体脂率对继发不育男性精液质量及体外受精结局的影响
|
摘要
目的探究男性体脂率对继发不育患者精液质量及体外受精结局的影响。方法采用历史性队列研究方法分析2016年1月至2018年1月就诊于潍坊医学院附属医院生殖医学中心的1 853名继发不育的男性。根据体脂率(BFP)分为低脂肪组(BFP<15%,n=90)、普通组(15%≤BFP<20%,n=458)、轻度肥胖组(20%≤BFP<25%,n=765)、肥胖组(BFP≥25%,n=540),收集各组患者的精液常规参数及精浆锌(ZN)浓度化验指标,计算各组受精率、优质胚胎率以及精子低渗肿胀试验(HOS)、精浆弹性硬蛋白酶(PMN)正常比例,分析各组间差异,并对各项参数间的关系进行皮尔逊相关性分析。通过多元逐步回归分析得出影响受精率、优质胚胎率及精子前向运动百分率(PR)的主要因素。结果 (1)低脂肪组优质胚胎率、精液量均显著低于其余三组(P<0.05);肥胖组受精率显著低于其余三组(P<0.05);肥胖组PR、精子活动率显著低于普通组(P<0.05);轻度肥胖组、肥胖组HOS正常比例显著低于普通组(P<0.05)。(2)相关性分析表明,受精率与精液量呈负相关,与精子浓度、精子形态呈正相关(P<0.05);优质胚胎率与精子浓度、PR、精子活动率、精子形态、精浆锌浓度呈正相关(P<0.05);BFP与精液量呈负相关(P<0.05)。(3)多元回归分析显示,受精率的独立影响因素为年龄、非前向运动精子百分率(NP)、精子浓度、精液量(P<0.05);优质胚胎率的独立影响因素为年龄、HOS、精子浓度(P<0.05);PR的独立影响因素为BFP、精子活动率、NP、HOS、年龄、体重(P<0.05)。结论体脂率过高或者过低,均会对精液质量及体外受精结局产生不良影响,此可能为其不育的原因之一。
Objective:To explore the effect of body fat percentage(BFP)on semen quality parameters and IVF outcome in secondary infertile males.Methods:The data of 1 853 secondary infertile males in the Reproductive Medicine Center of Weifang Medical University from January,2016 to January,2018 were analyzed in a historical cohort study.The patients were divided into four groups according to the BFP criteria:low-fat group(BFP<15%,n=90),normal group(15%≤BFP<20%,n=458),mild-obesity group(20%≤BFP<25%,n=756),and obesity group(BFP≥25%,n=540).The semen parameters and seminal zinc concentration,fertilization rate,high quality embryo rate,and the normal ratios of sperm hypo-osmotic swelling(HOS)test,seminal plasmaPMN-elastase(PMN)in each group were collected.The above indexes were compared by using Pearson correlation analysis among the four groups to explore the correlation among the parameters.The main factors affecting fertilization rate,high quality embryo rate and percentage of forward motile sperm(PR%)were analyzed by multivariate stepwise regression analysis.Results:The High quality embryos rate and semen volume in the low fat group were significantly lower than those in other groups(P<0.05).The fertilization rate in the obesity group was significantly lower than that in other groups(P <0.05).PR% and sperm motility in the obesity group were significantly lower than those in the normal group(P<0.05).The normal ratio of sperm HOS test in the mild obesity group and the obesity group was significant lower than that in the normal group(P<0.05).Fertilization rate was negatively correlated with semen volume,but positively correlated with sperm concentration and sperm morphology(P<0.05).The high quality embryo rate was positively correlated with sperm concentration,PR%,sperm motility,sperm morphology and seminal zinc concentration(P<0.05).The BFP was negatively correlated with semen volume(P<0.05).Multivariate logistic stepwise regression analysis showed that the independent factors influencing the fertilization rate were age,percentage of non-forward motile sperm(NP%),sperm concentration,and semen volume(P<0.05).The independent factors influencing the high quality embryo rate were age,HOS,and sperm concentration(P<0.05).The independent factors influencing PR% were BFP,sperm motility,NP,HOS,age and weight(P<0.05).Conclusions:Abnormal body fat percentage,i.e.too high or too low may have adverse effects on semen quality and IVF outcomes,which maybe one of the reasons for infertility.
