体外受精周期中正常精子形态对D 3优质胚胎的囊胚形成率及囊胚质量的影响
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摘要
目的探讨正常精子形态率(normal sperm morphology rate,NSMR)对D 3优质胚胎的囊胚形成率及囊胚质量的影响。方法回顾性分析2016～2017年在空军军医大学第二附属医院生殖医学中心采用体外受精(In vitro Fertilization,IVF)技术助孕患者的病例资料,共计3 894个取卵周期,11 521枚D 3优质胚胎。根据NSMR分为4组,A组:NSMR≥10%(272例),B组:4%≤NSMR≤9%(2 558例),C组:2%≤NSMR≤3%(977例),D组:NSMR≤1%(87例)。采用广义估计方程(generalized estimating equation,GEE)分析的方法,探讨NSMR对D 3优质胚胎囊胚及优质囊胚形成率的影响。结果囊胚形成率4组比较,差异无统计学意义(P>0.05);优质囊胚形成率:B组(30.4%)和C组(28.1%)低于A组(61.6%)(P<0.05),但矫正混杂因素后,A组设为对照组,结果显示B组与A组之间的差异性消失(P>0.05),且只有C组的优质囊胚率显著下降(P<0.05)。结论 NSMR虽然不影响囊胚形成率,但是随着NSMR降低,优质囊胚形成率呈下降趋势。
Objective To probe the effects of normal sperm morphology rate(NSMR)on blastocyst formation rate of D 3 high quality embryos and blastocyst quality during in vitro fertilization(IVF) cycle. Methods A retrospective analysis of the data of infertile patients with IVF technology from the Reproductive Medicine Center of the Second Affiliated Hospital of the Air Force Military Medical University from 2016 to 2017, totaling 3 894 egg retrieval cycles, 11 521 D 3 quality embryos.According to the NSMR, there were four groups: group A:NSMR≥10 %(272 cases),group B:4 %≤NSMR≤9 %(2 558 cases),group C:2 %≤NSMR≤3 %(977 cases)and group D:NSMR≤1 %(87 cases). The generalized estimating equation(GEE) analysis method was used to investigate the effect of NSMR on the formation rate of D 3 high quality embryo blastocysts and high quality blastocysts. Results There was no significant difference in blastocyst formation rate between the 4 groups(P>0.05). The high quality of blastocyst formation rate was lower in group B(30.4%) and C group(28.1%) than in group A(61.6%)(P<0.05). However, after adjusting for confounding factors, group A was set as the control group. The results showed that the difference between group B and group A disappeared(P>0.05), and only the high quality of blastocysts in group C decreased significantly(P<0.05). Conclusion Although NSMR does not affect the rate of blastocyst formation, with the decrease of NSMR, the formation rate of high quality blastocysts is decreasing.
Objective To probe the effects of normal sperm morphology rate(NSMR)on blastocyst formation rate of D 3 high quality embryos and blastocyst quality during in vitro fertilization(IVF) cycle. Methods A retrospective analysis of the data of infertile patients with IVF technology from the Reproductive Medicine Center of the Second Affiliated Hospital of the Air Force Military Medical University from 2016 to 2017, totaling 3 894 egg retrieval cycles, 11 521 D 3 quality embryos.According to the NSMR, there were four groups: group A:NSMR≥10 %(272 cases),group B:4 %≤NSMR≤9 %(2 558 cases),group C:2 %≤NSMR≤3 %(977 cases)and group D:NSMR≤1 %(87 cases). The generalized estimating equation(GEE) analysis method was used to investigate the effect of NSMR on the formation rate of D 3 high quality embryo blastocysts and high quality blastocysts. Results There was no significant difference in blastocyst formation rate between the 4 groups(P>0.05). The high quality of blastocyst formation rate was lower in group B(30.4%) and C group(28.1%) than in group A(61.6%)(P<0.05). However, after adjusting for confounding factors, group A was set as the control group. The results showed that the difference between group B and group A disappeared(P>0.05), and only the high quality of blastocysts in group C decreased significantly(P<0.05). Conclusion Although NSMR does not affect the rate of blastocyst formation, with the decrease of NSMR, the formation rate of high quality blastocysts is decreasing.
引文
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[22] SEKHON L,SHAIA K,SANTISTEVAN A,et al.The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response [J].Journal of Assisted Reproduction & Genetics,2017 (12):1-10.
