| Objective:Analyze the relationship between sperm DFI value and semen routine parameters,clarify the clinical application value of sperm DFI as an independent biomarker for male fertility and confirm the guiding role of sperm DFI in human assisted reproductive technology.Methods:1.Retrospective case data collection: We obtain data from the management system of assisted reproductive technology in the Reproductive Center of our hospital,the time limit is from January 2018 to December 2020.The data shall at least include the age,diagnosis,sperm DFI,semen parameters,assisted reproductive technology,fertilization,cleavage,D3 available embryos,pregnancy,and live births of patients.2.Grouping of subjects: They were divided into six sperm DFI groups(DFI <10%,10-20%,31-40%,31-40%,40-50%,and ≥ 50%),three male age groups(20-31 years old,31-40 years old and over 40 years old),two clinical groups(primary infertility group and secondary infertility),two female groups(20-30-year-old group and 31-40year-old group).3.Statistical analysis method: For continuous variables,the Shapiro-Wilk test was used to test for normality.Continuous data from independent samples were expressed as the mean ± standard deviation if they fit a normal distribution,and as the median [interquartile range] if the data did not fit a normal distribution.Count data is expressed in counts(%).For continuous data of independent samples,if the distribution conforms to the normal distribution,the comparison between multiple groups is performed by one-way ANOVA;if the distribution does not conform to the normal distribution,the Kruskal-Wallis H rank sum test is used for the comparison between multiple groups.P-value correction for multiple groups was performed using the Bonferroni method.If the distribution conformed to normal distribution,Pearson correlation analysis was used,otherwise,Spearman was used to analyze the correlation between sperm DFI and age,semen volume,concentration,deformity,and sperm motility parameters.Correlations between fertilization rate,cleavage rate,D3 viable embryo rate,biochemical pregnancy rate,clinical pregnancy rate,and live birth rate for different assisted reproductive techniques using restrictive legislative splines(RCS).All studies were two-sided,and P < 0.05 was considered statistically significant.Results:1.A total of 3971 patients with sperm DFI results were collected,with a median age of 33.4 years;The median sperm DFI was 14.3%.In different types of analysis,the cases that meet the conditions are screened out.Out of 3957 cases were selected to analyze the relationship between sperm DFI and semen parameters,3787 cases were used to compare DFI and semen parameters in different age groups,3779 cases were used to analyze DFI and semen parameters with different clinical indications,1804 cases were used to analyze the relationship between sperm DFI and IVF outcome,and394 cases were used to analyze the relationship between sperm DFI and ICSI outcome,The analysts of IVF or ICSI fertilization and pregnancy outcomes of different female spouses with sperm DFI > 31% were 1804 cases and 150 cases respectively,2198 cases were used for the comparative analysis of IVF and ICSI outcomes in different sperm DFI.2.DFI was divided into 6 groups from low to high.There was a significant difference in age between the groups(p =0.000,r=0.184).Sperm parameters(sperm concentration,progressive motile sperm,slow or sluggish progressive motile sperm,non forward motile sperm,proportional malformation rate,sperm malformation index)had significant differences among the groups(p > 0.05,r < 0.0),but there was no correlation in sperm volume(p =0.933,r = 0.0).3.There was a significant difference in sperm DFI between male age groups(p=0.000),but there was no significant difference in body mass index,semen volume,semen concentration,non-progressive motile sperm ratio,and sperm deformity rate(p >0.05).Progressive motile sperm and slow or sluggish progressive motile sperm showed statistical significance only between the 20-31 years old group and the over40 years old group(p =0.01).4.There were significant differences in sperm DFI,semen concentration,progressively motile sperm,slow or sluggish progressive motile sperm,and non-progressive motile sperm between the two groups(P<0.01),but there was no significant difference in sperm volume and sperm deformity between primary infertility and secondary infertility(P>0.05).5.In IVF,the fertilization rate had a significant difference among DFI groups(p=0.00),but it was reflected in DFI < 10% and DFI > 50% only.There was no significant difference in cleavage rate,D3 available embryo rate,and blastocyst formation rate(p>0.05).The transplantable embryo rate had a significant