| Objective:Analyze the correlation of sperm acrosin activity,DNA fragmentation index(DFI)and high DNA stainability(HDS)and the outcomes and program selection of assisted reproductive technology with normal semen routine,in order to providesuggestions for clinicians and infertile patients and to improve the pregnancy outcome of assisted reproductive technology.Methods:246 cycles assisted reproductive technology(ART)from the reproductive center of Northern Jiangsu People's Hospital from January 2018 to February 2019.For the study subjects,according to the ART scheme,it was divided into three groups:IVF group,ICSI group and IUI group;it was divided into two groups according to the acrosin activity:the normal group(?64.9 u IU/10~6)and the abnormal group(<64.9u IU/10~6);according to the DFI,it was divided into DFI?15%group,15<DFI<30%group,and DFI?30%group;it was divided into two groups according to the HDS:the normal group(?15%),and the abnormal group(>15%);according to male age,it was divided into the?25 years old,25-30 years old,30-35 years old,and>35 years old;it was divided into three groups according to the age of infertility:?2 years group,3-5years group and?5 years group;according to BMI of infertile men,it was divided into the low-weight group(BMI<18.5kg/m~2),the normal weight group(18.5?BMI<24kg/m~2),the super-recombination group(24?BMI<28kg/m~2),and the obese group(BMI?28kg/m~2).Data analysis using SPSS 24.0 statistical software,using the mean,standard deviation,median(1/4 points–3/4points),the rate to describe the general clinical data,and using t test and?~2test,the Mann-Whitney U test and other test methods to analysis datas.Result:A total of 265 cycles ART were included in the study,including 131 IVF cycles,7 ICSI cycles and 127 IUI cycles.In 66 IVF fresh cycles,the total fertilization rate was 78.99%(440/557),the total cleavage rate was 92.72%(408/440),and the total quality embryo rate was 63.24%(258/408).192 IVF resuscitation cycles and IUI cycles,the total clinical pregnancy rate was 28.13%(54/192)and the total abortion rate was12.96%(7/54).There were 226 cycles in the normal group of acrosin activity,39 cycles in the abnormal group,154 cycles in the DFI?15%group,104 cycles in the 15%<DFI?30%group,and 9 cycles in the DFI>30%group.There were 245 cycles in the HDS normal group and 20 cycles in the abnormal group.(1).The comparison of acrosin activity and DFI among IVF,ICSI and IUI groups was statistically significant(P<0.05),and the acrosin activity of the ICSI group was the lowest,while DFI was the highest(P<0.05).The comparison of HDS was notstatistically significant among the ART group(P>0.05),but HDS of the ICSI group was higher than the IUI group(P<0.05).Comparison of general conditions among the ART group:there was no statistical significance in male and female ages(P>0.05),and a slight difference in BMI,while the infertility years were statistically significant(P<0.05),and the infertility years of IVF group were highest(P<0.05).(2).There was no statistically difference fertilization rate,cleavage rate andhigh-quality embryo rate between acrosin activity group in IVF fresh cycle(P>0.05).In IVF resuscitation cycle and IUI cycle,the clinical pregnancy rate and abortion rate of the normal acrosin activity group were different from the abnormal group,but there was no statistical significance(P>0.05).The proportion of IVF cycles in the normal group was 51.33%(116/226),ICSI cycles were 0.88%(2/116),and IUI cycles were 47.79%(108/226),it exsited differences compared with the abnormal group(P<0.05).(3).There was no significant difference of fertilization rate and cleavage rateamong the DFI groups in IVF fresh cycle(P>0.05),while high-quality embryo rate of?15%DFI group were lower,but still no statistical significance(P>0.05).In IVF resuscitation cycle and IUI cycle,the clinical pregnancy rate and abortion rate among DFI groups were not significantly different(P>0.05).There was no statisticalsignificance in the proportion of ART cycle between the three DFI groups(P>0.05),but there was statistical significance in the proportion of ART cycle between the DFI?15%group and the 15%<DFI?30%group(P<0.05).(4).There was no obvious difference of fertilization rate in the HDS groups(P>0.05),but the cleavage rate and high-quality embryo rate of abnormal sperm HDS group were higher than the normal group(P<0.05).However,the clinical pregnancy rate and abortion rate in the IVF resuscitation cycle and IUI cycle between HDS group were not statistically significant(P>0.05).There was no statistically difference between sperm HDS groups on the proportion of ART cycles(P<0.05)(5).There was no statistical significance in the comparison of acrosin activityamong male age groups(P>0.05),while 26-30 years old group was significantly higher than that of 31-35 years old group(P<0.05).The difference of sperm DFI and HDSvalues among the HDS groups was statistically different(P<0.05),and the sperm HDS values of the>35years old group were significantly higher than those of the 31-35 years old>group(P<0.05).(6).The DFI in the infertility years groups were statistically significant(P<0.05),and DFI of 2-5 year group and?5 year group were significantly higher than that of?2 years group(P<0.05).There was no statistically significant difference of acrosin activity and sperm HDS in the three groups(P>0.05),while acrosin activity in theinfertility age?5 years group was significantly lower than that of?2-5 years group(P<0.05).(7).There was no statistical significance of sperm acrosin activity and DFI and HDS among the BMI groups(P>0.05),but acrosin activity of the super-recombinant group was higher than that in the normal weight group(P<0.05).(8).Spearman correlation test showed that sperm DFI was positively correlated with male BMI and HDS in the total ART cycle(P<0.05).There was no significant correlation among acrosin activity and DFI and HDS.In IVF cycle,sperm acrosin activity was negatively correlated with male age and infertility years(P<0.05),while DFI was positively correlated with male age(r=0.177,P=0.043).In ICSI cycle,HDS was positively correlated with DFI,while both were negatively correlated with BMI(P<0.05).In IUI cycle,DFI was positively correlated with BMI,and HDS was positively correlated with infertility years.Conclusion:In assisted reproductive techniques(IVF/ICSI/IUI)of male with normal semen routine:1.Sperm acrosin activity of ICSI cycle was lowest,while DFI was the highest,and sperm HDS showed no difference among ART;2.When sperm acrosin activity is abnormal,the IUI/ICSI cycle may berecommended,but sperm acrosin activity can't be independent of semen routine to predict the outcome of ART;3.The ability of sperm DFI to predict the outcome of ART pregnancy is limited,and the significance of sperm DFI on the selection of auxiliary schemes still needs to be prospectively studied;4.When sperm HDS>15%,ICSI cycle may be better than IVF cycle.There is insufficient evidence that sperm HDS can be used as an indicator to predict ARToutcome;5.Excluding the influence of semen routine,DFI is positively correlated with HDS,but acrosin activity is not correlated to DFI and HDS;6.Male age,BMI and infertility years will affect sperm acrosin activity,DFI and HDS.Therefore,infertile men with fertility needs should establish healthy living habits,control their weight,conduct relevant examinations fertility counseling as soon aspossible. |
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