摘要
目的探讨双层密度梯度离心联合上游法与浮游法精液处理对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法回顾性分析2023年8月1日至2024年7月31日期间在本院采用拮抗剂方案促排卵行常规IVF助孕的2015个周期(共1977对夫妇)临床资料,根据精液处理方法不同分为梯度上游组(1476个周期,共1447对夫妇)和浮游组(539个周期,共530对夫妇);其中新鲜移植599个周期(共596对夫妇)包括梯度上游组433周期(共431对夫妇)和浮游组166周期(共165对夫妇)。比较分析两组间的基本情况、受精情况、胚胎发育情况以及新鲜周期移植的妊娠结局。另外,选取2024年8月1日至2024年9月15日行常规IVF治疗夫妇中的22例男性精液样本,分别经两种精液处理方法进行优化,采用精子染色质扩散(SCD)法检测精子DNA碎片指数(DFI),比较两种精液处理方法后的精子DFI差异。结果基本情况比较中,除促性腺激素(Gn)用量外,其余基本资料均无显著性差异(P>0.05)。受精及胚胎发育情况比较中,除浮游组的多原核率(多PN率)显著低于梯度上游组(P<0.01)外,2PN率、D3优胚率、优质囊胚率、囊胚形成率和可冻囊胚率等在两组间均无显著性差异(P>0.05)。新鲜移植周期妊娠结局比较中,浮游组的胚胎着床率(34.94%vs.43.38%)、D3卵裂胚临床妊娠率(48.74%vs.60.74%)和总移植胚胎临床妊娠率(48.80%vs.60.05%)均显著低于梯度上游组(P<0.05)。DFI结果显示,两种精液优化处理方法均能筛选出低DFI精子,梯度上游组筛选出的精子DFI显著低于浮游组[0.62(0.40,1.39)%vs.2.02(1.32,6.46)%,P<0.05]。结论浮游法更有利于筛选出IVF-ET受精中多原核率较低的精子,而双层密度梯度离心联合上游法能获得更低DFI的精子,并且在新鲜移植周期中具有更好的妊娠结局。
Objective:To investigate the effects of dual-density gradient centrifugation combined with swim-up method and flotation method on the clinical outcomes of in vitro fertilization-embryo transfer(IVF-ET).Methods:A retrospective analysis was conducted on the clinical data of 2015 cycles(total 1977 couples)who underwent routine IVF assisted pregnancy using antagonist regimen during ovulation induction in Sichuan Jinxin Xinan Women&Children’s Hospital from August 1,2023 to July 31,2024 were retrospectively analyzed.According to different semen treatment methods,they were divided into gradient swim-up group(n=1476 cycles,1447 couples in total)and the flotation group(n=539 cycles,530 couples in total).There were 599 cycles in the fresh transplantation(596 couples in total),which were divided into the gradient swim-up group(n=433 cycles,431 couples in total)and the flotation group(n=166 cycles,165 couples in total).A comparative analysis was conducted on the basic characteristics,fertilization,embryo development and pregnancy outcomes of fresh transplantation cycles between the two groups.In addition,semen samples from 22 husbands of couples who underwent routine IVF treatment from August 1,2024 to September 15,2024 were selected and optimized by two semen treatment methods,respectively.The sperm DNA fragmentation index(DFI)was detected by sperm chromatin dispersion(SCD)method.The difference of sperm DFI after two methods of semen optimization was compared.Results:In the comparison of basic characteristics,except for the significant difference in the dosage of Gn,there were no significant differences in other basic data(P>0.05).In the comparison of fertilization and embryo development,except for the significantly lower multiple pronucleus(PN)rate(multi-PN rate)of the flotation group compared with the gradient swim-up group(P<0.01),there were no significant differences in 2PN rate,D3 high-quality embryo rate,high-quality blastocyst rate,blastocyst development rate,frozen blastocyst rate between the two groups(P>0.05).In the comparison of pregnancy outcomes in the fresh transplantation cycles,the embryo implantation rate(34.94%vs.43.38%),the clinical pregnancy rate of D3 cleavage embryos(48.74%vs.60.74%)and the clinical pregnancy rate of total transplanted embryos(48.80%vs.60.05%)in the flotation group were significantly lower than those in the gradient swim-up group(P<0.05).In the comparison of DFI,both of the two sperm optimization processing methods could screen out sperm with low DFI,and the sperm DFI screened out by the gradient swim-up group was significantly lower than that of the flotation group[0.62(0.40,1.39)%vs.2.02(1.32,6.46)%,P<0.05].Conclusions:Sperm with lower multi-PN rate in IVF-ET can be screened by flotation method,while sperm with lower DFI can be obtained by dual-density gradient centrifugation combined with swim-up method,resulting in better pregnancy outcome in fresh transplant cycle.
作者
张阳波
韩婷婷
徐敬良
王琪
严维
黄军
孟祥黔
ZHANG Yang-bo;HAN Ting-ting;XU Jing-liang;WANG Qi;YAN Wei;HUANG Jun;MENG Xiang-qian(Sichuan Jinxin Xinan Women&Children’s Hospital,Chengdu 610000)
出处
《生殖医学杂志》
2025年第9期1176-1182,共7页
Journal of Reproductive Medicine
基金
四川省医学会课题(S21098)
成都市卫生健康委员会课题(202301033807)。
关键词
双层密度梯度
浮游法
DNA碎片指数
胚胎着床率
Dual-density gradient
Flotation method
DNA fragmentation index
Embryo implantation rate
