微量精子冷冻复苏行卵胞浆内单精子注射的临床结局

The Clinical Outcomes of ICSI with Micro Amount of Frozen-thaw Sperm

目的:探讨经皮睾丸穿刺取精术(TESA)获得的微量精子经冷冻复苏后行卵胞浆内单精子注射(ICSI)治疗非梗阻性无精子症患者的临床效果。方法:回顾性分析2015年10月至2017年8月在我院生殖中心因少、弱、畸形精子症行射出精子常规ICSI及非梗阻性无精子患者TESA获得的微量精子行新鲜或冷冻后ICSI治疗,共238个周期的临床资料,132个周期为常规ICSI精子组,63个周期为冷冻TESA精子组,43个周期为新鲜TESA精子组,比较3组的实验室指标和临床妊娠结局。结果:常规ICSI精子组获卵数(10.58±5.37枚)与冷冻TESA精子组(10.73±4.19枚)和新鲜TESA精子组(10.88±4.67枚)相比差异无统计学意义(P>0.05)。3组患者卵子成熟率、正常受精率、优质胚胎率相比差异无统计学意义(P>0.05)。冷冻TESA精子组的临床妊娠率、多胎率、流产率(47.62%、26.67%、6.67%)与常规ICSI精子组(48.48%、25.00%、6.25%)及新鲜TESA精子组(51.16%、22.73%、4.55%)相比差异无统计学意义(P>0.05)。结论:经皮睾丸穿刺取精术后对有活动精子的睾丸组织进行冷冻复苏行ICSI可以获得较好的治疗效果,也是治疗非梗阻性无精子症不育患者的有效方法。

Objective： To investigate the clinical outcome of intracytoplasmic sperm injection（ ICSI） using frozen and thaw sperms by testicular sperm aspiration（ TESA） in patients with non-obstructive azoospermia.Methods： To review and analyze 238 cycles of clinical data from the patients of oligospermia,asthenozoospermia,teratozoospermia and azoospermia in the reproductive center of our hospital from October 2015 to August 2017.The 132 cycles using fresh ejaculated sperms were set as the routine ICSI sperm group,the other 63 cycles using frozen and thaw testicular sperms asfrozen TESA sperm group and 43 cycles using fresh testicular sperms as fresh TESA sperm group.The laboratory parameters and clinical pregnancy outcomes of the three groups were compared.Results： There was no significant difference on the average number of oocytes obtained among the routine ICSI group（ 10. 58±5. 37）,the frozen TESA sperm group（ 10. 73 ± 4. 19） and fresh TESA sperm group in（ 10. 88 ±4. 67）（ P〉0. 05）.There was no significant difference on the MetaphaseⅡrate,2 PN fertilization rate and good embryos rate among the three groups（ P〉0. 05）. There was no significant difference on the clinical pregnant rate,multiple pregnant rate and miscarriage rates among the Frozen TESA sperm（ 47. 62%、26. 67%、6. 67%）,routine ICSI group（ 48. 48%、25. 00%、6. 25%） and fresh TESA sperm groups（ 51. 16%、22. 73%、4. 55%）（ P〉0. 05）. Conclusions： ICSI using cryopreserved-thawed testicular sperm aspiration can produce very good clinical pregnancy outcomes and it is an effective method in the treatment of non-obstructive azoospermia.