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目的探讨精子顶体反应率与宫腔内人工授精临床妊娠率的关系。方法选取2013年3月-2014年5月我院生殖医学科宫腔内人工授精周期120例,均为促排卵周期且药物与方案一致,排除女方不育因素,术前2-7d取精模拟IUI精液优化,优化后的精液经钙离子载体A23187诱发顶体反应、PSA-FITC染色后观察并计数精子顶体反应率,比较妊娠组与未妊娠组患者精子顶体反应(Acrosome Reaction,AR)率,探讨诱发AR率与IUI临床妊娠率的关系,3次IUI未孕与妊娠组患者诱发顶体反应率的比较。结果 120例周期中,临床妊娠17例,总临床妊娠率14.17%(17/120)。其中3次IUI未孕患者8例。妊娠组与未妊娠组患者处理后正常形态率、前向运动精子总数、正常形态精子前向运动精子总数、自发AR率分别比较,均无统计学差异(P>0.05),而妊娠组患者诱发AR率显著高于未妊娠组(P<0.05)。诱发AR率小于15%、15%~30%、30%~50%、大于50%4组妊娠率分别为0%(0/12)、12.5%(3/24)、13.2%(5/38)、19.6%(9/46),诱发AR率小于15%患者临床妊娠率显著降低(P<0.05);3次IUI未孕组与妊娠组诱发AR率分别15.35±17.62、63.75±14.33,3次IUI未孕组诱发AR率明显低于妊娠组(P<0.05)。结论精子顶体反应率与宫腔内人工授精临床妊娠率有相关性,当诱发顶体反应率小于15%时妊娠率明显降低;反复IUI发生与顶体反应率降低密切相关。
Objective To investigate the relationship between sperm acrosome reaction rate and intrauterine insemination clinical pregnancy rate. Methods From March 2013 to May 2014, 120 cases of intrauterine insemination cycle in reproductive medicine department of our hospital were selected. All of them were ovulation induction cycles and the drugs were consistent with the protocol. Female infertility factors were excluded. Preoperative sperm injection was performed 2-7 days IUI sperm was optimized, and the optimized seminal fluid was induced by calcium ionophore A23187. The acrosome reaction was observed and counted after PSA-FITC staining. Acrosome Reaction (AR) was compared between pregnant women and nonpregnant women. Rate, to explore the relationship between the induced AR rate and the clinical pregnancy rate of IUI, and to compare the incidence of acrosome reaction induced by three IUI non-pregnant and pregnancy groups. Results In 120 cycles, clinical pregnancy was 17 and the total clinical pregnancy rate was 14.17% (17/120). Among them, 3 cases of IUI non-pregnant patients in 8 cases. There were no significant differences in the normal morphology rate, the total number of forward motile sperm, the total number of sperm motile sperm and the spontaneous AR rate in pregnant women and non-pregnant women (P> 0.05), while those in pregnant women AR rate was significantly higher than that of non-pregnant group (P <0.05). The pregnancy rates of 4 groups were 0% (0/12), 12.5% (3/24) and 13.2% (5/38), respectively. The pregnancy rates were less than 15%, 15% ~ 30%, 30% ~ 50% ) And 19.6% (9/46), respectively. The clinical pregnancy rate was significantly lower in patients with less than 15% AR (P <0.05). The AR rates in the three IUI non-pregnant groups and the pregnancy group were 15.35 ± 17.62 and 63.75 ± 14.33, The incidence of AR in non-pregnant IUI group was significantly lower than that in pregnancy group (P <0.05). Conclusions The acrosome reaction rate is related to the clinical pregnancy rate of intrauterine insemination. When the acrosome reaction rate is less than 15%, the pregnancy rate is significantly reduced. The recurrence of IUI is closely related to the reduction of acrosome reaction rate.