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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。
Objective: To observe the influence of sperm morphological parameters on the fertilization rate of in vitro fertilization and embryo transfer (IVF-ET) and to explore the clinical significance of sperm morphology parameters. Methods: A retrospective analysis of 824 couples from IVF-ET at the First Affiliated MCH Hospital of Tongji University from April 2016 to September 2016 was performed to screen for women who had undergone gynecological examinations for tubal factors, Controlled schedule for the promotion of short-term long-term program to exclude the failure to obtain eggs, the number of oocytes in the 6 to 15, excluding intraoperative day egg oocyte retrieval sperm injection (intracytoplasmic sperm injection, ICSI) and short-term fertilization samples . Male preoperative sperm routine examination of more than 2 times, the total number of forward motility sperm are more than 5 million, and ruled out the man’s infection, heredity and other factors, into the group of 136 pairs of observed objects. The male and female age, the normal sperm morphology, sperm concentration, percentage of forward motile sperm, head deformity, caudal deformity and sperm acrosome percentage of sperm head as the independent variable, fertilization rate as a variable, the line Logistic regression analysis. Results: The male age was (34.12 ± 4.30) years old (27-46 years old), the female age was (32.32 ± 4.14) years old (25-43 years old), the duration of infertility was (2.77 ± 1.34) years year). Sperm head deformity rate and fertilization rate was negatively correlated (P = 0.035); while sperm acrosome area of sperm head percentage and fertilization rate was positively correlated (P = 0.046); other independent variables and fertilization rate was not statistically significant Sex. CONCLUSIONS: Sperm head deformity and acrosome size have an impact on fertilization rate of IVF. Therefore, clinical analysis of sperm morphology report should not only focus on normal morphological rate, but should further classify the various sperm deformities to make accurate judgments.