Reproductive Medicine Center, Xiangya Hospital, Central South University, Hunan, People's Republic of China.
Reproductive Medicine Center, Xiangya Hospital, Central South University, Hunan, People's Republic of China.
Fertil Steril. 2014 Oct;102(4):998-1005.e8. doi: 10.1016/j.fertnstert.2014.06.033. Epub 2014 Sep 1.
To examine whether sperm DNA fragmentation has an effect on pregnancy and miscarriage after IVF and/or intracytoplasmic sperm injection (ICSI).
Systematic review and meta-analysis.
University-affiliated teaching hospital.
PATIENT(S): Infertility patient(s).
INTERVENTION(S): An exhaustive electronic literature search was conducted on MEDLINE, Google Scholar, and the Cochrane Library, from database inception to October 2013. We included clinical trials that examined the influence of sperm DNA damage on pregnancy and miscarriage of IVF/ICSI.
MAIN OUTCOME MEASURE(S): The outcomes of interest were pregnancy rate and miscarriage rate.
RESULT(S): In the analysis of pregnancy, 16 cohort studies (3,106 couples) were included. Of these, 14 studies (2,756 couples, 965 pregnancies) that also mentioned miscarriage were identified in the analysis of miscarriage. Meta-analysis showed that high-level sperm DNA fragmentation has a detrimental effect on outcome of IVF/ICSI, with decreased pregnancy rate and increased miscarriage rate. The stratified analysis by type of procedure (IVF vs. ICSI) indicated that high sperm DNA damage was related to lower pregnancy rates in IVF but not in ICSI cycles, whereas it was associated with higher miscarriage rates in both IVF and ICSI cycles.
CONCLUSION(S): The results indicate that assays detecting sperm DNA damage should be recommended to those suffering from recurrent failure to achieve pregnancy. Selection of sperm without DNA damage for use may improve the clinical outcome of ART. The data also provide a rationale for conducting further research aimed at evaluating the underlying mechanism(s) responsible for the detrimental effect of high sperm DNA fragmentation and the potential therapy.
探讨精子 DNA 碎片化对体外受精和/或卵胞浆内单精子注射（ICSI）后妊娠和流产的影响。
系统评价和荟萃分析。
大学附属教学医院。
患者（s）：不孕患者（s）。
对 MEDLINE、Google Scholar 和 Cochrane 图书馆进行了全面的电子文献检索，检索时间从数据库建立到 2013 年 10 月。我们纳入了研究精子 DNA 损伤对体外受精/ICSI 妊娠和流产影响的临床试验。
感兴趣的结果是妊娠率和流产率。
在妊娠分析中，纳入了 16 项队列研究（3106 对夫妇）。其中，在流产分析中还确定了 14 项研究（2756 对夫妇，965 例妊娠）。荟萃分析表明，高水平的精子 DNA 碎片化对体外受精/ICSI 的结果有不利影响，降低了妊娠率，增加了流产率。按手术类型（IVF 与 ICSI）进行的分层分析表明，精子 DNA 损伤高与 IVF 周期妊娠率降低有关，但与 ICSI 周期妊娠率无关，而与 IVF 和 ICSI 周期流产率升高有关。
结果表明，建议对反复妊娠失败的患者进行精子 DNA 损伤检测。选择无 DNA 损伤的精子用于受精可能会改善 ART 的临床结局。这些数据还为进一步研究提供了依据，旨在评估高水平精子 DNA 碎片化的有害影响及其潜在治疗机制。
