症及女方不孕相关因素，不能确定为half-ICSI或ICSI指征。

关键词: 弱精子症, 少精子症, 畸形精子症, 受精，体外, 精子注射，细胞质内, 流产，自然
Objective

To analyze the influence factors of fertilization rate of conventional in vitro fertilization(IVF) in half intra-cytoplasmic sperm injection(half-ICSI) cycles.

Methods

A total of 180 half-ICSI cycles of 180 barren patients treated with half-ICSI from August 2010 to August 2012 in reproductive center of West China Second University Hospital, Sichuan University, were chosen as study objects.According to conventional IVF fertilization rate, the 180 half-ICSI cycles were divided into low fertilization rate group, including 46 cycles in which ICSI fertilization rate was over 50% and conventional IVF fertilization rate was equal or less than 25%; and another 134 cycles in which ICSI and conventional IVF fertilization rate were both over 50% were enrolled into high fertilization rate group.The relative factors including 9 female factors(age, duration of infertility, etc.) and 8 male factors(sperm concentration, ratio of progressive sperm, etc.) were analyzed retrospectively, and made single factor analyze of these 17 factors.According to clinical experiences and single factor analyze result, the sperm concentration, progressive sperm percentage and normal morphology sperm percentage, ratio of asthenozoospermia and teratozoospermia males, which remained statistical significance of conventional IVF fertilization rate in these 17 factors were analyzed by multivariate unconditional logistic regression analysis.

Results

①The mean sperm concentration, progressive sperm percentage and normal morphology sperm percentage of low fertilization rate group were lower than those of high fertilization rate group, while the ratio of asthenozoospermia and teratozoospermia males were higher than those of high fertilization rate group, and the differences were statistically significant(P<0.05). There were no significant differences between two groups of half-ICSI cycles in 9 female factors including age, duration of infertility, constituent ratio of primary or secondary infertility, rate of artificial insemination by husband(AIH) treatment history, incidence rate of endometriosis(EMS) and polycystic ovary syndrome(PCOS), spontaneous abortion rate, female ratio of age≥35 years old and duration of infertility≥3 years; and other 3 male factors including total sperm number, ratio of oligospermia and teratozoospermia in which sperms were totally malformation(P>0.05). ②The multivariate unconditional logistic regression analysis showed that the independent risk factor of conventional IVF fertilization rate in half-ICSI cycles was asthenozoospermia(OR=6.476, 95%CI: 1.621-25.877, P<0.05).

Conclusions

The risk of fertilization failure of conventional IVF in half-ICSI cycles may be increased in patients with asthenozoospermia.Males with teratozoospermia or females′ related infertility factors are not valid indications for half-ICSI or ICSI therapy.

Key words: Asthenozoospermia, Oligospermia, Teratozoospermia, Fertilization in vitro, Sperm injections, intracytoplasmic, Abortion, spontaneous
表1 两组half-ICSI周期相关观察因素比较[例数(%)]
组别 周期数 涉及女方的观察因素
年龄(岁，±s) 不孕年限(年，±s) 不孕类型构成比 既往AIH助孕率 既往EMS发生率
原发不孕 继发不孕
低受精率组 46 30.6±4.2 5.0±2.8 26(56.5) 20(43.5) 5(10.9) 5(10.9)
高受精率组 134 31.0±3.8 4.9±3.3 73(54.5) 61(45.5) 13(9.7) 20(14.9)
检验值 ? t＝0.662 t＝0.179 χ2＝0.058 χ2＝0.052 χ2＝0.471
P值 ? 0.509 0.858 0.810 0.820 0.493
组别 周期数 涉及女方的观察因素 涉及男方的观察因素
既往PCOS发生率 既往自然流产率 年龄≥35岁者所占比例 不孕年限≥3年者所占比例 精子浓度(106个/mL，±s) 精子总数(×106个，±s)
低受精率组 46 3(6.5) 4(8.7) 7(15.2) 31(67.4) 55.7±36.4 165.3±136.5
高受精率组 134 9(6.7) 6(4.5) 30(22.4) 78(58.2) 70.8±43.4 199.7±139.8
检验值 ? χ2＝0.002 χ2＝1.161 χ2＝1.078 χ2＝1.209 t＝2.120 t＝1.449
P值 ? 1.000 0.280 0.299 0.272 0.035 0.149
组别 周期数 涉及男方的观察因素
前向运动精子百分率(%，±s) 少精子症患者所占比例 弱精子症患者所占比例 畸形精子症患者所占比例 精子全部畸形患者所占比例 正常形态精子百分率[%，M(P25～P75)]
低受精率组 46 38.5±15.2 4(8.7) 19(41.3) 41(89.1) 11(26.8) 1.000(0.375～2.000)
高受精率组 134 45.7±12.1 6(4.5) 17(12.7) 98(73.1) 23(23.5) 2.000(0.500～4.100)
检验值 ? t＝3.290 χ2＝1.161 χ2＝17.528 χ2＝4.982 χ2＝0.177 Z＝2.265
P值 ? 0.001 0.281 0.000 0.026 0.674 0.005
表2 影响half-ICSI周期常规IVF受精率相关因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
精子浓度 0.008 0.005 2.566 0.109 1.008 0.998～1.018
前向运动精子百分率 0.013 0.023 0.298 0.585 0.987 0.943～1.033
弱精子症 1.868 0.707 6.986 0.008 6.476 1.621～25.877
畸形精子症 1.300 0.859 2.287 0.130 3.668 0.681～19.764
正常形态精子百分率 0.036 0.063 0.317 0.573 0.965 0.852～1.093
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