Biology of Reproduction, CECOS Laboratory, Normandie Univ., UNIROUEN, EA 4308 "Gametogenesis and Gamete Quality", Rouen University Hospital, F 76000, Rouen, France.
ART Center, Normandie Univ., UNIROUEN, Rouen University Hospital, F 76000, Rouen, France.
J Assist Reprod Genet. 2019 Jul;36(7):1387-1399. doi: 10.1007/s10815-019-01471-4. Epub 2019 Jul 9.
The impact of sperm DNA damage on intracytoplasmic sperm injection (ICSI) outcomes remains controversial. The purpose of the study was to evaluate the prognostic value of several types of sperm nuclear damage on ICSI clinical pregnancy.
Our retrospective study included a total of 132 couples who consulted for male or mixed-factor infertility that benefited from ICSI cycles from January 2006 to December 2015. All infertile males presented at least one conventional semen parameter alteration. Sperm nuclear damage was assessed using the Motile Sperm Organelle Morphological Examination for sperm head relative vacuolar area (RVA), aniline blue staining for chromatin condensation, terminal deoxynucleotidyl transferase dUTP nick-end labeling for DNA fragmentation, and fluorescence in situ hybridization for aneuploidy.
Infertile males who achieved pregnancy after ICSI had fewer chromatin condensation defects than did males who did not achieve any pregnancy (15.8 ± 12.0% vs. 11.4 ± 7.9%, respectively, P = 0.0242), which remained significant in multivariate regression analysis (RR = 0.40 [0.18 to 0.86], P = 0.02). RVA, DNA fragmentation, and aneuploidy were not predictive factors of ICSI outcomes. The pregnancy rate was significantly decreased by number of progressive motile spermatozoa with normal morphology after migration (P = 0.04). In female partners, 17β estradiol of less than 2000 pg/mL on the day of ovulation induction significantly reduced the occurrence of clinical pregnancy (P = 0.04).
Sperm chromatin condensation defects were more frequently observed in couples with ICSI failure and should be considered a negative predictive factor for the occurrence of clinical pregnancy.
精子 DNA 损伤对卵胞浆内单精子注射（ICSI）结局的影响仍存在争议。本研究旨在评估几种类型的精子核损伤对 ICSI 临床妊娠的预测价值。
我们的回顾性研究共纳入 132 对因男性或混合因素不孕而于 2006 年 1 月至 2015 年 12 月接受 ICSI 周期治疗的夫妇。所有不育男性至少存在一项常规精液参数异常。采用精子头部相对空泡区（RVA）的运动精子细胞器形态检查、苯胺蓝染色评估染色质浓缩、末端脱氧核苷酸转移酶 dUTP 缺口末端标记法评估 DNA 碎片化、荧光原位杂交评估非整倍体来评估精子核损伤。
ICSI 后妊娠的不育男性的染色质浓缩缺陷少于未妊娠的男性（分别为 15.8%±12.0%和 11.4%±7.9%，P=0.0242），这在多变量回归分析中仍然具有统计学意义（RR=0.40[0.18 至 0.86]，P=0.02）。RVA、DNA 碎片化和非整倍体不是 ICSI 结局的预测因素。经迁移后具有正常形态的前向运动精子数减少显著降低妊娠率（P=0.04）。在女性伴侣中，排卵诱导日 17β 雌二醇低于 2000pg/mL 显著降低了临床妊娠的发生（P=0.04）。
ICSI 失败的夫妇中更常观察到精子染色质浓缩缺陷，应将其视为临床妊娠发生的阴性预测因素。