[23] 速存梅,王珏,苏兰,等.影响宫腔内人工授精妊娠率的临床及精液因素分析 [J].中华妇幼临床医学杂志(电子版),2013,9(4):405-408.
[24] SPRESS?O M,OLIANI A H,OLIANI D C.Value of the ultrasound in the study of ovarian reserve for prediction of oocyte recovery [J].Revista Brasileira de Ginecologia e Obstetricia :Revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia,2016,38 (10):499-505.
[25] KNEZ K,ZORN B,TOMAZEVIC T,et al.The IMSI procedure improves poor embryo development in the same infertile couples with poor semen quality:a comparative prospective randomized study [J].Reproductive Biology and Endocrinology :RB&E,2011,9 (1):123.
[26] LEWIS-JONES I,AZIZ N,SESHADRI S,et al.Sperm chromosomal abnormalities are linked to sperm morphologic deformities [J].Fertility&Sterility,2003,79 (1):212-215.
[27] ENCISO M,CISALE H,JOHNSTON S D,et al.Major morphological sperm abnormalities in the bull are related to sperm DNA damage [J].Theriogenology,2011,76 (1):23-32.
[28] SEDó C A,BILINSKI M,LORENZI D,et al.Effect of sperm DNA fragmentation on embryo development:clinical and biological aspects [J].Jbra Assisted Reproduction,2017,21(4):343-350.
[29] COBAN O,SERDAROGULLARI M,SEKERCI Z O,et al.Evaluation of the impact of sperm morphology on embryo aneuploidy rates in a donor oocyte program [J].Systems Biology in Reproductive Medicine,2018,64 (3):169-173.
[30] CALOGERO A E,BURRELLO N,DE P-a,et al.Sperm aneuploidy in infertile men [J].Reproductive BioMedicine Online,2003,6 (3):310-317.
[31] GAT I,TANG K,QUACH K,et al.Sperm DNA fragmentation index does not correlate with blastocyst aneuploidy or morphological grading [J].PLOS One,2017,12 (6):e0179002.
[2] VANNI V S,SOMIGLIANA E,RESCHINI M,et al.Top quality blastocyst formation rates in relation to progesterone levels on the day of oocyte maturation in GnRH antagonist IVF/ICSI cycles [J].PLOS One,2017,12 (5):e0176482.
[3] BROUSSARD A L,COLVER R,REUTER L,et al.No difference in euploidy rates between patients under 35 and oocyte donors despite differences in blastocyst quality and developmental rates [J].Fertility and Sterility,2017,108 (3,S):E286.
[4] WIWEKO B,UTAMI P.Predictive value of sperm deoxyribonucleic acid (DNA) fragmentation index in male infertility [J].Basic and Clinical Andrology,2017,27 (1):1.
[5] ALCANTARA OLIVEIRA J B,MASSARO F C,RAZERA BARUFFI R L,et al.Correlation between semen analysis by motile sperm organelle morphology examination and sperm DNA damage [J].Fertility and Sterility,2010,94 (5):1937-1940.
[6] LI Bo,MA Ye-fei,HUANG Jian-lei,et al.Probing the effect of human normal sperm morphology rate on cycle outcomes and assisted reproductive methods selection [J].PLOS One,2014,9 (11):e113392.
[7] CHAPUIS A,GALA A,FERRIèRESHOA A,et al.Sperm quality and paternal age:effect on blastocyst formation and pregnancy rates [J].Basic & Clinical Andrology,2017,27 (1):2.
[8] WU Yi-xuan,KANG Xiang-jin,ZHENG Hai-yan,et al.Effect of paternal age on reproductive outcomes of in vitro fertilization [J].PLOS One,2015,10 (9):e0135734.
[9] 马媛,李懋,梁新新,等.不同位置子宫内膜息肉TCRP术后对IVF/ICSI妊娠结局的影响 [J].生殖医学杂志,2017,26(12):1206-1211.
[10] 周晶,李博,陈书强,等.冻融胚胎与新鲜胚胎移植的新生儿结局比较 [J].生殖医学杂志,2017,26(1):9-13.
[11] 中华医学会生殖医学分会第一届实验室学组.人类体外受精-胚胎移植实验室操作专家共识(2016) [J].生殖医学杂志,2017,26(1):1-8.
