| BACKGROUNDIn recent years,due to the social and economic development,people's living environment,dietary habits and other changes,China's "two-child" policy has been fully liberalized,the incidence of infertility is also rising year by year.According to statistics,15%of couples can not get pregnant within a year and see a doctor.About 50%of infertile couples have abnormal sperm morphology.Sperm morphology is an important indicator of sperm quality evaluation.Malformed sperm can affect fertilization rate and embryonic development potential,and bring about adverse pregnancy outcomes,which has become one of the main problems affecting male reproductive health.From 1980 to 2010,the World Health Organization(WHO)has published five editions of the "Laboratory Manual for Human Semen Examination and Processing".In these manuals,the reference values of normal sperm ratios are constantly changing.In the latest edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen,published in 2010,4%of the normal sperm morphology threshold,stipulates that abnormal sperm can be diagnosed only if the normal sperm morphology is less than 4%.The reference value of the percentage of normal sperm was reduced from 15%in the fourth edition to 4%.The new revision made it difficult for many male doctors and laboratory technicians to adapt to the changes for a while,which also caused great trouble for pregnant couples.In the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen,the decline in the normal percentage of sperm morphology has a real impact on fertility.Whether sperm morphology alone can affect the final pregnancy outcome remains controversial.More importantly,the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen does not contain any data or information from Chinese men,who account for one fifth of the world's population.Whether the fifth edition of sperm morphology is suitable for Chinese population is still worth discussing.Whether teratozoospermia can reduce the impact on pregnancy outcomes remains to be determined by screening embryos with good developmental potential after in vitro culture to blastocyst stage and then transplantation.In the process of assisted pregnancy,in addition to the successful fresh cycle transplantation in this treatment,there are still some patients because of various reasons are not suitable for transplantation,the embryos need to be frozen,waiting forthe right time to freeze-thaw embryo recovery transplantation.In order to better study the effect of sperm morphology on pregnancy outcome,we will discuss it in two parts.The first part is the influence of sperm morphology on the outcome of fresh-cycle pregnancy in patients receiving assisted reproductive technology.The second part is the influence of sperm morphology on the outcome of resuscitation cycle pregnancy,and then provides evidence for clinical work.Rational fertilization should be chosen to reduce economic burden for patients.Part ?:Effect of sperm morphology on pregnancy outcome in patients undergoing assisted reproductive technology during fresh cyclePurposes1.To investigate the predictive value of sperm morphology on pregnancy outcomes in patients undergoing assisted reproductive technology(ART)according to the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen,including the fertilization,high-quality embryo rate and clinical outcome of fresh-cycle transplantation in normal and teratozoospermia patients after different fertilization methods.Bed pregnancy,abortion rate,as well as embryo transfer and blastocyst transfer pregnancy outcome comparison;2.To explore whether sperm morphology on conventional assisted reproductive technology predictive role and evaluation value,whether it can be used as a basis for the choice of fertilization methods,provide evidence-based basis and guidance for clinical.MethodsA retrospective analysis of 1277 cycles of ART patients in a tertiary general hospital in Shandong Province from January 2015 to December 2017 was conducted.All the male patients who received IVF or ICSI were abstinent for 3 to 7 days before operation.The semen was taken from masturbation and placed in a sterile cup for half an hour in a 37-degree water bath.After liquefaction,the basic semen was analyzed.The smears were smeared and stained with Diff-Quik rapid staining.The stained sperm smears were examined under a microscope.It is necessary to count not less than 200 sperm continuously,counting all normal and abnormal sperm defects.According to the standard and operation procedure of the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen,the manual counting method is adopted.According to 4%as the critical value of normal sperm morphology,<4%is diagnosed as azoospermia.According to different fertilization methods(IVF or ICSI)of assisted pregnant women,they were divided into four groups,group 1 was normal sperm group with IVF,group 