睾丸精子卵母细胞浆内注射治疗梗阻性无精子症所致不育的临床体会

Experience of intracytoplasmic sperm injection with testicle sperm in the treatment of obstructive azoospermia

目的:探讨睾丸精子单精子卵母细胞浆内注射(ICSI)治疗梗阻性无精子症所致的男性不育的疗效,以完善辅助生殖技术。方法:选男性不育症夫妇905例分成两组:ICSI组和TESE+ICSI组。ICSI组自行排精后精液内可以找到正常形态活精子的少精症患者行ICSI治疗共863例,TESE+ICSI组经附睾抽吸取精失败而睾丸切开后可找到形态正常活精子的梗阻性无精子症患者用睾丸内精子行ICSI治疗共42例,两组患者的女方均给予超促排卵用药后获取卵母细胞。结果:ICSI组863周期,获得卵子9650个,其中成熟卵母细胞7879个,ICSI7879个,移植808个周期,妊娠256例,妊娠率为31·68%。TESE+ICSI组42周期,获得卵子567个,其中成熟卵母细胞479个,ICSI479个,移植42个周期,妊娠20例,妊娠率为47·60%。对两组的受精率、优质胚胎获得率、临床妊娠率进行比较及统计学分析,TESE+ICSI组的受精率稍低于ICSI组(P<0·05),而两组的优质胚胎获得率及临床妊娠率无显著差异(P>0·05)。结论:睾丸切开取精子进行ICSI治疗同样能够得到较高的受精率、优质胚胎获得率和临床妊娠率。

Objectives： To study the efficacy of intracytoplasmic sperm injection （ICSI） with testicle sperm in the trestment of obstructive azoospermia male infertility. Methods： From August. 2001 to December. 2005 905 male infertility couples were divided into ICSI teem and TESE ＋ ICS! teem. ICSI teem were 863 oligozoospzrmia couples and husbands could find alive normal sperms in spermatic fluid. TESE ＋ ICSI teem were 42 obstructive azoospermia couples and husbands could find alive normal sperms in testicle but in epididymal could not find. Two teems were treated with ICSI after wifes obtained oocytes by ovarian stimulation. Results： ICSI teem were 863 cycles, obtained 7879 mature oocytes to ICSI, transplanted 808 cycles, pregnancy 256 couples, pregnancy rate was 31.68%. TESE ＋ ICSI teem were 42 cycles, obtained 576 mature oocytes to ICSI, transplanted 42 cycles, pregnancy 20 couples, pregnancy rate was 47.60%. Compared ICSI teem with TESE ＋ ICSI teem about impregnation rate, high quality embryo obtained rate, pregnancy rate by statistics. Impregnation rate of TESE ＋ ICSI teem was lower than ICSI teem （ P 〈 0. 05 ）. High quality embryo obtained rate and pregnancy rate of two teems did not have obvious difference （P 〉 0. 05）. Conclusion： ICSI with testicle sperm also obtained higher impregnation rate, high quality embryo obtained rate and pregnancy rate.