Yang Si-Jie, Li Ting, Liu Wen, Li Shi-Jun, Xie Nan, Zhang Chen, Gao Xuan, Liu Xiao-Dan
Center of Reproductive Medicine / National Research Center for Assisted Reproductive Technology and Reproductive Genetics / Key Laboratory of the Ministry of Education for Reproductive Endocrinology, Shandong University, Jinan, Shandong 250001, China.
Zhonghua Nan Ke Xue. 2018;24(1):39-44.
To investigate the application value of pre-implantation genetic screening (PGS) in intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) for infertile patients with high sperm DNA fragmentation index (DFI).
We selected 90 infertile patients undergoing ICSI-ET in our center from April 2015 to October 2016, 60 with sperm DFI =≥15% and 30 with sperm DFI <15%. Of the 60 cases with sperm DFI =≥15%, 30 received PGS-ICSI (high DFI-PGS group) while the other 30 did not receive PGS (high DFI-ICSI group). The 30 cases with sperm DFI <15% were included in the low DFI-ICSI group. We made comparisons between the high and low DFI-ICSI groups in the rates of normal fertilization, good-quality embryos, blastocyst formation and embryo implantation as well as between the high DFI-PGS and high DFI-ICSI groups in the ages of the males and females, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in the males, sperm concentration, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DFI, and the rates of sperm nucleoprotein immaturity, normal fertilization, good-quality embryos, blastocyst formation and embryo implantation.
Statistically significant differences were found between the high and low DFI-ICSI groups in the rate of embryo implantation (31.25 vs 52.50%, P <0.01) but not in the rates of normal fertilization (［65.38 ± 24.62］ vs ［73.00 ± 17.00］%, P >0.05), good-quality embryos (［62.41 ± 25.97］ vs ［73.00 ± 22.10］%, P >0.05), or blastocyst formation (［62.55 ± 25.21］ vs ［64.30 ± 18.60］%, P >0.05). The rate of embryo implantation was markedly higher in the high DFI-PGS than in the high DFI-ICSI group (60.97% vs 31.25%, P <0.01), but there were no statistically significant differences between the two groups in the ages of the males and females, the levels of FSH, LH and T in the males, sperm concentration, the percentages of PMS and MNS, sperm DFI, sperm nucleoprotein immaturity, or the rates of normal fertilization (［69.76 ± 15.82］ vs ［65.38 ± 24.62］%, P >0.05), good-quality embryos (［64.42 ± 30.75］ vs ［62.41 ± 25.97］%, P >0.05) and blastocyst formation (［67.53 ± 19.24］ vs ［62.55 ± 25.21］%, P >0.05).
For the infertile patients with sperm DFI =≥15%, PGS-ICSI, rather than ICSI alone, can significantly increase the rate of embryo implantation.
探讨胚胎植入前遗传学筛查（PGS）在精子DNA碎片指数（DFI）高的不孕患者卵胞浆内单精子注射（ICSI）及胚胎移植（ET）中的应用价值。
选取2015年4月至2016年10月在本中心接受ICSI-ET的90例不孕患者，其中精子DFI≥15%者60例，精子DFI<15%者30例。在精子DFI≥15%的60例患者中，30例接受PGS-ICSI（高DFI-PGS组），另30例未接受PGS（高DFI-ICSI组）。将精子DFI<15%的30例患者纳入低DFI-ICSI组。比较高、低DFI-ICSI组的正常受精率、优质胚胎率、囊胚形成率和胚胎植入率，以及高DFI-PGS组与高DFI-ICSI组的男女年龄、男性卵泡刺激素（FSH）、黄体生成素（LH）和睾酮（T）水平、精子浓度、前向运动精子百分比（PMS）、形态正常精子百分比（MNS）、精子DFI、精子核蛋白未成熟率、正常受精率、优质胚胎率、囊胚形成率和胚胎植入率。
高、低DFI-ICSI组在胚胎植入率上差异有统计学意义（31.25%对52.50%，P<0.01），但在正常受精率（［65.38±24.62］%对［73.00±17.00］%，P>0.05）、优质胚胎率（［62.41±25.97］%对［73.00±22.10］%，P>0.05）或囊胚形成率（［62.55±25.21］%对［64.30±18.60］%，P>0.05）上差异无统计学意义。高DFI-PGS组的胚胎植入率明显高于高DFI-ICSI组（60.97%对31.25%，P<0.01），但两组在男女年龄、男性FSH、LH和T水平、精子浓度、PMS和MNS百分比、精子DFI、精子核蛋白未成熟率、正常受精率（［69.76±15.82］%对［65.38±24.62］%，P>0.05）、优质胚胎率（［64.42±30.75］%对［62.41±25.97］%，P>0.
