[优化精子的精子畸形指数、顶体异常率及精子DNA碎片指数在预测体外受精受精失败中的价值]

[Values of the sperm deformity index, acrosome abnormity rate, and sperm DNA fragmentation index of optimized sperm in predicting IVF fertilization failure].

作者信息

Jiang Wei-jie, Jin Fan, Zhou Li-ming

出版信息

Zhonghua Nan Ke Xue. 2016 Feb;22(2):147-52.

Abstract

OBJECTIVE

To investigate the values of the sperm deformity index (SDI), acrosome abnormity rate (AAR), and DNA fragmentation index (DFI) of optimized sperm in the prediction of fertilization failure (fertilization rate < 25%) in conventional in vitro fertilization (IVF).

METHODS

We selected 695 cycles of conventional IVF for pure oviductal infertility in this study, including 603 cycles of normal fertilization and 92 cycles of fertilization failure. On the day of oocyte retrieval, we examined sperm morphology, acrosome morphology, and DNA fragmentation using the Diff-Quik, PSA-FITC and SCD methods. We established the joint predictor (JP) by logistic equation and analyzed the values of different parameters in predicting fertilization failure with the receiver operating characteristic (ROC) curve.

RESULTS

The fertilization rate was negatively correlated with SDI (r = - 0.07; P = 0.03), AAR (r = -0.49; P < 0.01), and DFI (r = -0. 21; P < 0.01). The SDI, AAR, and DFI in the normal fertilization group were 1.24 ± 0.20, (7.75 ± 2.28)%, and (7.87 ± 3.15)%, and those in the fertilization failure group were 1.42 ± 0.15, (12.02 ± 3.06)%, and (13.32 ± 4.13)%, respectively, all with statistically significant differences between the two groups (P < 0.05). SDI, AAR, and DFI were all risk factors of fertilization failure ( OR = 2.68, 14.11, and 3.85; P = 0.01, < 0.01, and < 0.01). The areas under the ROC curves for SDI, AAR, DFI, and JP were 0.651 ± 0.033, 0.895 ± 0.019, 0.789 ± 0.022, and 0.915 ± 0.017, respectively. According to the Youden index, the optimal cut-off values of SDI, AAR, and DFI obtained for the prediction of fertilization failure were approximately 1.45, 10%, and 12%.

CONCLUSION

The SDI, AAR and DFI of optimized sperm are closely associated with the fertilization rate, and all have the value for predicting fertilization failure in IVF. The AAR is more valuable than the other single predictors, but JP is more effective than the AAR.

摘要

目的

探讨优化精子的精子畸形指数（SDI）、顶体异常率（AAR）及DNA碎片指数（DFI）在预测常规体外受精（IVF）中受精失败（受精率<25%）方面的价值。

方法

本研究选取695个单纯输卵管性不孕的常规IVF周期，其中正常受精周期603个，受精失败周期92个。在取卵日，采用Diff-Quik、PSA-FITC和SCD方法检测精子形态、顶体形态及DNA碎片情况。通过逻辑方程建立联合预测指标（JP），并采用受试者工作特征（ROC）曲线分析不同参数预测受精失败的价值。

结果

受精率与SDI（r = - 0.07；P = 0.03）、AAR（r = -0.49；P < 0.01）及DFI（r = -0. 21；P < 0.01）呈负相关。正常受精组的SDI、AAR及DFI分别为1.24±0.20、（7.75±2.28）%及（7.87±3.15）%，受精失败组分别为1.42±0.15、（12.02±3.06）%及（13.32±4.13）%，两组间差异均有统计学意义（P < 0.05）。SDI、AAR及DFI均为受精失败的危险因素（OR = 2.68、14.11及3.85；P = 0.01、< 0.01及< 0.01）。SDI、AAR、DFI及JP的ROC曲线下面积分别为0.651±0.033、0.895±0.019、0.789±0.022及0.915±0.017。根据约登指数，预测受精失败时SDI、AAR及DFI的最佳截断值分别约为1.45、10%及12%。