上游处理前后精子形态与IVF结局的关系

发布时间：2018-04-12 21:44

本文选题：Kruger标准 + 受精率　；参考：《中国医科大学》2008年硕士论文

【摘要】： 目的通过对取卵当日男方上游后精子进行形态学分析,探讨其与IVF结局各项指标之间的关系,并与未处理的原始精液中精子形态与IVF结局间的关系进行比较,以期为单纯卵管因素不孕夫妇实施IVF提供更为准确的指导标准。方法对单纯由于卵管因素造成不孕的夫妇经Kruger标准对处理前后的精子形态进行分析后,以正常形态10%为界,分别将上游前后的数据分为两组,即正常形态≥10%组和正常形态＜10%组。上游前后两组女方年龄、FSH和取卵数间,男方精子总活动率、前向运动率及a级精子百分比间差异均无统计学差异。结果平均受精率为72.15%,95%可信区间为(68.84%,75.46%),平均卵裂率为95.45%,95%可信区间为(93.49%,97.40%)。优质胚胎率总平均值为21.83%,95%可信区间为(17.78%,25.88%)。总的临床妊娠率为40.66%(37/91)。总的种植率为19.70%(40/203)。上游前以正常形态10%为界分组后,精子正常形态≥10%组的受精率为72.90%±4.234%,卵裂率为95.20%±2.607%,优质胚胎率为23.35%±5.194%,临床妊娠率为39.58%,种植率为18.35%;＜10%组受精率为71.33%±5.096%,卵裂率95.71%±2.881%,优质胚胎率为20.18%±6.154%,妊娠率为41.86%,种植率为21.28%。无论是≥10%组还是＜10%组,其IVF结局各项指标之间均不存在统计学联系(p＞0.05)。上游处理后,精子正常形态≥10%组受精率为72.72%±3.352%,卵裂率为95.64%±2.038%,优质胚胎率为24.39%±4.567%,临床妊娠率为50%,种植率为23.87%;＜10%组受精率为70.27%±8.820%,卵裂率为94.82%±4.939%,优质胚胎率为13.45%±7.389%,临床妊娠率为9.52%,种植率为6.25%。尽管二组之间受精率及卵裂率的差异不存在显著性,但优质胚胎率、妊娠率及种植率间的差异具有统计学意义(p＜0.05)。结论上游前的精子形态与妊娠结局之间不具有统计学联系,通过观察上游前精子正常形态百分比不能很好的预测妊娠结局。上游后精子正常形态百分比虽然与受精率和卵裂率之间没有联系,但与优质胚胎率、种植率和妊娠率之间存在着明显的统计学联系。因此,对于女方为单纯卵管因素不孕,男方的生殖能力不存在器质和功能异常且精液常规检查基本正常的夫妇,若其精液样本经过上游处理后,应用Kruger标准评价正常形态精子≥10%,则可以建议他们实施常规的IVF-ET治疗;若正常形态精子＜10%,这时最好应用其他辅助生殖技术以期得到更好的结果。
[Abstract]:objective
The man on the day of oocyte retrieval after sperm morphology analysis of the upstream, and explore its relationship with IVF outcome indicators, compare the relationship between sperm morphology and outcome of IVF and the original semen and untreated, in order to implement IVF simple tubal factor infertility couples provide more accurate guidance standards.
Method
The only due to tubal factors causing infertility couples by the standard Kruger treatment on the sperm morphology analysis, the normal form of 10% circles, respectively before and after the upstream data were divided into two groups, namely the normal form of more than 10% group and normal group. Morphology of < 10% upstream of the two groups before and after the age of FSH and female. The number of eggs, the total sperm activity rate were no significant difference between the forward rate and the percentage of sperm movement level differences.
Result
The average fertilization rate was 72.15%, 95% confidence interval (68.84%, 75.46%), the average cleavage rate was 95.45%, 95% confidence interval (93.49%, 97.40%). The total average rate of high quality embryos was 21.83%, 95% confidence interval (17.78%, 25.88%). The total clinical pregnancy rate was 40.66% (37/91) of the total. The implantation rate was 19.70% (40/203).
Prior to the 10% normal form for the upstream industry group, more than 10% of the normal sperm morphology group fertilization rate was 72.90% + 4.234%, the cleavage rate was 95.20% + 2.607%, 23.35% + 5.194% high-quality embryo rate, clinical pregnancy rate was 39.58%, the implantation rate was 18.35%; P < 10% group fertilization rate was 71.33% + 5.096%, the cleavage rate of 95.71% + 2.881%, 20.18% + 6.154% high-quality embryo rate, pregnancy rate was 41.86%, the implantation rate was 21.28%. it is larger than 10% or less than 10% group group, between the IVF outcome indicators were not statistically associated (P > 0.05).
Upstream after treatment, more than 10% normal sperm morphology group fertilization rate was 72.72% + 3.352%, the cleavage rate was 95.64% + 2.038%, 24.39% + 4.567% high-quality embryo rate, clinical pregnancy rate was 50%, the implantation rate was 23.87%; P < 10% group fertilization rate was 70.27% + 8.820%, 94.82% + 4.939% cleavage rate, high-quality embryo rate 13.45% + 7.389%, the clinical pregnancy rate was 9.52%, the implantation rate was 6.25%. despite the differences between the two groups the fertilization rate and cleavage rate was not significant, but the rate of high quality embryos, statistically significant differences in pregnancy rate and implantation rate between (P < 0.05).
conclusion
Is not a statistical association between the upstream sperm morphology and pregnancy outcome, pregnancy outcome prediction by observing the percentage of normal sperm morphology before the upper reaches is not very good. Although the percentage of normal sperm morphology after upstream between the fertilization rate and the cleavage rate of no contact, but with the high quality embryo rate exist significant obvious connections between implantation rate and pregnancy rate. Therefore, for the woman as simple tubal factor infertility. Male reproductive ability there is no structural and functional abnormalities and their normal semen routine examination, if the semen samples by upstream after application of Kruger standard in evaluation of normal sperm morphology is more than 10%, you can suggest that they implement regular IVF-ET treatment; if normal sperm morphology is less than 10%, then the best application of assisted reproductive technology in order to get better results.

【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R321-33

【共引文献】