附睾睾丸活动与不动精子卵胞浆内注射治疗阻塞性无精子症效果分析

Analysis on effects of intracytoplasmic injection of motile and non-motile sperms of testis and epididymis in treatment of obstructive azoospermia

目的:对附睾、睾丸活动精子与不动精子ICSI的助孕效果进行比较分析。方法:收集2004年1月～2008年7月在福建省妇幼保健院辅助生殖技术研究室接受ICSI治疗的114例阻塞性无精症患者为研究对象,长方案进行超促排卵,ICSI常规操作,比较分析附睾、睾丸活动精子组与不动精子组ICSI后的妊娠结局。结果:114例阻塞性无精症患者120个周期ICSI助孕。获卵1415枚,平均获卵(11.79±6.15)枚,其中可注射的MⅡ成熟卵1187枚(83.88%),受精率75.82%,卵裂率88.22%;ET114周期,平均移植胚胎数2.01±0.34,种植率20.00%,周期临床妊娠率32.46%。6例双胎,双胎率16.22%,目前已出生32名健康婴儿,其中男婴14名,女婴18名,男女比例为0.78,尚有4例5胎继续妊娠中。睾丸活动精子组的受精率差异有统计学意义(P<0.01);卵裂率、种植率及妊娠率等指标两组间比较差异均无统计学意义(P>0.05)。结论:ICSI是治疗阻塞性无精症性不育的有效措施,取睾丸、附睾活动或HOST阳性精子卵胞浆内显微注射助孕效果一致。

Objective：To compare and analyze the outcomes of intracytoplasmic injection（ICSI） between motile and non-motile sperms of testis and epididymis in treatment of obstructive azoospermia.Methods：114 patients with obstructive azoospermia receiving ICSI from January 2004 to July 2008 were selected,long protocol was used for promoting superovulation,ICSI was conducted according to routine operation,the pregnant outcomes of ICSI in motile sperm group and non-motile sperm group were compared and analyzed.Results：114 patients with obstructive azoospermia received 120 ICSI cycles,the total number of oocytes collected was 1 415,（11.79 ± 6.15） each cycle on average,1 187 oocytes were injectable,M Ⅱ mature oocytes（83.88%）,the fertilization rate was 75.82%,the cleavage rate was 88.22%;among 114 embryo transfer cycles,the average number of embryo transfer was（2.01±0.34）,the implantation rate was 20.00%,the clinical pregnancy rate per cycle was 32.46%;the rate of twin pregnancy was 16.22%（6 cases）;32 healthy neonates were born,including 14 boys and 18 girls,the ratio of boys and girls was 0.78,4 cases（5 fetuses） continued pregnancy;there was significant difference in fertilization rate of motile sperm of testis（P0.01）;there was no significant difference in cleavage rate,implantation rate and pregnancy rate between the two groups（P0.05）.Conclusion：ICSI is an effective method in treatment of infertility induced by obstructive azoospermia,the outcomes of ICSI between motile and non-motile sperms of testis and epididymis are consistent.