目的 探讨体外受精、胚胎移植(IVF-ET)后过夜培养精子存活率对临床结局的影响.方法 回顾性分析我中心850例常规IVF周期受精后精子过夜培养后的存活率,并分为3组:过夜精子存活率≤20％为A组,存活率大于20％且小于或等于58％为B组,存活率＞58％为C组；再依据正常形态精子百分率将上述三组患者每组再进一步分为3组:1组为正常精子形态≤4％,2组为正常精子形态大于4％且小于或等于15％,3组为正常精子形态＞15％.比较各组间的受精率、优质胚胎率及妊娠率.结果 (1)A组的受精率明显低于B、C两组,差异均有统计学意义(P＜0.05)；而且受精率随着存活率的升高而升高；A组的优质胚胎率低于B、C两组,差异有统计学意义(P＜0.05),而B、C两组间差异不具统计学意义.(2) A1组的存活率、受精率、优质胚胎率均低于A2及A3组,差异有统计学意义(P＜0.05)；B1组的存活率、受精率、优质胚胎率均低于B3组,差异有统计学意义(P＜0.05); C1的存活率、受精率、优质胚胎率均低于C2及C3组,差异有统计学意义(P＜0.05)；同时,可以观察到随正常精子形态百分率及隔夜培养存活率升高,受精率、优质胚胎率均随之升高；而A、B、C三组间的妊娠率无统计学差异.结论 精液培养24h后检测精子存活率可以作为一种新的检测指标预测IVF-ET的受精率及优质胚胎率的结局,对临床选择受精方式有一定的参考价值.%Objective To investigate the effects of sperm viability after overnight culture on clinical outcome of in vitro fertilization and embryo transfer (IVF-ET). Methods Total of 850 cases of conventional IVF cycles in our center were retrospectively analyzed. And the surplus sperm used for fertilizing were cultured for 24 hours, then the survival rate and morphology were analyzed. All case were divided into 3 groups based on survival rate including Group A (survival rate of sperm ≤20%), Group B( survival rate> 20% and ≤ 58%) and Group C( survival rate>58%). Based on the percentage of normal sperm morphology, patients in the above three groups were further divided into three subgroups: group l(the percentage of normal sperm morphology ≤4% in, group 2(the percentage of normal sperm morphology more than 4%≤15%, and group 3(the percentage of normal sperm morphology more than 15%) for. Amongthese groups, fertilization rate, embryo quality and pregnancy rate were compararatively analyzed. Results 1, The fertilization rate and high-quality embryos ofGroupAwas significantly lowerthan those of Group B and C(P<0.05); 2. Survival rate, fertilization rate, embryo quality of Group Al was less than those of Group A2 and A3, the difference was statistically significant (P<0.05). Survival rate,rnfertilization rale, embryo quality rates of Group B1 was lower Ehan those of Group B2 and B3, (P<0.05), Survival rate, fertilization rate, embryo quality rates of Group Cl was lower than those of Group C2 and C3. There were no significant differences among the three groups in pregnancy rate. Conclusion The survival rale of sperm after 24 hours culture is of a certain correlation with fertilization rate and good embryo rate, which can be used as a new index for ART treatment.
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