不同来源的精子ICSI治疗周期妊娠结局分析

Outcomes of ICSI with Sperm from Different Sources:A Retrospective Study of 431 Cycles

目的：比较不同来源的精子进行ICSI治疗后受精率、胚胎种植率、临床妊娠率等临床指标有无差异。方法：回顾性分析2006年1月~2008年12月本院生殖中心进行的431个ICSI治疗周期,按精子来源分为A组（重度少弱精子症组）287个周期、B组（梗阻性无精子症附睾穿刺组）109个周期、C组（梗阻性无精子症睾丸穿刺组）35个周期,比较各组女方平均年龄、男方平均年龄、不孕病史、平均MII卵数、受精率、卵裂率、胚胎利用率、平均移植胚胎数量、种植率、妊娠率、流产率等指标的差异。结果：A组与B、C两组在种植率、妊娠率方面差异有统计学意义（18.46%vs25.23%、28.76%;31.23%vs42.16%、39.39%,P〈0.05）;B、C两组之间各数据差异无统计学意义（P〉0.05）,受精率、卵裂率、流产率3组之间差异无统计学意义。结论：重度少弱精子症患者射出精子进行ICSI治疗后胚胎种植率、临床妊娠率低于梗阻性无精子症患者。

Objective： To compare the outcomes of intracytoplasmic sperm injection（ICSI） with retrieved epididymal and testicular sperm for obstructive azoospermia and with ejaculated sperm for severe oligozoospermia and asthenospermia.Methods： We retrospectively analyzed 431 ICSI cycles,which were divided according to sperm sources into Groups A（n=287 in patients with severe oligozoospermia or asthenospermia using ejaculated sperm）,B（n=109 in obstructive azoospermia patients with sperm retrieved by percutaneous epididymal sperm aspiration,PESA） and C（n=35 in obstructive azoospermia patients with sperm retrieved by testicular sperm extraction,TESE）.Comparisons were made among the three groups in the rates of embryo implantation,fertilization,pregnancy,cleavage,and miscarriage.Results： Group A showed statistically significant differences from Groups B and C in the rates of embryo implantation and pregnancy（18.46% vs 25.23% and 28.76%,31.23% vs 42.16% and 39.39%,P0.05）.But no significant differences were seen in the rates of fertilization,cleavage and miscarriage among the three groups（P0.05）.Conclusion： The rates of embryo implantation and clinical pregnancy are higher in patients with obstructive azoospermia than in those with severe oligozoospermia or asthenospermia after ICSI with ejaculated sperm.