ICSI 后获得的精子与手术获得的精子对婴儿临床和新生儿结局的影响：一项回顾性队列研究。
Clinical and Neonatal Outcomes of Children Born After ICSI With or Without Surgically Acquired Sperm: A Retrospective Cohort Study.
机构信息
The Reproduction Center, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jan 25;12:788050. doi: 10.3389/fendo.2021.788050. eCollection 2021.
OBJECTIVE
The purpose of this study was to explore the effects of different methods of obtaining sperm for intracytoplasmic sperm injection (ICSI) cycles on the live birth rate (LBR) and neonatal outcomes.
METHODS
This was a single-center retrospective cohort study conducted from January 2016 to December 2019. A total of 3557 ICSI cycles were included in the analysis, including 540 cycles in the surgically acquired sperm group and 3017 cycles in the ejaculated sperm group. The main outcome measure was the LBR.
RESULTS
The clinical pregnancy rate in the surgically acquired sperm group was 69.4%, which was significantly higher than the 59.7% clinical pregnancy rate in the ejaculated sperm group (P=0.01). The LBR of the surgically acquired sperm group was significantly higher than that of the ejaculated sperm group (63.1% 51.2%, P<0.01). Similarly, the singleton LBR was also higher in the surgically acquired sperm group than in the ejaculated sperm group (45.4% 39.2%, P=0.04). Due to differences in the baseline characteristics of the two groups, multiple logistic regression analysis was performed. After multiple logistic regression analysis, the different methods of obtaining sperm were independent risk factors influencing the clinical pregnancy rate (adjusted odds ratio (AOR)=0.73, 95% confidence (CI)=0.56-0.95, P=0.02) and LBR (AOR=0.69, 95% CI=0.54-0.89, P=0.01). The preterm birth rate (AOR=1.42, 95% CI=0.62-3.25, P=0.41) and the incidence of low birth weight (AOR=1.03, 95% CI=0.45-2.34, P=0.95), small for gestational age (AOR=0.81, 95% CI=0.39-1.68, P=0.57), macrosomia (AOR=0.88, 95% CI=0.47-1.66, P=0.70) and large for gestational age (AOR=1.08, 95% CI=0.65-1.82, P=0.76) were not affected by the different methods.
CONCLUSION
The clinical pregnancy rate and LBR of the surgically acquired sperm group were higher than those of the ejaculated sperm group. There was no significant difference between the neonatal outcomes of the two groups.
目的
本研究旨在探讨不同方法获取精子进行卵胞浆内单精子注射（ICSI）周期对活产率（LBR）和新生儿结局的影响。
方法
这是一项单中心回顾性队列研究，于 2016 年 1 月至 2019 年 12 月进行。共纳入 3557 例 ICSI 周期，其中 540 例为手术获取精子组，3017 例为射出精子组。主要结局指标为活产率。
结果
手术获取精子组的临床妊娠率为 69.4%，明显高于射出精子组的 59.7%（P=0.01）。手术获取精子组的 LBR 明显高于射出精子组（63.1% 51.2%，P<0.01）。同样，手术获取精子组的单胎活产率也高于射出精子组（45.4% 39.2%，P=0.04）。由于两组基线特征存在差异，因此进行了多因素 logistic 回归分析。多因素 logistic 回归分析后，获取精子的不同方法是影响临床妊娠率（调整优势比（AOR）=0.73，95%置信区间（CI）=0.56-0.95，P=0.02）和 LBR（AOR=0.69，95% CI=0.54-0.89，P=0.01）的独立危险因素。早产率（AOR=1.42，95% CI=0.62-3.25，P=0.41）和低出生体重发生率（AOR=1.03，95% CI=0.45-2.34，P=0.95）、小于胎龄儿发生率（AOR=0.81，95% CI=0.39-1.68，P=0.57）、巨大儿发生率（AOR=0.88，95% CI=0.47-1.66，P=0.70）和大于胎龄儿发生率（AOR=1.08，95% CI=0.65-1.82，P=0.76）不受不同方法的影响。
结论
手术获取精子组的临床妊娠率和 LBR 高于射出精子组。两组新生儿结局无显著差异。
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