The Research On The Effects Of Sperm DNA Integrity And IVF/ICSI Fertilization Methods On Pregnancy Outcomes

Objective:This clinical research is focused on the effects of sperm DNA integrity and fertilization methods(IVF/ICSI)at different degrees of its damage on pregnancy outcomes in assisted reproduction technology(ART),for increasing the clinical pregnancy rate and improving pregnancy outcomes.Methods:The infertile couples who received IVF/ICSI ET at the Northern Jiangsu Peoples Hospital from May 2016 to March 2019 were selected as the retrospective study objects.A total of 782 cycles were screened that met the criteria,including 599freeze-thaw cycles and 183 fresh cycles.The sperm DNA fragmentation index(DFI)calculated by sperm chromatin structure assay(SCSA)used to evaluate sperm DNA integrity.According to the value of DFI,it was divided into 3 groups:Group A:DFI?15%,Group B:15%<DFI?30%,Group C:DFI>30%.SPSS 25.0 software was used to analyze the experimental data collected previously.The impact of sperm DNA integrity damage and two fertilization methods(IVF/ICSI)during different DFI levels on pregnancy outcomes in two transplantation cycles were analyzed.Results:(1).In all patients undergoing IVF/ICSI,there were statistical difference(P<0.05)in male age(P=0.000),abstinence duration(P=0.001),sperm concentration(P=0.000),sperm survival rate(P=0.000),sperm motility(P=0.000)and normal morphology rate(P=0.000)among groups A,B,and C;infertility years was a statistical difference between group A and group C(P=0.009);there was no difference in semen volume among the three groups(P>0.05).(2).In the fresh cycle of IVF,the fertilization rate(c~2=21.075,P=0.000),cleavage rate(c~2=13.802,P=0.002),embryo implantation rate(c~2=7.287,P=0.026),biochemical pregnancy rate(c~2=13.230,P=0.001),clinical pregnancy rate(c~2=17.024,P=0.000),and live birth rate(c~2=9.048,P=0.011)were statistical differences in each DFI subgroup(P<0.05),which decreased with the increase of DFI.The high-quality embryo rate in group A was higher than that in group B,and the difference was statistically significant(P<0.05).There was no statistical difference in abortion rate in each group(P>0.05).(3).There was no statistical difference in pregnancy outcomes among the three groups during the fresh cycle of ICSI(P>0.05).It is worth noting that the fertilization rate,embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate and live birth rate all decreased with the increase of DFI.(4).In the freeze-thaw cycle of IVF,the embryo implantation rate(c~2=35.519,P=0.000),biochemical pregnancy rate(c~2=35.519,P=0.000),clinical pregnancy rate(c~2=17.024,P=0.000),and live birth rate(c~2=9.048,P=0.011)in group A were obviously higher than those in groups B and C,which were statistically significant(P<0.05);there was no significant difference in fertilization rate,cleavage rate,high-quality embryo rate,and abortion rate among the three groups(P>0.05).(5).In the freeze-thaw cycle of ICSI,the biochemical pregnancy rate,embryo implantation rate,clinical pregnancy rate,and live birth rate decreased with the increase of DFI,but there were no statistical differences among the three groups(P>0.05);the cleavage rate was higher in group B than that in group C(c~2=5.260,P=0.022),the difference was statistically significant(P<0.05);the rate of high-quality embryos in group A was higher than that in group B(c~2=8.762,P=0.003),and the difference was statistically significant(P<0.05).There was no statistical difference in fertilization rates and miscarriage rates among the subgroups(P>0.05).(6).When DFI?15%,there was no statistically significant difference in pregnancy outcomes between the two fertilization methods in the fresh cycle and frozen cycle(P>0.05).However,the embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,and live birth rate in the ICSI group were lower than those in the IVF group in the freeze-thaw cycle.(7).When 15%<DFI?30%,the fertilization rate of the ICSI group was higher than that of the IVF group during the freeze-thaw cycle(c~2=9.034,P=0.003),the difference was statistically significant(P<0.05);the clinical pregnancy rate,miscarriage rate and live birth rate of the ICSI group were higher than those of the IVF group in both cycles;especially in the fresh cycle,the clinical pregnancy rate in the ICSI group was obviously higher than that in the IVF group(56.3%VS 29.4%),which was statistically significant(P<0.05).(8).When DFI>30%,except for the cleavage rate,the pregnancy outcomes of the ICSI group and the IVF group were not statistically different in the two cycles(P>0.05).However,the biochemical pregnancy rate,clinical pregnancy rate,and live birth rate were higher in ICSI group than those in IVF group in both cycles.Conclusion:1.Male age,abstinence duration,infertility years were positively correlated with damage to sperm DNA integrity.2.Sperm DNA damage was negatively correlated with sperm concentration,sperm survival rate,sperm motility,and sperm normal morphology rate.3.With the decline of sperm DNA integrity,embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,and live birth rate have all decreased,and the role of IVF is more obvious than that of ICSI.4.When DFI?15%,IVF treatment can be preferentially selected after comprehensive consideration;when DFI>15%,ICSI frozen-thawed embryo transfer can be given priority.