Center for Reproductive Medicine and Genetics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021.
Graduate School of Guilin Medical University, Guilin Guangxi 541004, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Jan 28;47(1):63-71. doi: 10.11817/j.issn.1672-7347.2022.210021.
As a remedy for the failure of in vitro fertilization (IVF), rescue intracytoplasmic sperm injection (R-ICSI) has been widely carried out, but it has failed to significantly improve the fertilization rate and clinical pregnancy rate. Sperm DNA fragmentation index (DFI) was highly correlated with pregnancy outcome of artificial assisted reproduction. This study aims to investigate the effect of the sperm DFI on the outcome of R-ICSI and the clinical value of R-ICSI.
This retrospective analysis was conducted among 140 infertile couples receiving R-ICSI in from January 2014 to December 2019. The subjects were assigned into a total fertilization failure (TFF)+low DFI group (R-ICSI after TFF and DFI<30%) (=63), a TFF+high DFI group (R-ICSI after TFF and DFI≥30%) (=16), a partial fertilization failure (PFF)+low DFI group (R-ICSI after PFF and DFI<30%) (=52), a PFF+high DFI group (R-ICSI after PFF and DFI≥30%) (=9). All transferred embryos were come from R-ICSI. The general clinical data [infertility duration, male age, female age, basal serum level of follicle stimulating hormone (FSH), basal serum level of luteinizing hormone (LH), antral follicle count, endometrial thickness of human chorionic gonadotropin (HCG) day, and eggs] and R-ICSI cycle outcomes (fertilization rate, normal fertilization rate, cleavage rate, good embryo rate, implantation rate, clinical pregnancy rate and live birth rate) were analyzed. In addition, the effect of R-ICSI on the fertilization outcome of conventional IVF total fertilization failure and partial fertilization failure was explored.
There was no significant difference in the general clinical data and R-ICSI cycle outcome between the TFF+low DFI group and the TFF+high DFI group (all >0.05). There was no significant difference in the general clinical data between the PFF+low DFI group and the PFF+high DFI group (all >0.05). The fertilization rate and normal fertilization rate in the PFF+low DFI group were significantly higher than those in the PFF+high DFI group (85.40% vs 72.41%, 71.90% vs 58.62%, respectively; both <0.05). However, there was no significant difference in cleavage rate, good embryo rate, implantation rate, clinical pregnancy rate, and live birth rate between the 2 groups (all >0.05). The R-ICSI cycle of TFF: A total of 79 fresh cycles, 57 fresh transplant cycles, a total of 761 unfertilized oocytes, and 584 M II oocytes were treated with R-ICSI, the fertilization rate was 83.22%, the normal fertilization rate was 75.51%, the cleavage rate was 98.15%, the good embryo rate was 40.74%, the implantation rate was 30.56%, and the clinical pregnancy rate was 43.86%; 29 live births were obtained. The R-ICSI cycle of PFF: A total of 61 fresh cycles, 31 fresh transplant cycles, a total of 721 unfertilized oocytes, and 546 M II oocytes were treated with R-ICSI; the fertilization rate was 83.33%, the normal fertilization rate was 69.78%, the cleavage rate was 97.36%, the good embryo rate was 44.39%, the implantation rate was 25.42%, and the clinical pregnancy rate was 45.16%; 12 live births were obtained.
In the case of partial fertilization failure of IVF, the sperm DFI affects the fertilization rate and normal fertilization rate of R-ICSI; whether it is a TFF of IVF or PFF of IVF, ICSI can be used as an effective remedy way.
体外受精（IVF）失败的补救方法，即卵胞浆内单精子注射（ICSI）的应用已得到广泛开展，但仍未能显著提高受精率和临床妊娠率。精子 DNA 碎片指数（DFI）与辅助生殖的妊娠结局高度相关。本研究旨在探讨精子 DFI 对 R-ICSI 结局的影响，以及 R-ICSI 的临床价值。
这是一项回顾性分析，纳入了 2014 年 1 月至 2019 年 12 月期间接受 R-ICSI 的 140 对不孕夫妇。根据是否存在总受精失败（TFF）和 DFI 水平，将患者分为总受精失败+低 DFI 组（TFF 后 DFI<30%，R-ICSI；n=63）、总受精失败+高 DFI 组（TFF 后 DFI≥30%，R-ICSI；n=16）、部分受精失败+低 DFI 组（PFF 后 DFI<30%，R-ICSI；n=52）和部分受精失败+高 DFI 组（PFF 后 DFI≥30%，R-ICSI；n=9）。所有的胚胎均来自 R-ICSI。分析一般临床资料[不孕持续时间、男性年龄、女性年龄、基础卵泡刺激素（FSH）水平、基础黄体生成素（LH）水平、窦卵泡数、人绒毛膜促性腺激素（HCG）日子宫内膜厚度、卵子数]和 R-ICSI 周期结局（受精率、正常受精率、卵裂率、优质胚胎率、着床率、临床妊娠率和活产率）。此外，还探讨了 R-ICSI 对常规 IVF 总受精失败和部分受精失败的受精结局的影响。
TFF+低 DFI 组与 TFF+高 DFI 组之间的一般临床资料和 R-ICSI 周期结局均无显著差异（均>0.05）。PFF+低 DFI 组与 PFF+高 DFI 组之间的一般临床资料也无显著差异（均>0.05）。PFF+低 DFI 组的受精率和正常受精率显著高于 PFF+高 DFI 组（85.40% vs 72.41%，71.90% vs 58.62%，均<0.05）。然而，两组之间的卵裂率、优质胚胎率、着床率、临床妊娠率和活产率均无显著差异（均>0.05）。TFF 的 R-ICSI 周期：共 79 个新鲜周期，57 个新鲜移植周期，共 761 个未受精卵和 584 个 MII 卵接受 R-ICSI 治疗，受精率为 83.22%，正常受精率为 75.51%，卵裂率为 98.15%，优质胚胎率为 40.74%，着床率为 30.56%，临床妊娠率为 43.86%；获得 29 例活产。PFF 的 R-ICSI 周期：共 61 个新鲜周期，31 个新鲜移植周期，共 721 个未受精卵和 546 个 MII 卵接受 R-ICSI 治疗；受精率为 83.33%，正常受精率为 69.78%，卵裂率为 97.36%，优质胚胎率为 44.39%，着床率为 25.42%，临床妊娠率为 45.16%；获得 12 例活产。
在 IVF 部分受精失败的情况下，精子 DFI 影响 R-ICSI 的受精率和正常受精率；无论是 IVF 的 TFF 还是 IVF 的 PFF，ICSI 都可以作为一种有效的补救方法。