2 was abnormal sperm group with IVF,group 3 was normal sperm group with ICSI and group 4 was abnormal sperm group with ICSI.The basic data,average number of eggs retrieved,2PN fertilization rate,cleavage rate,high quality embryo rate,clinical pregnancy rate,abortion rate and delivery rate were compared among the four groups.The HCG positive rate,clinical pregnancy rate and abortion rate of cleavage embryos and blastocysts were compared between the four groups.Results(1)There were no significant differences in the average number of eggs,mature eggs and high quality embryos among the four groups(P>0.05),but there were significant differences in the 2PN fertilization rate and 2PN cleavage rate(P<0.05).The 2PN fertilization rate in ICSI group was significantly higher than that in IVF group(P<0.05),and the cleavage rate in normal sperm morphology group was significantly higher than that in sperm morphology malformation group(P<0.05).(2)The positive rate of HCG in blood and the delivery rate of male and female infants were significantly different among the four groups(P<0.05).The positive rate of HCG in abnormal sperm group was higher than that in normal sperm group(P<0.05),and the clinical pregnancy rate in abnormal sperm group was higher than that in normal sperm group(P<0.05).(3)the rate of delivery of female babies in the abnormal sperm group was higher than that in the normal sperm group.However,there were no significant differences in the clinical pregnancy rate,abortion rate,multiple pregnancy rate,ectopic pregnancy rate,delivery rate,mean gestational age and pregnancy outcomes between the four groups(P>0.05).ConclusionCompared with normal sperm morphology,patients with deformed spermatozoa have a higher risk of infertility when treated with conventional IVF-ET,and intrafollicular sperm injection can improve the normal fertilization rate of patients with deformed spermatozoa.There are limitations in predicting the outcome of pregnancy based on the morphology of spermatozoa.Although teratozoospermia patients were cultured to blastocysts to screen embryos with good developmental potential,it did not significantly improve pregnancy outcomes.Part II:Effect of sperm morphology on pregnancy outcome in patients undergoing assisted reproductive technology during freeze-thaw cyclePurposesTo compare the clinical pregnancy rate and abortion rate of cleavage embryo transfer and resuscitation blastocyst transfer in the frozen embryo resuscitation and transfer cycles between abnormal spermatozoa and normal sperm morphology,and to explore the influence of sperm morphology on pregnancy outcome in the freeze-thaw cycle.MethodsA retrospective analysis of 318 cycles of cryopreserved embryo transfer in the reproductive center of a tertiary general hospital in Shandong Province from January 2015 to December 2017 was carried out.In order to reduce the influence of female factors,the inclusion criteria included female primary infertility and no ovulation-inducing drugs were used during the cryopreserved embryo cycle.According to the different ways of fertilization in fresh cycle,they were divided into four groups according to the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen.Group 1:Fresh cycle sperm with normal IVF morphology group;Group 2:Fresh cycle sperm with abnormal IVF morphology group;Group 3:normal ICSI morphology sperm group;Group 4:ICSI abnormal sperm group;The basic data,clinical pregnancy rate,abortion rate and delivery rate of these 4 groups were compared.Each group was divided into freeze-thaw embryo thawing cycle and freeze-thaw blastocyst thawing cycle according to the different attributes of frozen embryos.The pregnancy outcomes such as HCG positive rate,clinical pregnancy rate and abortion rate were compared between the four groups.Results(1)There was no significant difference in clinical pregnancy rate,abortion rate,multiple pregnancy rate,ectopic pregnancy rate,delivery rate and mean gestational age between the four groups(P>0.05).However,the positive rate of HCG and clinical pregnancy rate in the thawing blastocyst transplantation group were significantly higher than those in the thawing embryo transplantation group and the ICSI sperm malformation group(P<0.05).(2)The multiple pregnancy rate of the thawing blastocyst transplantation group with normal sperm morphology was significantly lower than that of the thawing embryo transplantation group(P<0.05).ConclusionThere is no significant difference in pregnancy outcome between patients with teratozoospermia and those with normal sperm morphology after cryopreserved embryos or blastocysts from IVF and ICSI.During the freeze-thaw cycle,embryos from teratozoospermia patients treated with ICSI were cultured into blastocysts to screen embryos with good developmental potential and improve pregnancy outcomes. |
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