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目的:探讨未经优化处理的精子形态参数在常规体外受精(IVF)中的应用价值。方法:分析优化处理前后精子形态差异,并根据处理前精子形态将因单纯输卵管因素进行IVF的908个周期进行分组:研究1为≤4%组、>4%~≤15%组及>15%组;研究2为≤1%组、>1%~≤2%组、>2%~≤3%组及>3%~≤4%组,分别比较各组间的受精率、卵裂率、优质胚胎率、囊胚转化率及妊娠率等指标有无显著性差异。结果:正常形态精子百分率≤4%组的总受精率显著低于>4%~≤15%组及>15%组(74.40%vs 78.61%及80.03%)(P<0.01);>3%~≤4%组的2PN受精率(85.47%vs 77.23%、78.97%及78.99%)、卵裂率(98.73%vs 95.71%、96.01%和97.27%)、囊胚形成率(63.41%vs 53.85%、49.01%和49.55%)均显著高于≤1%组、>1%~≤2%组及>2%~≤3%组(P<0.01或0.05),而临床妊娠率、种植率、早期流产率、活产率、出生畸形率各组间均无统计学差异(P>0.05)。结论:正常形态精子百分率≤4%可影响IVF的总受精率,正常形态精子百分率≤3%时IVF的正常受精率下降。但即使正常形态精子百分率≤1%仍不会造成受精障碍或受精失败,因此,畸形精子症不能单独成为决定ICSI的指征。同时,精子形态检测对IVF的胚胎质量、临床妊娠率及抱婴率等无明显预测意义。
Objective: To investigate the value of unprocessed sperm morphology parameters in routine in vitro fertilization (IVF). Methods: The differences of sperm morphology before and after optimization were analyzed. 908 cycles of simple fallopian tube factor (IVF) were divided according to pre-treatment sperm morphology. Study 1 was ≤4%,> 4% ≤15%, and> 15% Group 2, group 1 ≤1%, group ≥1% ≤≤2%, group ≥2% ≤≤3% and group ≥3% ≤≤4%. The fertilization rate, cleavage rate, Quality embryo rate, blastocyst conversion rate and pregnancy rate and other indicators have no significant difference. Results: The total fertilization rate of normal spermatozoa ≤4% was significantly lower than that of> 4% ~ ≤15% and> 15% (74.40% vs 78.61%, 80.03%) (P <0.01) The rates of blastocyst formation (63.41% vs 53.85%, P <0.05) were significantly higher in the group of ≤ 4% of 2PN fertilization (85.47% vs 77.23%, 78.97% and 78.99% 49.01% and 49.55% respectively) were significantly higher than those in ≤1%,> 1% ≤2% and> 2% ~ ≤3% (P <0.01 or 0.05), while clinical pregnancy rate, implantation rate, early abortion Rate, live birth rate, birth deformity rate between the groups showed no significant difference (P> 0.05). Conclusion: The percentage of sperm in normal form ≤ 4% can affect the total fertilization rate of IVF. The normal fertilization rate of IVF decreases when the percentage of normal sperm ≤ 3%. However, even if the percentage of normal spermatozoa ≤1% still does not cause fertilization disorder or fertilization failure, so abnormal spermosis can not alone become an indication of ICSI. At the same time, there was no significant predictive value of sperm morphology detection on IVF embryo quality, clinical pregnancy rate and infantization rate.