[12] BALABAN B,BRISON D,CALDERóN G,et al.The Istanbul consensus workshop on embryo assessment:proceedings of an expert meeting [J].Reproductive BioMedicine Online,2011,22 (6):632-646.
[13] 胡琳莉,黄国宁,孙海翔,等.CSRM指南共识的制定规范(2016) [J].生殖医学杂志,2017,26(4):289-301.
[14] MUNCH E M,SPARKS A E,ZIMMERMAN M B,et al.High FSH dosing is associated with reduced live birth rate in fresh but not subsequent frozen embryo transfers [J].Human Reproduction,2017,32 (7):1.
[15] TANNUS S,SON W Y,DAHAN M H.Elective single blastocyst transfer in advanced maternal age [J].Journal of Assisted Reproduction and Genetics,2017,34 (6):741-748.
[16] SUNDHARARAJ U,MADNE M,BILIANGADY R,et al.Single blastocyst transfer:the key to reduce multiple pregnancy rates without compromising the live birth rate [J].Journal of Human Reproductive Sciences,2017,10 (3):201-207.
[17] 姚元庆,张新艳.胚胎基因组的形成和激活 [J].生殖医学杂志,2008,17(6):499-502.
[18] BUYALOS R,LI M,KUMAR A,et al.Does advancing maternal age ameliorate the advantage of blastocyst transfer?the implantation rate of blastocyst compared to cleavage stage embryo transfer as a function of patient age [J].Fertility&Sterility,2011,95 (4):S 13-S 14.
[19] Mai Q Y,Huang K J,Center R M.Oocyte development and retrieval in advanced-age women [J].Journal of Reproductive Medicine,2016,25(10):884-887.
[20] AMSIEJIENE A,DRASUTIENE G,USONIENE A A,et al.The influence of age,body mass index,waist-to-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART [J].Gynecological Endocrinology,2017,33 (1):41-43.
[21] Kalmbach K,Antunes D,Wang F,et al.Oocyte telomere length is associated with ovarian reserve and ovarian response in female infertility patients [C]//American Society of Reproductive Medicine,2013:S45.
[22] SEKHON L,SHAIA K,SANTISTEVAN A,et al.The cumulative dose of gonadotropins used for controlled ovarian stimulation does not influence the odds of embryonic aneuploidy in patients with normal ovarian response [J].Journal of Assisted Reproduction & Genetics,2017 (12):1-10.
[23] 速存梅,王珏,苏兰,等.影响宫腔内人工授精妊娠率的临床及精液因素分析 [J].中华妇幼临床医学杂志(电子版),2013,9(4):405-408.
[24] SPRESS?O M,OLIANI A H,OLIANI D C.Value of the ultrasound in the study of ovarian reserve for prediction of oocyte recovery [J].Revista Brasileira de Ginecologia e Obstetricia :Revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia,2016,38 (10):499-505.
[25] KNEZ K,ZORN B,TOMAZEVIC T,et al.The IMSI procedure improves poor embryo development in the same infertile couples with poor semen quality:a comparative prospective randomized study [J].Reproductive Biology and Endocrinology :RB&E,2011,9 (1):123.
[26] LEWIS-JONES I,AZIZ N,SESHADRI S,et al.Sperm chromosomal abnormalities are linked to sperm morphologic deformities [J].Fertility&Sterility,2003,79 (1):212-215.
[27] ENCISO M,CISALE H,JOHNSTON S D,et al.Major morphological sperm abnormalities in the bull are related to sperm DNA damage [J].Theriogenology,2011,76 (1):23-32.
[28] SEDó C A,BILINSKI M,LORENZI D,et al.Effect of sperm DNA fragmentation on embryo development:clinical and biological aspects [J].Jbra Assisted Reproduction,2017,21(4):343-350.
[29] COBAN O,SERDAROGULLARI M,SEKERCI Z O,et al.Evaluation of the impact of sperm morphology on embryo aneuploidy rates in a donor oocyte program [J].Systems Biology in Reproductive Medicine,2018,64 (3):169-173.
[30] CALOGERO A E,BURRELLO N,DE P-a,et al.Sperm aneuploidy in infertile men [J].Reproductive BioMedicine Online,2003,6 (3):310-317.
[31] GAT I,TANG K,QUACH K,et al.Sperm DNA fragmentation index does not correlate with blastocyst aneuploidy or morphological grading [J].PLOS One,2017,12 (6):e0179002.