目的 探讨卵泡期长效长方案和拮抗剂方案对不同精子DNA损伤程度患者卵胞质内单精子注射(ICSI)结局的影响。方法 回顾性分析2022年1月至2024年2月在金华市人民医院行ICSI的274对夫妻的临床资料，根据精子DNA碎片指数(DFI)分为DFI<15%组(n=189)和DFI≥15%组(n=85)。比较两组长效长方案和拮抗剂方案的临床资料、胚胎发育情况和妊娠结局。结果 两组长效长方案促性腺激素(Gn)天数均长于拮抗剂方案(P<0.05)。在DFI<15%组和DFI≥15%组中，两种促排卵方案MⅡ卵率、正常受精率、2PN卵裂率、可移植胚胎率比较，差异无统计学意义(P>0.05);两组长效长方案获卵数均高于拮抗剂方案(P<0.05);DFI<15%组两种促排卵方案优质胚胎率比较，差异无统计学意义(P>0.05);DFI≥15%组长效长方案优质胚胎率低于拮抗剂方案(P<0.05)。DFI<15%组长效长方案优质胚胎率高于DFI≥15%组长效长方案(P<0.05);DFI<15%组拮抗剂方案优质胚胎率与DFI≥15%组拮抗剂方案比较，差异无统计学意义(P>0.05)。在DFI<15%组和DFI≥15%组中，两种促排卵方案胚胎移植数、优质胚胎移植率、生化妊娠率、早期流产率、多胎妊娠率、异位妊娠率比较，差异无统计学意义(P>0.05);DFI<15%组长效长方案临床妊娠率和种植率均高于拮抗剂方案(P<0.05);DFI≥15%组两种促排卵方案临床妊娠率和种植率比较，差异无统计学意义(P>0.05)。结论 拮抗剂方案可为患者带来更优质的卵母细胞，在ICSI周期中可修复更多的精子DNA损伤，得到更优质的胚胎。

Objective To investigate the effect of long-acting long protocol in follicular phase and antagonist protocol on intracytoplasmic sperm injection(ICSI) outcome in patients with different degrees of sperm DNA damage. Methods The clinical data of 274 couples who underwent ICSI in Jinhua People′s Hospital from January 2022 to February 2024 were retrospectively analyzed. According to the sperm DNA fragmentation index(DFI), they were divided into DFI<15% group(n=189) and DFI≥15% group(n=85). The clinical data, embryonic development condition and pregnancy outcomes were compared between the long-acting long protocol and the antagonist protocol in the two groups. Results The days of gonadotropin(Gn) in the long-acting long protocol of the two groups were longer than those in the antagonist protocol(P<0.05). In DFI<15% group and DFI≥15% group, there was no significant difference in MⅡ oocyte rate, normal fertilization rate, 2PN cleavage rate and transplantable embryo rate between the two ovulation induction protocols(P>0.05). The number of oocytes retrieved in the long-acting long protocol was higher than that in the antagonist protocol in both groups(P<0.05). There was no significant difference in the high-quality embryo rate between the two ovulation induction protocols in the DFI<15% group(P>0.05). The high-quality embryo rate of long-acting long protocol in DFI≥15% group was lower than that of antagonist protocol(P<0.05). The high-quality embryo rate of long-acting long protocol in DFI<15% group was higher than that in DFI≥15% group(P<0.05). There was no significant difference in the high-quality embryo rate between the antagonist protocol in the DFI<15% group and the antagonist protocol in the DFI≥15% group(P>0.05). In DFI<15% group and DFI≥15% group, there was no significant difference in the number of embryo transfer, high-quality embryo transfer rate, biochemical pregnancy rate, early abortion rate, multiple pregnancy rate and ectopic pregnancy rate between the two ovulation induction protocols(P>0.05). The clinical pregnancy rate and implantation rate of long-acting long protocol in DFI<15% group were higher than those of antagonist protocol(P<0.05). There was no significant difference in the clinical pregnancy rate and implantation rate between the two ovulation induction protocols in DFI≥15% group(P>0.05). Conclusions The antagonist protocol can bring better oocytes for patients, repair more sperm DNA damage in ICSI cycles, and obtain better embryos.