附睾及睾丸精子行ICSI治疗无精子症妊娠结局

Outcome of Intracytoplasmic Injection of Epididymal and Testicular Sperm Obtained from Azoospermic Patients

目的 :回顾性分析 5 0例无精子症患者利用附睾或睾丸精子行卵细胞胞质内单精子注射 (ICSI)的治疗结局。 方法 :经皮附睾精子抽吸术 (PESA)或睾丸切开取精术 (TESE)获得精子行ICSI,评估取精的成功率 ,ICSI后的受精率、种植率及临床妊娠率 ,以精液精子ICSI组作为对照。 结果 :PESA、TESE与精液精子组分别注射MⅡ期成熟卵子 2 86、36 0、15 6 9个 ,受精率 3组差异无显著性 (74 .8% ,75 .2 %vs 77.5 % ,P >0 .0 5 )。种植率、妊娠率TESE与精液精子组差异无显著性 (2 9.87%vs 2 9.5 4 % ;4 8.15 %vs 5 2 .6 0 % ,P >0 .0 5 ) ,PESA组显著高于TESE组及精液精子组 (5 0 .85 %vs 2 9.87% ,2 9.5 4 % ;6 8%vs 4 8.15 % ,5 2 .6 0 % ,P <0 .0 5 )。PESA组共妊娠 17例 ,已分娩 6例 ,继续妊娠 9例 ,流产 2例 ;TESE组共妊娠 13例 ,已分娩 7例 ,继续妊娠 4例 ,流产 2例。 结论 :采用附睾或睾丸精子行ICSI是治疗男性无精子症的有效方法。

Objective: To review the treatment results of intracytoplasmic injection of epididymal and testicular sperm obtained from 50 azoospermic patients from January 2003 to May 2004. Methods: Sperm was retrieved by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) was performed. The rates of successful sperm retrieval, fertilization, implantation and pregnancy were analysed and evaluated. Results: In the PESA?TESE and ejaculation groups, the number of MⅡ oocytes suitable for ICSI were 286, 360 and 1 569 respectively. The difference of fertilization rates among the three groups was not significant( 74.8%, 75.2% vs 77.5%,P> 0.05). No difference was seen in the implantation and clinical pregnancy rates of the TESE group from the ejaculation group( 29.87% vs 29.54%; 48.15% vs 52.60%, P> 0.05). However the implantation and clinical pregnancy rates were higher in the PESA group compared with the TESE and ejaculation groups( 50.85% vs 29.87%, 29.54%; 68% vs 48.15%, 52.60%, P< 0.05). In the PESA group, 17 clinical pregnancies were achieved including 9 ongoing pregnancies, and 6 live deliveries and 2 miscarriages. While in the TESA group, 13 clinical pregnancies were achieved including 4 ongoing pregnancies, 7 live deliveries and 2 miscarriages. Conclusion: ICSI with PESA and TESE is an effective method to treat azoospermia.