单精子卵细胞质内注射治疗梗阻性无精子症

Intracytoplasmic sperm injection for obstructive azoospermia

目的:总结单精子卵细胞质内注射治疗梗阻性无精子症的诊疗经验。方法:回顾总结2006年1月～2008年12月间107例梗阻性无精子症病例ICSI助孕资料,比较先天性输精管缺如组与非先天性输精管缺如组之间受精率、卵裂率以及妊娠率的差异。结果:107例梗阻性无精子症病例ICSI助孕中共行单精子卵细胞质内注射949枚卵子,形成受精卵678枚(受精率71.4%),获得胚胎卵裂605枚(卵裂率89.2%),临床妊娠44例,临床妊娠率41.1%。其中先天性输精管缺如49例,行单精子卵细胞质内注射442枚卵子,形成受精卵308枚(受精率69.6%),获得胚胎卵裂279枚(卵裂率90.6%),临床妊娠27例,临床妊娠率55.1%;炎症或手术等原因引起的梗阻性无精子症58例,行单精子卵细胞质内注射507枚卵子,形成受精卵370枚(受精率72.9%),获得胚胎卵裂326枚(卵裂率88.1%),临床妊娠17例,临床妊娠率29.3%。两组比较受精率、卵裂率无统计学差异(P>0.05),临床妊娠率有统计学差异(P<0.01)。结论:采用经皮附睾或睾丸穿刺抽吸精子结合ICSI技术助孕是治疗梗阻性无精子症的安全有效方法。先天性输精管缺如较其它原因所导致的梗阻性无精子症有更高的临床妊娠率。炎症或手术等原因除引起精道梗阻外也可能影响精子的质量,导致胚胎发育潜能下降。

Objective：To sum up the experience in the treatment of obstructive azoospermia by intracytoplasmic sperm injection （ICSI）. Methods：We retrospectively analyzed 107 cases of obstructive azoospermia treated by ICSI in our center from Jan. 2006 to Dec. 2008,and compared the rates of fertilization,cleavage and pregnancy between the patients with congenital bilateral absence of vas deferens （CBAVD） and those with non-CBAVD. Results：A total of 949 oocytes were injected for the 107 patients undergoing ICSI,of which 678 （71.4%） were fertilized and 605 （89.2%） cleaved,with 44 pregnancies （41.4%）. Of the 442 oocytes injected for the 49 patients with CBAVD,308 （69.6%） were fertilized and 279 （90.6%） cleaved,with 27 pregnancies （55.1%）,and of the 507 oocytes injected for the 58 cases induced by inflammation or surgery,370 （72.9%） were fertilized and 326 （88.1%） cleaved,with 17 pregnancies （29.3%）. The rate of pregnancy was significantly higher in the CBAVD than in the non-CBAVD group （P 0.01）,but there were no significant differences in the rates of fertilization and cleavage between the two groups （P 0.05）.Conclusion：PESA or TESE combined with ICSI is an effective approach to the treatment of male infertility induced by obstructive azoospermia,which may achieve a higher rate of pregnancy in patients with CBAVD than in those with non-CBAVD. Inflammation or surgery may not only cause the obstruction of the deferent duct,but also affect sperm quality,and consequently reduce the potentiality of embryonic development.