附睾和睾丸精子活力对卵胞浆内单精子注射结局的影响

The outcomes of intracytoplasmic injection of sperm from epididymis/testis with different motilities

目的比较附睾或睾丸来源及其不同活力精子行卵胞浆内单精子注射(ICSI)的结局。方法回顾性分析2005年1月至2008年5月在本生殖中心经皮附睾精子抽吸术(PESA)、睾丸精子抽吸术(TESA)助孕的218例无精子症患者的资料,比较附睾和睾丸及其不同活力精子的正常受精率、卵裂率、优质胚胎率、临床妊娠率、种植率和早期流产率。结果附睾精子组与睾丸精子组比较,正常受精率、卵裂率、临床妊娠率、种植率和早期流产率无显著性差异(P>0. 05);优质胚胎率附睾精子组显著高于睾丸精子组(P<0. 05)。附睾活动精子、睾丸活动精子和睾丸不活动精子的正常受精率显著高于附睾不活动精子(P<0. 01) ;睾丸活动精子的正常受精率显著高于睾丸不活动精子组(P<0. 05);以上各组间的优质胚胎率、临床妊娠率、种植率、流产率均无显著性差异(P>0. 05)。结论 PESA操作简单且不影响妊娠率,无精子症患者行ICSI治疗时可首选附睾精子;附睾或睾丸不活动精子影响ICSI的受精率,应优先选择活力较好的精子,若无活动精子则选择睾丸不活动精子。

Objectives： To analyze and evaluate the outcomes testicular sperm with different motilities. of intracytoplasmic injection of epididymal and Methods： The outcomes of ICSI for 218 azoospermic patients who had their sperm retrieved by percutaneous epididymal sperm aspiration （PESA） or testicular sperm aspiration （TESA） from Jan. 2005 to May 2008 were analyzed. The rates of normal fertilization, cleavage, good embryos, clinical pregnancy, implantation and early abortion were compared. Results： The rates of normal fertilization, cleavage, implantation, clinical pregnancy, and early abortion were similar in epididymal and testicular sperm groups （P〉0.05）, while the rate of good embryos was higher in epididymal group （P〈0. 05）. The normal fertilization rate of motile epididymal sperm, motile or immotile testicular sperm was higher than that of immotile epididymal sperm （P〈0.01） ; the normal fertilization rate of motile testicular sperm was higher than that of immotile testicular sperm （P〈0.05） ; the rates of good embryos, clinical pregnancy, implantation and early abortion were similar among these four groups （P〉0.05）. Conclusions： The technique of PESA was simple and pregnancy rate with epididymal sperm was similar to that with testicular sperm from azoospermic patients, so sperm from epididymis should be chosen first. Since the motility of epididymal or testicular sperm plays an important role in the rate of fertilization,the sperm with better motility should be chosen first. If no motile sperm available, the immotile testicular sperm rather than immotile epididymal sperm should be chosen.