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 探讨针灸治疗在体外受精—胚胎移植技术的临床效果。方法 以2013年8月—2015年8月在顺德妇幼保健院生殖科,因不孕进入IVF/ICSI周期的108例患者为研究对象,按照随机自愿原则将其分为三组,针刺组、安慰针刺组、对照组各36例,针刺组:在移植前24小时、移植后30分钟进行相关的针刺治疗,安慰针刺组:针刺穴位与妊娠无关,对照组:不使用针刺疗法,比较三组临床效果。结果 治疗后针刺组Ⅰ型内膜血流类型及PI、RI、S/D低于治疗前,Ⅱ+Ⅲ型内膜下血流类型高于治疗前,差异有统计学意义(P＜0.05)。针刺组总有效率高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。针刺组种植成功率、妊娠成功率及活产率均高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。结论 在体外受精—胚胎移植技术中为患者实施针灸治疗可改善子宫内膜下血流情况,提高临床疗效、改善妊娠结局。

Objective To investigate clinical results of acupuncture treatment in vitro fertilization-embryo transfer technology. Methods August 2013-August 2015 reproductive and child health hospital in Shunde branch,due to infertility entering IVF/ICSI cycles of 108 patients for the study,in accordance with the principle of voluntary they were randomly divided into three groups,the acupuncture group,placebo group and control group 36 cases,respectively.Acupuncture group:24 hours before transplantation,30 minutes post-transplant treatment of infertility acupuncture.Placebo group:acupuncture and were unrelated to infertility.The control group:acupuncture was not used.We compared three groups of clinical effect. Results In the treatment of type Ⅰ endometrial blood flow in the acupuncture group type and PI,RI,S/D were significantly lower than before treatment,Ⅱ+Ⅲ,endometrial blood type under were significantly higher than before treatment.the difference was significance(P<0.05). The acupuncture group was more efficient than placebo group and the control group,the three groups was significant(P<0.05). The success rate of acupuncture group planting,the success rate of pregnancy and live birth rates were higher than placebo group and the control group,the three groups was significant differences(P<0.05). Conclusion In vitro fertilization-embryo transfer technology into the implementation of acupuncture treatment for patients can improve blood flow under the endometrium,improve clinical outcomes and improve pregnancy outcomes.