Fertility-Assisted Fertilization Center, São Paulo, Brazil.
Urology. 2011 Oct;78(4):786-91. doi: 10.1016/j.urology.2011.06.018. Epub 2011 Aug 5.
To (1) analyze possible relationships between motile sperm organelle morphology examination (MSOME) and sperm chromatin status, aneuploidy incidence, and patient's age; (2) determine the effects of sperm morphologic abnormalities on intracytoplasmic sperm injection (ICSI) outcomes; and (3) identify the benefits of intracytoplasmic morphologically selected sperm injection (IMSI) in patients with high DNA fragmentation rate.
The study was performed in 50 patients undergoing ICSI cycles. The MSOME, sperm DNA fragmentation, and sperm aneuploidy incidence were performed in 200 sperm cells of each patient. Regression models were used to assess the relationships among sperm morphology and sperm aneuploidy, sperm DNA fragmentation, patient's age, and ICSI outcomes. In cycles with patients showing a high incidence of DNA fragmentation, oocytes were split into 2 groups according to the sperm selection method: Standard-ICSI (n = 82) and IMSI (n = 79). Fertilization and high-quality embryo rates were compared between the groups.
A close relationship between sperm DNA fragmentation and the presence of vacuoles in the MSOME was noted. The patient's age was correlated to the presence of vacuoles. No correlation between sperm aneuploidy and IMSI was observed. Vacuolated cells were negatively correlated with fertilization, pregnancy, and implantation. In patients with a high incidence of sperm DNA fragmentation, fertilization and high-quality embryo rates were similar when comparing IMSI and Standard-ICSI.
Our data demonstrate a correlation between paternal age and the incidence of nuclear vacuoles, as well as an effect of large and small vacuoles on late embryo development.
（1）分析活动精子顶体形态检查（MSOME）与精子染色质状态、非整倍体发生率和患者年龄之间可能存在的关系；（2）确定精子形态异常对卵胞浆内单精子注射（ICSI）结果的影响；（3）确定在 DNA 碎片率高的患者中，细胞质内形态选择精子注射（IMSI）的益处。
该研究纳入了 50 例行 ICSI 周期的患者。对 200 个患者的精子进行了 MSOME、精子 DNA 碎片化和精子非整倍体发生率的检测。回归模型用于评估精子形态与精子非整倍体、精子 DNA 碎片化、患者年龄和 ICSI 结果之间的关系。在 DNA 碎片发生率较高的周期中，根据精子选择方法将卵母细胞分为 2 组：标准-ICSI（n=82）和 IMSI（n=79）。比较两组的受精率和优质胚胎率。
发现精子 DNA 碎片化与 MSOME 中出现空泡之间存在密切关系。患者年龄与空泡的出现相关。精子非整倍体与 IMSI 之间无相关性。空泡细胞与受精、妊娠和着床呈负相关。在 DNA 碎片发生率较高的患者中，比较 IMSI 和标准-ICSI 时，受精率和优质胚胎率相似。
我们的数据表明，父系年龄与核空泡的发生率之间存在相关性，大空泡和小空泡对晚期胚胎发育有影响。
