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目的了解精子形态在体外受精(in vitro fertilization,IVF)中的作用。方法回顾性调查在本生殖中心接受常规IVF治疗者共397个周期的精子正常形态率,397个周期按精子正常形态率不同分为A组(≤5%)、B组(5%14%),按IVF临床结局分为临床妊娠、未妊娠及未移植组,分析其与精液其他参数的关系以及对IVF结局的影响。结果精子正常形态率与精液其他参数如精子密度、活率及前向运动精子百分率(PMS)呈显著的正相关(r分别为0.188、0.197、0.190,P<0.01),精子正常形态率、精子密度、活率及PMS与受精率均呈显著的正相关关系(r分别为0.237、0.171、0.155、0.187,P<0.01)。A、B组及C组间受精率差异存在统计学意义(P<0.05),未移植组的精子正常形态率为(15.53±7.54)%,明显低于临床妊娠组的(20.05±9.51)%(P<0.05),但临床妊娠组与未妊娠组(19.06±9.14)%之间差异无统计学意义(P>0.05)。在继发不孕患者中,A组年龄[(41.4±14.1)岁]明显大于B组[(35.4±6.4)岁]和C组[(34.7±4.6)岁](P<0.05,P<0.01)。结论精子形态对IVF受精率和结局有影响,精子正常形态率可能是预测IVF结果更好的参数;随着年龄的增长,精子正常形态率下降。
Objective To understand the role of sperm morphology in in vitro fertilization (IVF). Methods A total of 397 cycles of sperm normal morphology in this reproductive center were retrospectively studied. The 397 cycles were divided into group A (≤5%), group B (5% 14%). According to the clinical outcome of IVF, they were divided into clinical pregnancy, non-pregnancy and non-transplantation group, and their relationship with other parameters of semen and the influence on IVF outcome were analyzed. Results There was a significant positive correlation between normal sperm motility and other semen parameters such as sperm density, viability and forward motile spermatozoa percentage (r = 0.188,0.197,0.190, P <0.01, respectively), sperm normal morphology, There was a significant positive correlation between density, viability, PMS and fertilization rate (r = 0.237,0.171,0.155,0.187, P <0.01). There was a significant difference in fertilization rate between A, B and C groups (P <0.05). The normal sperm morphology of non-transplanted group was (15.53 ± 7.54)%, which was significantly lower than that of clinical pregnancy group (20.05 ± 9.51)% (P <0.05), but there was no significant difference between clinical pregnancy group and non-pregnant group (19.06 ± 9.14)% (P> 0.05). In the group of secondary infertility, the age of group A (41.4 ± 14.1) was significantly higher than that of group B (35.4 ± 6.4) and group C (34.7 ± 4.6) (P <0.05, P <0.01) ). Conclusion The morphology of sperm affects the fertilization rate and outcome of IVF. The normal morphology rate of sperm may be a better parameter for predicting IVF outcome. As the age increases, the normal sperm morphology rate decreases.