卵子中空透明帶可篩除染色體異常之精蟲

卵子中空透明帶ZP可篩除染色體異常之精蟲
-----除非精蟲很差，儘量使用IVF


swim-up vs. grading 精蟲處理方式比較
-----grading 精蟲染色體異常比例較高


http://humrep.oxfordjournals.org/content/15/7/1529.full

Incidence of aneuploid spermatozoa from subfertile men: selected with motility versus hemizona-bound5

1. Q.Van Dyk1, 
2. S. Lanzendorf2, 
3. P. Kolm3, 
4. G.D. Hodgen2 and 
5. M.C. Mahony2,4

+Author Affiliations

1. ¹Reproductive Medicine and Infertility Associates, P.A., 360 Sherman Street, St Paul, MN,
2. ²The Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, and
3. ³Biostatistics, Eastern Virginia Medical School, Norfolk, VA, USA

• Received July 30, 1999.
• Accepted March 28, 2000.

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Abstract

Spermatozoa–zona pellucida binding selects for human spermatozoa with progressive motility, normal morphology and functional competency. We postulated that this gamete interaction would also act to select against spermatozoa with chromosomal numerical aberrations. Spermatozoa from 41 men participating in the intracytoplasmic sperm injection (ICSI) programme were evaluated for the incidence of aneuploidy of chromosomes 18, X and Y. The hemizona assay was utilized to determine whether zona-bound spermatozoa from these patients have a reduced incidence of aneuploidy compared with those selected by motility only in a standard swim-up procedure. Using multicolour fluorescence in-situ hybridization (FISH) with DNA probes specific for chromosomes 18, X and Y, the disomy rates for chromosomes 18, X, Y and XY were found to be 0.31, 0.27, 0.29 and 0.14% respectively in the swim-up motile fraction, and 0.31, 0.33, 0.32 and 0.19% respectively in the pellet fraction. Analysing the zona-bound spermatozoa, the disomy rates for chromosome 18, X, Y and XY were found to be 0.02, 0.15, 0.12 and 0.07% respectively. The zona-bound spermatozoa had a significantly lower frequency of aneuploidy than the swim-up motile fraction or the pellet fraction (P < 0.0001). The incidence of chromosome 18 aneuploidy, including both chromosome 18 disomy and nullisomy, in the swim-up motile fractions was significantly increased in patients with an abnormal or borderline hemizona index compared with those with a normal hemizona index (P < 0.05). We also found that a high incidence of sperm aneuploidy was associated to a certain extent with low fertilization rate, and with failure to achieve pregnancy through ICSI. This study suggests that the human zona pellucida has the capacity to select against aneuploid spermatozoa by an as yet undetermined mechanism.

Figure 1.

Hemizona-bound sperm nuclei hybridized with alpha-satellite centromeric probes (×600 magnification) specific for chromosomes X (green), Y (orange) and 18 (aqua) and were counterstained with DAPI II.

Table II.

The incidence of sperm sex-chromosome nullisomy and disomy in the swim-up motile fractions (SU), the pellet fractions (Pellet), and the spermatozoa–hemizona complexes (S-HZ) in 41 ICSI patients

	Total spermatozoa	Nullisomy (%)	Disomy (%)				Sex-chromosome aneuploidy (%)
			XX	YY	XY	Total
a,bComparisons between a and b showed significant difference (P < 0.0001).
SU	21 839	0.70	0.27	0.29	0.14	0.70	1.41a
Pellet	21 936	0.85	0.33	0.32	0.19	0.84	1.69a
S-HZ	4081	0.27	0.15	0.12	0.07	0.34	0.61b

Table III.

The incidence of sperm chromosome 18 nullisomy and disomy in the swim-up motile fractions (SU), the pellet fractions (Pellet), and the spermatozoa–hemizona complexes (S-HZ) in 41 ICSI patients

	Total spermatozoa	Nullisomy (%)	Disomy (%)	Chromosome 18 aneuploidy (%)
a,bComparisons between a and b showed significant difference (P < 0.0001).
SU	21 839	0.29	0.31	0.60a
Pellet	21 936	0.41	0.31	0.72a
S-HZ	4081	0.07	0.02	0.10b

Table IV.

The incidence of sex-chromosome aneuploidy and the incidence of chromosome 18 aneuploidy in the swim-up motile fractions (SU), in the pellet fractions (Pellet), and in the spermatozoa–hemizona complexes (S-HZ) in 41 ICSI patients

Sample	Sex-chromosome (%)	Chromosome 18 (%)	P
SU	1.41	0.60	<0.0001
Pellet	1.69	0.72	<0.0001
S-HZ	0.61	0.10	<0.0001

Table V.

The incidence of diploid spermatozoa in the swim-up motile fractions (SU), in the pellet fractions (Pellet), and in the spermatozoa–hemizona complexes (S-HZ) in 41 ICSI patients

	Total spermatozoa	Diploid (%)			Total diploid (%)
a,bComparisons between a and b showed significant difference (P < 0.0001).
	46,XX	46,YY	46,XY
SU	21 839	0.10	0.07	0.08	0.26
Pellet	21 936	0.12	0.09	0.15	0.35a
S-HZ	4081	0.05	0.02	0.00	0.0