Objective:To explore the effect of body fat percentage(BFP)on semen quality parameters and IVF outcome in secondary infertile males.Methods:The data of 1 853 secondary infertile males in the Reproductive Medicine Center of Weifang Medical University from January,2016 to January,2018 were analyzed in a historical cohort study.The patients were divided into four groups according to the BFP criteria:low-fat group(BFP<15%,n=90),normal group(15%≤BFP<20%,n=458),mild-obesity group(20%≤BFP<25%,n=756),and obesity group(BFP≥25%,n=540).The semen parameters and seminal zinc concentration,fertilization rate,high quality embryo rate,and the normal ratios of sperm hypo-osmotic swelling(HOS)test,seminal plasmaPMN-elastase(PMN)in each group were collected.The above indexes were compared by using Pearson correlation analysis among the four groups to explore the correlation among the parameters.The main factors affecting fertilization rate,high quality embryo rate and percentage of forward motile sperm(PR%)were analyzed by multivariate stepwise regression analysis.Results:The High quality embryos rate and semen volume in the low fat group were significantly lower than those in other groups(P<0.05).The fertilization rate in the obesity group was significantly lower than that in other groups(P <0.05).PR% and sperm motility in the obesity group were significantly lower than those in the normal group(P<0.05).The normal ratio of sperm HOS test in the mild obesity group and the obesity group was significant lower than that in the normal group(P<0.05).Fertilization rate was negatively correlated with semen volume,but positively correlated with sperm concentration and sperm morphology(P<0.05).The high quality embryo rate was positively correlated with sperm concentration,PR%,sperm motility,sperm morphology and seminal zinc concentration(P<0.05).The BFP was negatively correlated with semen volume(P<0.05).Multivariate logistic stepwise regression analysis showed that the independent factors influencing the fertilization rate were age,percentage of non-forward motile sperm(NP%),sperm concentration,and semen volume(P<0.05).The independent factors influencing the high quality embryo rate were age,HOS,and sperm concentration(P<0.05).The independent factors influencing PR% were BFP,sperm motility,NP,HOS,age and weight(P<0.05).Conclusions:Abnormal body fat percentage,i.e.too high or too low may have adverse effects on semen quality and IVF outcomes,which maybe one of the reasons for infertility.
引文
[1] El Salam MAA.Obesity,an enemy of male fertility:a mini review[J].Oman Med J,2018,33:3-6.
[2] Ng M,Fleming T,Robinson M,et al.Global,regional,and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the global burden of disease study 2013[J].Lancet,2014,384:766-781.
[3] Li L,Wang C,Bao Y,et al.Optimal body fat percentage cutoffs for obesity in Chinese adults[J].Clin Exp Pharmacol Physiol,2012,39:393-398.
[4] Goonasegaran AR,Nabila FN.Comparison of the effectiveness of body mass index and body fat percentage in defining body composition[J].Singapore Med J,2012,53:403-408.
[5] Devlieger R,Guelinckx I.The impact of obesity on female reproductive function[J].Obes Rev,2008,9:181-183.
[6] Physical status:the use and interpretation of anthropometry report of a WHO expert committee[J].World Health Organ Tech Rep Ser,1995,854:1-452.
[7] WHO.世界卫生组织人类精液检查与处理实验室手册[M].第5版,北京:人民卫生出版社,2011.
[8]吴永明,徐华,李玉,等.超重及肥胖与精液常规参数及精浆生化指标关系研究[J].实验与检验医学,2014,32:500-502.
[9] Ferramosca A,Conte A,Moscatelli N.A high-fat diet negatively affects rat sperm mitochondrial respiration[J].Andrology,2016,4:520-525.
[10] Xu X,Sun M,Ye J,et al.The effect of aromatase on the reproductive function of obese males[J].Horm Metab Res,2017,49:572-579.
[11] Niederberger C.Re:The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy[J].J Urol,2012,187:1377.
[12]韩瑞钰,马婧,马姣英,等.肥胖男性精液参数与精浆炎性因子的相关性分析[J].中华男科学杂志,2017,23:894-898.
[13] Belloc S,Cohen-Bacrie M,Amar E,et al.High body mass index has a deleterious effect on semen parameters except morphology:results from a large cohort study[J].Fertil Steril,2014,102:1268-1273.
[14] Provost MP,Acharya KS,Acharya CR,et al.Pregnancy outcomes decline with increasing body mass index:analysis of239,127fresh autologous in vitro fertilization cycles from the2008-2010 society for assisted reproductive technology registry[J].Fertil Steril,2016,105:663-669.
[15] Xia W,Chiu YH,Afeiche MC,et al.Impact of men’s dairy intake on assisted reproductive technology outcomes among couples attending a fertility clinic[J].Andrology,2016,4:277-283.
[16] Moschos S,Chan JL.Leptin and reproduction:a review[J].Fertil Steril,2002,77:433-444.
[17]李江源.精子发生的内分泌激素调节[J].生殖医学杂志,2014,23:697-702.
[18] Cincik M,Ergur AR,Tutuncu L,et al.Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation:correlations with other sperm parameters to predict ICSI cycles[J].Arch Androl,2007,53:25-28.