difference among DFI groups(p =0.00),but it was reflected in DFI 10-31% group only.There was a significant difference in clinical pregnancy rate among the groups(p = 0.010),but it was only reflected in DFI > 50% group.There was no significant difference in non-pregnancy rate,h CG positive rate,and live birth rate among the groups(p > 0.05).However,RCS analysis showed that with the increase of sperm DFI,IVF fertilization rate gradually decreased and cleavage rate gradually increased,while the rate of transplantable embryos,h CG positive rate,clinical pregnancy rate and live birth rate gradually decreased.6.In ICSI,there was a significant difference in fertilization rate among DFI groups(p = 0.00),but it was only reflected in the 21-40% range of DFI cases.There was a significant difference in cleavage rate among DFI groups(p = 0.00),but it was only reflected in the 31-40% group of DFI.There was no significant difference in D3 available embryo rate and blastocyst formation rate among DFI groups(p>0.05),There was no significant difference in embryo transfer rate among DFI groups(p=0.116),but it was only reflected in cases in the range of 10-31% of sperm DFI.There was a significant difference between the non-pregnancy rate and the DFI group(p=0.037),but only in DFI 31-40% group and > 50% group.There was no significant difference in the h CG positive rate in the sperm DFI group(p=0.571),but there was a significant difference in DFI 21-40%(p<0.05).There was a significant difference in clinical pregnancy rate in the sperm DFI group(p=0.033),There was no significant difference in the live birth rate among sperm DFI groups(p=0.092).RCS analysis showed that with the increase of sperm DFI value,the fertilization rate and cleavage rate of ICSI decreased gradually,while the embryo transfer rate,h CG positive rate,clinical pregnancy rate and live birth rate also increased.7.In the study on the effect of a female spouse’s age on IVF or ICSI outcome when sperm DFI> 31%,it was found that there was no significant difference in IVF fertilization rate and cleavage rate among different age groups(p>0.05),but there was a significant difference in D3 available embryo rate(p<0.05),and there was no significant difference in the four parameters of pregnancy outcome(non-pregnancy rate,h CG positive rate,clinical pregnancy rate and live birth rate)(p> 0.05).Compared with the elderly group,the fertilization rate,cleavage rate and D3 available embryo rate of the ICSI group were significantly higher than those of the elderly group(p<0.05).There was no significant difference in the four parameters of pregnancy outcome(p>0.05).8.The comparative analysis of IVF and ICSI in different sperm DFI values showed that compared with IVF,the fertilization rate of ICSI increased and the cleavage rate decreased,the available embryo rate of D3 increased and the overall blastocyst formation rate decreased.Compared with IVF,the embryo transfer rate using ICSI technology was significantly higher among DFI groups(there was no significant difference only in 41-50% group),the non-pregnancy rate was significantly lower in the group with sperm DFI > 50%(p=0.002),and the clinical pregnancy rate and live birth rate using ICSI were significantly higher than those using IVF when sperm DFI> 50%(p=0.002 and p=0.013).Conclusion:1.Sperm DFI has a positive correlation with age and a poor correlation with conventional semen parameters.Therefore,it can be used as an independent predictor to not only evaluate the integrity of sperm chromatin but also provide additional information on fertilization ability.2.Sperm DFI in patients with primary infertility was significantly higher than that in patients with secondary infertility.When the sperm DFI > 30%,it may have exceeded the repairability of oocytes to sperm,which will affect the outcome of IVF.Therefore,when the sperm DFI > 30%,especially DFI > 50%,the clinical pregnancy rate and live birth rate of ICSI are significantly higher than that of IVF.3.In IVF,there were significant differences in the fertilization rate of sperm DFI< 10% or DFI > 50%,but it did not affect the subsequent cleavage rate.When DFI >50%,the clinical pregnancy rate will be significantly reduced.With the increase of sperm DFI value,the IVF fertilization rate decreased and the cleavage rate increased gradually,while the transplantable embryo rate,h CG positive rate,clinical pregnancy rate and live birth rate decreased gradually.4.In ICSI,with the increase of sperm DFI value,the fertilization rate and cleavage rate of ICSI decreased gradually,while the embryo transfer rate,h CG positive rate,clinical pregnancy rate and live birth rate also increased. |
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