隐匿精子症和严重弱精子症的ICSI术前准备和疗效分析

Preoperative preparation and outcome analysis of ICSI for cryptozoospermia and severe asthenospermia

目的总结运用卵胞浆内单精子显微注射(ICSI)技术治疗隐匿精子症和严重弱精子症的诊治经验。方法283周期隐匿精子症及65周期严重弱精子症患者经药物治疗提高活动精子数量后再进入ICSI治疗周期,观察ICSI操作情况和受精、妊娠等治疗结果,并以52周期供精ICSI作为对照组。结果隐匿精子症和严重弱精子症两组分别有15周期和3周期因精子不足或卵子数量较多使用部分供精,其余均使用夫精完成ICSI操作治疗。隐匿精子症组的受精率与对照组比较有显著差异(77.4%vs85.1%,P=0.001),临床妊娠率无显著差异(40.7%vs38.8%,P=0.805);严重弱精子症组的受精率和临床妊娠率与对照组比较均无显著差异(81.2%vs85.1%,P=0.131;31.3%vs38.8%,P=0.404)。结论恰当的ICSI术前准备和熟练的ICSI操作技术能使隐匿精子症和严重弱精子症达到与正常精子相似或稍低的受精率和妊娠率。

Objective To summarize the experience of intracytoplasmic sperm injection （ICSI） following preparation in cases of cryptozoospermia and severe asthenospermia. Methods Two hundred and eighty-three cycles with cryptozoospermia and 65 cycles with severe asthenospermia underwent appropriate drug therapy prior to the ICSI procedure. Fifty-two ICSI procedures in which donor spermatozoa was used were served as controls. Details of each ICSI procedure were recorded, as well as subsequent fertilization and pregnancy rates. Results Due to insufficient patient spermatozoa, 15 cycles with cryptozoospermia and 3 cycles with severe asthenospermia required the combination of donor and patients＇ spermatozoa for ICSI. The rest of the ICSI procedures used spermatozoa from a single source. There were significant differences in fertilization rates between the cryptozoospermia and controls （77.4% vs 85. 1% , P = 0. 001 ） , while the fertilization rates of the group with severe asthenospermia were not significantly different from those of the control group （81.2% vs 85. 1% P = 0. 131 ）. There was no significant difference in pregnancy rates between the groups of cryptozoospermia and controls （40. 7% vs 38.8% , P = 0. 805） and between the groups of severe asthenospermia and controls （31.3% vs 38.8% ,P = 0. 404）. Conclusion In patients with cryptozoospermia and severe asthenospermia, the combination of skillful ICSI techniques and appropriate preparation before ICSI may achieve fertilization rates and pregnancy rates slightly lower than or similar to the procedures done with normal sperm.