A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters
A prospective randomized study to evaluate the effect of hyaluronic acid sperm selection on the intracytoplasmic sperm injection outcome of patients with unexplained infertility having normal semen parameters
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DOI：
10.1007/s10815-013-0108-9
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发表时间：
2013-11-01
影响因子：
3.1
通讯作者：
Majumdar, Abha
中科院分区：
文献类型：
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作者：
Majumdar, Gaurav;Majumdar, Abha
精子质量在决定胚胎发育和胞浆内单精子注射 (ICSI) 结果方面发挥着重要作用。根据精子与透明质酸 (HA) 结合的能力来选择有能力的精子已被建议作为评估精子质量的方法之一。本研究的目的是检查注射 HA 结合精子是否有助于改善精液参数正常、不明原因不孕症患者接受 ICSI 治疗的结果。根据 WHO 2010 年标准，精液参数正常、接受第一次 IVF-ICSI 周期的不明原因不孕症患者在研究过程中被纳入。156 名患者在卵母细胞取出后被前瞻性随机分配，并被分配到 要么是 ICSI 组，其中基于视觉评估来选择注射的精子，要么是 PICSI 组，其中根据精子与 HA 结合的能力来选择精子。分析中仅包括新鲜胚胎移植。ICSI 组和 PICSI 组之间的受精率、优质胚胎数量和临床妊娠率没有差异（分别为 65.7% vs 64.7%；45.8% vs 43.6% 和 35% vs 35.2%）。然而，与 PICSI 组相比，ICSI 组的妊娠丢失率较高（25% vs 12%；P = 0.227），但差异无统计学意义。 PICSI 组和 ICSI 组的着床率分别为 22.03% 和 18.84%。 PICSI 组有 22 例（31%）活产，ICSI 组有 21 例（26.3%）活产。具有正常精液参数的不明原因不孕患者可能构成无法从这种精子选择方法中受益的患者群体。可能需要进行更大规模的研究来确定 PICSI 与接受 IVF 的不明原因不孕患者的流产率之间的关系。
Sperm quality plays an important role in determining embryo development and intracytoplasmic sperm injection (ICSI) outcome. Selection of competent sperm based on its ability to bind to hyaluronic acid (HA) has been suggested as one of the methods to assess sperm quality. The aim of the present study was to examine whether injection of HA bound sperm helps in improving outcome in patients undergoing ICSI with unexplained infertility having normal semen parameters.Patients with unexplained infertility having normal semen parameters in accordance with WHO 2010 criterion, undergoing their first IVF-ICSI cycle were enrolled during the course of the study.156 patients were prospectively randomized after oocyte retrieval and were assigned to either the ICSI group, where sperm selection for injection was based on visual assessment, or the PICSI group, where sperm were selected based on their ability to bind to HA. Only fresh embryo transfers were included in the analysis.There was no difference in the fertilization rates, number of top quality embryos and clinical pregnancy rates between the ICSI and PICSI groups (65.7 % vs 64.7 %; 45.8 % vs 43.6 % and 35 % vs 35.2 % respectively). However, a higher pregnancy loss rate was observed in the ICSI group (25 % vs 12 %; P = 0.227) as compared to the PICSI group, but the difference was not statistically significant. Implantation rates were 22.03 % and 18.84 % in the PICSI and ICSI groups respectively. There were 22 (31 %) live births in the PICSI group and 21(26.3 %) live births in the ICSI group.Patients with unexplained infertility having normal semen parameters may constitute a patient group which does not benefit from this sperm selection method. A larger study may be necessary to establish a relationship between PICSI and pregnancy loss rate in patients undergoing IVF with unexplained infertility.