不射精症及死精子症经皮穿刺输精管吸精子辅助受孕的研究

The management of male infertility due to anejeculation and necrospermia using percutaneous vasal sperm aspiration （PVSA） and intrauterine insemination

目的探讨不射精症及死精子症不育患者经皮穿刺输精管吸精子（percutaneous vasal sperm aspiration，PVSA）结合宫腔内人工授精（IUI）的治疗效果。方法PVSA前后进行常规精液分析，通过精子伊红Y湿片染色，计算死精子百分比，不育男性PVSA52例，其中不射精症患者36例，死精子症患者16例，进行精子体外处理及IUI。结果PVSA-IUI共进行67个月经周期，25例妊娠，总的周期妊娠率为37．3％。其中不射精症患者36例，PVSA-IUI进行45个月经周期，22例妊娠，周期妊娠率为48．9％；死精子症患者16例，PVSA-IUI进行22个月经周期，3例妊娠，周期妊娠率为13．6％。不射精症不育患者PVSA吸出的精子活动率、（a＋b）级精子均明显高于死精子症不育患者，（P〈0．01），IUI后妊娠率也明显高于死精子症不育患者（P〈0．05），而畸形精子比率明显低于死精子症不育患者（P〈0．05）。结论不射精症及死精子症不育患者通过PVSA可以获得较高活率的精子，PVSA结合IUI辅助受孕为射精功能障碍及死精子症不育者提供了新的、有效的治疗方法。

Objective To explore the effect in the treatment of male infertility due to necrospermia and anejeculation by means of percutaneous vasal sperm aspiration （PVSA） and intrauterine insemination （IUI）. Methods Routine semen analysis was carried out before and after PVSA, and the percentage of dead sperms was determined by using the eosin Y wet method. PVSA was performed in 52 infertile males. Sperm preparation in vitro and IUI were carried out in 52 infertile couples. Results PVSA-IUI were performed in 67 period cycles and 25 pregnancies achieved （the total pregnancy rate was 37.3%, 25/67）. Thirty-six cases suffered from anejeculation. The intervention lasted for 45 period cycles and 22 pregnancies achieved [the cycle pregnancy rate was 48.9% （22/45）]. Sixteen cases suffered from necrospermia. The intervention lasted for 22 period cycles and 3 pregnancies achieved [the cycle pregnancy rate was 13.6% （3/22）]. There was a significant difference in sperm motility （P〈0.01）, sperm progressive motility （P〈0.01）,abnormal sperms （P〈0.05） and pregnancy rate per IUI cycle （χ^2=3.994, P〈0.05） in anejeculation infertile men and necrospermia men. Conclusion Sperms with high motility and high progressive motility may be obtained from patients with anejeculation or necrospermia by PVSA. PVSA-IUI is a new, effective approach in the treatment of anejeculation and necrospermia.