目的 探讨精子DNA碎片率对常规体外受精-胚胎移植(IVF-ET)结局的影响.方法 选取2010年1月到2010年7月间在本中心实施IVF的221对不孕夫妇,采用改良上游法优选精子,部分用于体外受精,部分采用精子染色质扩散法(the Sperm Chromatin Dispersion,SCD)分析DNA碎片率.根据精子DNA碎片指数(the DNA Fractionation Index,DFI)将患者分为两组:DFI＜15%组(A组)和DFI≥15%组(B组).比较两组受精率、胚胎可用率、优质胚胎率和妊娠率.结果 A组受精率、可用胚胎率分别为69.52%和61.81%,高于B组66.82%和57.91,差异无统计学意义:优质胚胎率A组为24.89%,显著高于B组16.98%(P＜0.05).妊娠率和胚胎种植率A组为40.12%和26.02%,B组为38.98%和25.22%,差异无统计学意义.结论 改良上游法优选精子的DNA碎片率对于常规IVF-ET的受精率、可用胚胎率无显著影响,但碎片率高的精子所得到的优质胚胎率下降,提示在常规IVF-ET周期前检查精子DNA碎片率具有临床应用价值.%Objective To investigate the effect of sperm DNA fragment on the outcomes of IVF-ET. Methods Total of 221 couples who underwent conventional IVF from January to July 2010 in Reproductive Center of Ruijin Hospital were enrolled in the study. The parameters of sperm routine test were normal. Sperm DNA damage was measured by the sperm chromatin dispersion (SCD) assay. All couples were classified into two groups based on DNA fractionation index (DFI) threshold value such asgroup A < 15% and group B≥15%. Fertilization rate, embryo quality and clinical pregnancy rate, implantation rate were compared between the two groups. Results There was no statistical difference in the average age, infertility years, basic hormone level, estrogen level of HCG day between the high-(A) and low-(B) DFI groups. In group A, fertilization rate, clinical pregnancy rate and implantation rate was a little higher than those in group B, but the differences had no statistical significance (P>0.05). However, the high quality embryo rate was statistically higher in group A than that in group B (P<0.05). Conclusion Our results suggest that DFI can not provide independent information about fertilization and pregnancy, but the relationship between DFI and high quality embryo rate provide preliminary evidence that sperm with high levels of DNA fragmentation (≥ 15%) was at greater risk for low quality embryo. The potential adverse effect of sperm DNA damage on the quality of embryo should be a concern. We consider it is necessary to test sperm DNA damage when evaluation the sperm function.
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