Abstract：
The objective of this study was to investigate the impact of sperm source on embryo morphokinetics and the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles by considering the clustering of data (multiple embryos per patient that share a comparable developmental timing). This matched cohort study was performed at a private university-affiliated in vitro fertilization center. Women who underwent ICSI with epididymal sperm between January 2019 and December 2020 (the percutaneous epididymal sperm aspiration group, n = 32 cycles) were matched with women who underwent ICSI with ejaculated sperm because of idiopathic male factor infertility (the male factor infertility [MFI] group, n = 32 cycles) or female infertility (the control group, n = 32 cycles). Embryos were cultured in a time-lapse imaging incubator, and morphokinetic development was recorded and compared among the groups. Significantly slower divisions were observed in embryos derived from epididymal sperm than in those derived from the MFI and control groups. Embryos derived from epididymal sperm had a significantly lower KIDScore (3.1 ± 0.2) than did those derived from ejaculated spermatozoa from the MFI (5.4 ± 0.1) and control (5.6 ± 0.2, p < 0.001) groups. Epididymal sperm-derived embryos showed a significantly greater occurrence of multinucleation (23.2%) than did those derived from ejaculated sperm from the MFI and control groups (2.8% and 3.7%, p < 0.001, respectively). Epididymal sperm-derived embryos were significantly more likely to undergo direct or reverse cleavage (11.1%) than ejaculated sperm-derived embryos in the control group (4.3%, p = 0.001). In conclusion, delayed cell cleavage and increased incidences of blastomere multinucleation and abnormal cleavage patterns are observed when epididymal-derived sperm are used for ICSI.
摘要：
这项研究的目的是通过考虑数据的聚类（每位患者有多个胚胎，具有可比的发育时间），研究精子来源对胚胎形态动力学和卵胞浆内单精子注射（ICSI）周期的临床结果的影响。这项匹配的队列研究是在私立大学附属的体外受精中心进行的。在2019年1月至2020年12月期间接受附睾精子ICSI的女性（经皮附睾精子抽吸组，n=32个周期）与因特发性男性因素不育症而接受ICSI精子射精的女性相匹配（男性因素不育症[MFI]组，n=32个周期）或女性不孕症（对照组，n=32个周期)。胚胎在延时成像培养箱中培养，并记录和比较各组的形态动力学发展。在来自附睾精子的胚胎中观察到的分裂明显慢于来自MFI和对照组的胚胎。来自附睾精子的胚胎的KIDScore（3.1±0.2）明显低于来自MFI组（5.4±0.1）和对照组（5.6±0.2，p<0.001）的射精精子。附睾精子来源的胚胎显示出多核化的发生率（23.2％）明显高于MFI和对照组的射精精子来源的胚胎（2.8％和3.7％，p分别<0.001)。在对照组中，附睾精子来源的胚胎比射精精子来源的胚胎更容易发生直接或反向卵裂（11.1％）（4.3％，p=0.001)。总之,当附睾来源的精子用于ICSI时，观察到细胞裂解延迟，卵裂球多核化和异常裂解模式的发生率增加。
