目的  探讨精子DNA碎片指数（DFI）对体外受精-胚胎移植（IVF-ET）胚胎发育及妊娠结局的影响，为优化男性生育力评估及辅助生殖治疗策略提供依据。方法  回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇，根据男方DFI检测结果分为低碎片组（DFI≤15%，n=42）、临界组（15%＜DFI＜30%，n=45）和高碎片组（DFI≥30%，n=39）。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异，并分析DFI与各指标的相关性。结果  低碎片组双原核率（2PN）率、优质胚胎率及囊胚形成率均高于临界组和高碎片组（P＜0.001），低碎片组1PN率、多PN率均低于临界组和高碎片组（P＜0.001）；三组种植率、临床妊娠率、早期流产率比较差异无统计学意义（P＞0.05），但高碎片组活产率低于低碎片组（P＜0.05）。相关性分析结果表明，DFI与优质胚胎率（r=-0.412，P＜0.001）、囊胚形成率（r=-0.387，P＜0.001）、活产率（r=-0.287，P=0.012）呈负相关，与早期流产率（r=0.206，P=0.059）、种植率（r=-0.215，P=0.058）、临床妊娠率（r=-0.203，P=0.072）无显著相关性。结论  精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素，高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降，临床需对高DFI患者进行干预以改善治疗结局。

       Objective  To investigate the impact of sperm DNA fragmentation index（DFI）on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer（IVF-ET），and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies．Methods  A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024．According to the male DFI test results，they were divided into three groups：low fragmentation group（DFI≤15%，n=42），critical group（15% ＜ DFI ＜ 30%，n=45），and high fragmentation group（DFI≥30%，n=39）．Differences in fertilization-related indicators，embryo development indicators，and pregnancy outcome indicators were compared among the three groups，and the correlation between DFI and each indicator was analyzed．Results  The 2 pronuclei rate（PN）rate，high-quality embryo rate，and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups（P＜0.001）．The 1PN  rate and multi-PN  rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups（P＜0.001）．There was no significant difference in the three groups of implantation rate，clinical pregnancy rate and early abortion rate（P＞0.05），but the live birth rate of high fragment group was significantly lower than that of low fragment group（P＜0.05）．The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos（r=-0.412，P＜0.001），blastocyst formation rate（r=-0.387，P＜0.001）and live birth rate（r=-0.287，P=0.012），but not with the rate of early abortion（r=0.206，P=0.059），implantation rate（r=-0.215，P=0.058）and clinical pregnancy rate（r=-0.203，P=0.072）．Conclusions  Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET．High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion．Clinically，early intervention is needed for patients with high DFI to improve treatment outcomes．

目的 我们探讨2019年6月—2020年1月复发性流产夫妇男性患者精浆弹性蛋白酶同精液参数及DNA碎片率的可能关系。方法 研究对象纳入80例复发性流产的男性患者及25例因女方输卵管因素行IVF-ET正常生育的男性患者。精液标本用来进行精浆弹性蛋白酶、精液常规分析、精子核染色质分析及精子形态学等参数分析。结果 结果表明同正常生育男性相比,复发性流产的弹性蛋白酶是增高(P=0.010)。我们将复发性流产男性患者分为正常组(<600 ng/mL)及异常组(≥600 ng/mL)。结果表明异常组患者的精子前向运动比例(P=0.002)及正常形态百分率(P=0.009)均降低,而精子DNA碎片率(P=0.002)增高。Spearman相关性分析发现精浆弹性蛋白酶同精子前向运动比例(r=-0.43,P<0.001)及正常形态百分率(r=-0.39,P<0.001)负相关,而同精子DNA碎片率(r=0.36,P=0.001)正相关。结论 精浆弹性蛋白酶可能影响复发性流产男性患者的精子活力、形态及DNA碎片率。复发性流产男性患者的生殖道隐性感染值得重视,其相关临床探讨性值得深入研究。

Objective Our study is aim to investigate the possible relationship of seminal elastase, on semen parameters and DNA fragmentation in male patients of recurrent pregnancy loss (RPL) between June 2019 and January 2020. Methods The patients included 80 male patients of RPL couple and 25 male patients from couples with clinical pregnancy through in vitro fertilization due to the female tubal factor. The semen samples were used to determine the seminal elastase, computed assisted semen analysis, sperm dispersion test and sperm morphology analysis. Results Compared to the control group, the levels of seminal elastase was increased in the RPL group. The RPL group was divided into the normal group (Elastase<600 ng/mL) and abnormal group (Elastase ≤ 600 ng/mL).The abnormal group exhibited the lower percentage of progressive sperm (P=0.002) and normal morphology (P=0.009),but higher precentage of DNA fragmentation (P=0.002). Meanwhile, the seminal elastase was positively associated with DNA fragmentation (r=0.36,P=0.001), but was inversely associated with the sperm motility (r=-0.43,P<0.001) and normal morphology (r=-0.39,P<0.001). Conclusion Our study may unveil the possible effects of the seminal elastase on the semen parameters and DNA fragmentation in the male patients of RPL couples. Further studies should put more emphasis on the silent genital tract inflammation of the patients.