采用新鲜和冻融精子进行卵母细胞胞质内单精子注射的临床效果比较

Outcome of intracytoplasmic sperm injection cycle： fresh compared to cryopreserved-thawed testicular and epididymal spermatozoa

目的比较采用新鲜和冻融的睾丸及附睾精子进行卵母细胞胞质内单精于注射（ICSI）的临床效果。方法选择2006年9月-2007年5月因无精症于北京大学第三医院生殖医学中心行ICSI的患者208例，按患者意愿分为冻融组37例和新鲜组171例。冻融组在行ICSI前将冻存的睾丸或附睾精子解冻并复苏。观察冻融组睾丸和附睾精子的临床利用率；比较两组患者的临床结局（包括正常受精率、优质胚胎率、临床妊娠率及胚胎着床率等）和妊娠结局（包括流产率、分娩孕周及新生儿出生体重等）。结果（1）冻融组睾丸精子的临床利用率为92％（23／25），附睾精子为100％（12／12）。（2）新鲜组患者的正常受精率、优质胚胎率、临床妊娠率及胚胎着床率分别为62．25％（973／1563）、78．9％（768／973）、44．4％（60／135）和29．3％（84／287），分别与冻融组[分别为64．53％（282／437）、79．1％（223／282）、46．9％（15／32）和33．3％（23／69）]比较，差异均无统计学意义（P〉0．05）。（3）新鲜组患者的流产率、单胎妊娠分娩孕周、双胎妊娠分娩孕周、单胎妊娠平均新生儿出生体重及双胎妊娠平均新生儿出生体重分别为11％（6／55）、（39．0±1．4）周、（36．8±1．7）周、（3409±393）g和（2584±266）g，分别与冻融组[分别为7％（1／15）、（38．7±0．6）周、（36．3±1．2）周、（3350±383）g和（2635±171）g]比较，差异均无统计学意义（P〉0．05）。结论采用冻融的睾丸或附睾精子行ICSI安全、有效，值得在临床推广。

Objective To compare clinical outcome of intracytoplasmic sperm injection （ICSI） cycle by using fresh and cryoprescrved-thawed testicular and epididymal spermatozoa in azoospermic patients. Methods Between September 2006 and May 2007, 208 azoospermic patients underwent in vitro fertilization （IVF） were treated in Center of Reproductive Medicine, Peking University Third Hospital. Those couples were divided into two groups based on their wishes, including 171 cases in fresh group and 37 cases in cryopreserved-thawed group. The cryopreserved testicular or epididymal spermatozoa were thawed and recovered before ICSI procedure in thawed group. The outcomes of ICSI in each group were compared, including clinical outcomes （two pronuclear fertilization, high quality embryo, clinical pregnancy and embryo implantation ） and pregnancy outcomes （spontaneous miscarriage, gestational weeks and neonatal birth weight）. Results （ 1 ） The utilization rate were 92% （ 23/25 ） in cryopreserved-thawed testicular spermatozoa and 100% （12/12） in epididymal spermatozoa. （2） Between fresh and cryopreserved-thawed groups, no statistical difference was observed in two pronuclear fertilization rate [ 62.25% （973/1563） vs. 64. 53% （282/437）, P = 0. 960 ], high quality embryo rate [ 78.9% （768/973） vs. 79.1% （ 223/282 ）, P = 0. 985 ] , clinical pregnancy rate per embryo transfer [ 44.4% （ 60/135 ） vs. 46. 9% （ 15/32）, P = 0. 688 ] and embryo implantation rate [ 29.3% （ 84/287 ） vs. 33.3% （ 23/69 ）, P = 0. 508 ]. （ 3 ） No significant difference between fresh and cryopreserved group was found in spontaneous miscarriage rate （11% vs. 7%,P = 1.000）, gestational weeks （single birth： 39.0 weeks vs. 38.7 weeks, P =0.538;twins： 36. 8 weeks vs. 36. 3 weeks, P = 0. 571 ） and birth weight （ single birth： 3409 g vs. 3350 g,P = 0. 699;twins： 2584 g vs. 2635 g,P = 0. 703 ）. Conclusion It suggested that tissue from the azoospermic patients who underwent diagnostic testicular and epididymal biopsy should be cryopreseved for IVF-ET.