Objective: To investigate the application value of pre-implantation genetic screening (PGS) in intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) for infertile patients with high sperm DNA fragmentation index (DFI).
Methods: We selected 90 infertile patients undergoing ICSI-ET in our center from April 2015 to October 2016, 60 with sperm DFI =≥15% and 30 with sperm DFI <15%. Of the 60 cases with sperm DFI =≥15%, 30 received PGS-ICSI (high DFI-PGS group) while the other 30 did not receive PGS (high DFI-ICSI group). The 30 cases with sperm DFI <15% were included in the low DFI-ICSI group. We made comparisons between the high and low DFI-ICSI groups in the rates of normal fertilization, good-quality embryos, blastocyst formation and embryo implantation as well as between the high DFI-PGS and high DFI-ICSI groups in the ages of the males and females, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T) in the males, sperm concentration, the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS), sperm DFI, and the rates of sperm nucleoprotein immaturity, normal fertilization, good-quality embryos, blastocyst formation and embryo implantation.
Results: Statistically significant differences were found between the high and low DFI-ICSI groups in the rate of embryo implantation (31.25 vs 52.50%, P <0.01) but not in the rates of normal fertilization (［65.38 ± 24.62］ vs ［73.00 ± 17.00］%, P >0.05), good-quality embryos (［62.41 ± 25.97］ vs ［73.00 ± 22.10］%, P >0.05), or blastocyst formation (［62.55 ± 25.21］ vs ［64.30 ± 18.60］%, P >0.05). The rate of embryo implantation was markedly higher in the high DFI-PGS than in the high DFI-ICSI group (60.97% vs 31.25%, P <0.01), but there were no statistically significant differences between the two groups in the ages of the males and females, the levels of FSH, LH and T in the males, sperm concentration, the percentages of PMS and MNS, sperm DFI, sperm nucleoprotein immaturity, or the rates of normal fertilization (［69.76 ± 15.82］ vs ［65.38 ± 24.62］%, P >0.05), good-quality embryos (［64.42 ± 30.75］ vs ［62.41 ± 25.97］%, P >0.05) and blastocyst formation (［67.53 ± 19.24］ vs ［62.55 ± 25.21］%, P >0.05).
Conclusions: For the infertile patients with sperm DFI =≥15%, PGS-ICSI, rather than ICSI alone, can significantly increase the rate of embryo implantation.
目的： 探讨植入前遗传学筛查（PGS）对高精子DNA碎片指数（DFI）不育夫妇的辅助生殖妊娠结局的应用价值。方法： 选取2015年4月至2016年10月精子DFI=≥15%行ICSI治疗的男性不育患者60例作为病例组，其中行PGS-ICSI治疗的患者30例作为高DFI-PGS组，未行PGS检测的患者30例作为高DFI-ICSI组；另选取DFI<15%行ICSI治疗的30例患者作为低DFI-ICSI组。比较高DFI-ICSI组与低DFI-ICSI组正常受精率、优质胚胎率、囊胚形成率、胚胎种植率的差异；比较高DFI-PGS组与高DFI-ICSI组女方年龄，男方年龄、精子浓度、前向运动精子百分率、正常形态精子百分率、FSH、LH、T、精子DFI、核蛋白不成熟精子百分率，正常受精率、优质胚胎率、囊胚形成率、胚胎种植率差异。结果： 高DFI-ICSI组与低DFI-ICSI组相比，正常受精率［ (65.38±24.62) % vs (73.00±17.00)%］、优质胚胎率［(62.41±25.97)% vs (73.00±22.10%)］、囊胚形成率［(62.55±25.21)% vs (64.30±18.60)% ］均无统计学差异（P均>0.05），胚胎种植率［31.25% vs 52.50%］有统计学差异（P<0.01）。高DFI-PGS组与高DFI-ICSI组相比，女方年龄，男方年龄、精子浓度、前向运动精子百分率、正常形态精子百分率、FSH、LH、T、精子DFI、核蛋白不成熟精子百分率，正常受精率［(69.76±15.82)% vs (65.38±24.62)%］、优质胚胎率［(64.42±30.75)% vs (62.41±25.97)%］、囊胚形成率［(67.53±19.24)% vs (62.55±25.21)%］均无统计学差异（P均>0.05），两组间胚胎种植率(60.97% vs 31.25%)差异有统计学意义（P<0.01）。结论： 对于精子DFI=≥15%的不育患者，行单纯ICSI治疗并不能提高其胚胎种植率；而行PGS可以显著提高患者胚胎种植率。.
Keywords: embryo implantation; embryo repair; intracytoplasmic sperm injection; sperm DNA fragmentation index; pre-implantation genetic screening.