Y染色体微缺失患者与无精子或严重少弱精子症患者ICSI治疗结局比较

Y-chromosome microdeletions do not affect the outcomes of ICSI for infertile males

目的:比较Y染色体微缺失患者和没有Y染色体微缺失的无精子或严重少弱精子症患者的卵细胞胞质内单精子注射(ICSI)治疗结局。方法:回顾性分析了本医院2008年1月至2009年12月确诊Y染色体微缺失行ICSI治疗的48例56个周期,与治疗时间严格匹配的无Y染色体微缺失的其他无精子或严重少弱精子症的90例患者94个ICSI周期。比较两组患者女方年龄、不孕年限、男方年龄、精液参数、获卵数、ICSI卵子数、受精率、卵裂率、优质胚胎率、平均移植胚胎数、移植日内膜厚度、胚胎种植率、生化妊娠率、临床妊娠率、流产率、活产率、活产男女比例差异。结果:Y染色体微缺失组与无精子或严重少弱精子症的对照组在女方年龄、不孕年限、男方年龄、获卵数、ICSI卵子数、平均移植胚胎数等基本情况差别无统计学意义(P>0.05);Y染色体微缺失组与无精子或严重少弱精子症的对照组相比受精率(69.0%vs73.2%)、卵裂率(96.0%vs95.3%)、优质胚胎率(53.3%vs48.7%)、胚胎种植率(24.0%vs30.3%)、生化妊娠率(41.1%vs44.7%)、临床妊娠率(37.5%vs35.1%)、早期流产率(4.8%vs6.1%)、活产率(35.7%vs29.2%)差别无统计学意义。结论:Y染色体微缺失不影响ICSI治疗结局;男性后代将会面临生育问题,是否选择胚胎植入前遗传学诊断(PGD)应在充分遗传咨询的情况下遵从患者夫妇意愿。

Objective： To compare the outcomes of intracytoplasmic sperm injection（ICSI） for infertile males with Y-chromosome microdeletions and for those with azoospermia or severe oligospermia but without Y-chromosome microdeletions.Methods： We retrospectively analyzed 56 cycles of ICSI for 48 infertile cases with Y microdeletions（Group A） and 94 cycles for 90 cases with azoospermia or severe oligospermia but without Y-chromosome microdeletions（Group B） during the same period.We compared the two groups in the females＇ age,duration of infertility,males＇ age,number of oocytes retrieved,number of ICSI oocytes,fertilization rate,good embryo rate,number of embryos transferred,implantation rate,clinical pregnancy rate,abortion rate,live birth rate and babies＇ sexes.Results： There were no significant differences between Groups A and B in the females＇ age,duration of infertility,males＇ age,number of oocytes retrieved,number of ICSI oocytes and number of embryos transferred（P0.05）,nor in the rates of fertilization（69.0% vs 73.2%）,good embryos（53.3% vs 48.7%）,implantation（24.0% vs 30.3%）,biochemical pregnancy（41.1% vs 44.7%）,clinical pregnancy（37.5% vs 35.1%）,early abortion（4.8% vs 6.1%） and live birth（35.7% vs 29.2%）（P0.05）.Conclusion： Y-chromosome microdeletions do not affect the outcomes of ICSI.The affected couples should be informed of the necessity of prenatal genetic diagnosis before embryo implantation and the inevitability of vertical transmission to male offspring.