[19]张红烨,陆金春,冯瑞祥.24种精浆生化指标与精液常规参数的相关性研究[J].中华男科学杂志,2015,21:1087-1092.
[20] Jayaraman V,Ghosh S,Sengupta A,et al.Identification of biochemical differences between different forms of male infertility by nuclear magnetic resonance(NMR)spectroscopy[J].J Assist Reprod Genet,2014,31:1195-1204.
[21]覃湛,袁逸之,袁少英,等.精索静脉曲张不育症患者精浆生化标志物与精子顶体酶的测定与分析[J].中国医药导报,2014,11:12-16.
[22] Salgado RM,Marques-Silva MH,Gon9alves E,et al.Effect of oral administration of tribulus terrestris extract on semen quality and body fat index of infertile men[J].Andrologia,2017,49(5).doi:10.1111/and.12655.
[23] Kahn BE.Obesity and male infertility[J].Curr Opin Urol,2017,27:441-445.
[2] Ng M,Fleming T,Robinson M,et al.Global,regional,and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the global burden of disease study 2013[J].Lancet,2014,384:766-781.
[3] Li L,Wang C,Bao Y,et al.Optimal body fat percentage cutoffs for obesity in Chinese adults[J].Clin Exp Pharmacol Physiol,2012,39:393-398.
[4] Goonasegaran AR,Nabila FN.Comparison of the effectiveness of body mass index and body fat percentage in defining body composition[J].Singapore Med J,2012,53:403-408.
[5] Devlieger R,Guelinckx I.The impact of obesity on female reproductive function[J].Obes Rev,2008,9:181-183.
[6] Physical status:the use and interpretation of anthropometry report of a WHO expert committee[J].World Health Organ Tech Rep Ser,1995,854:1-452.
[7] WHO.世界卫生组织人类精液检查与处理实验室手册[M].第5版,北京:人民卫生出版社,2011.
[8]吴永明,徐华,李玉,等.超重及肥胖与精液常规参数及精浆生化指标关系研究[J].实验与检验医学,2014,32:500-502.
[9] Ferramosca A,Conte A,Moscatelli N.A high-fat diet negatively affects rat sperm mitochondrial respiration[J].Andrology,2016,4:520-525.
[10] Xu X,Sun M,Ye J,et al.The effect of aromatase on the reproductive function of obese males[J].Horm Metab Res,2017,49:572-579.
[11] Niederberger C.Re:The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy[J].J Urol,2012,187:1377.
[12]韩瑞钰,马婧,马姣英,等.肥胖男性精液参数与精浆炎性因子的相关性分析[J].中华男科学杂志,2017,23:894-898.
[13] Belloc S,Cohen-Bacrie M,Amar E,et al.High body mass index has a deleterious effect on semen parameters except morphology:results from a large cohort study[J].Fertil Steril,2014,102:1268-1273.
[14] Provost MP,Acharya KS,Acharya CR,et al.Pregnancy outcomes decline with increasing body mass index:analysis of239,127fresh autologous in vitro fertilization cycles from the2008-2010 society for assisted reproductive technology registry[J].Fertil Steril,2016,105:663-669.
[15] Xia W,Chiu YH,Afeiche MC,et al.Impact of men’s dairy intake on assisted reproductive technology outcomes among couples attending a fertility clinic[J].Andrology,2016,4:277-283.
[16] Moschos S,Chan JL.Leptin and reproduction:a review[J].Fertil Steril,2002,77:433-444.
[17]李江源.精子发生的内分泌激素调节[J].生殖医学杂志,2014,23:697-702.
[18] Cincik M,Ergur AR,Tutuncu L,et al.Combination of hypoosmotic swelling/eosin Y test for sperm membrane integrity evaluation:correlations with other sperm parameters to predict ICSI cycles[J].Arch Androl,2007,53:25-28.
[19]张红烨,陆金春,冯瑞祥.24种精浆生化指标与精液常规参数的相关性研究[J].中华男科学杂志,2015,21:1087-1092.
[20] Jayaraman V,Ghosh S,Sengupta A,et al.Identification of biochemical differences between different forms of male infertility by nuclear magnetic resonance(NMR)spectroscopy[J].J Assist Reprod Genet,2014,31:1195-1204.
[21]覃湛,袁逸之,袁少英,等.精索静脉曲张不育症患者精浆生化标志物与精子顶体酶的测定与分析[J].中国医药导报,2014,11:12-16.
[22] Salgado RM,Marques-Silva MH,Gon9alves E,et al.Effect of oral administration of tribulus terrestris extract on semen quality and body fat index of infertile men[J].Andrologia,2017,49(5).doi:10.1111/and.12655.
[23] Kahn BE.Obesity and male infertility[J].Curr Opin Urol,2017,27:441-445.