不同来源精子行卵胞浆内单精子注射临床结局分析

Clinical outcome of intracytoplasmic sperm injection: a comparison between ejaculated and testicular sperm

目的:比较不同来源精子行卵胞浆内单精子注射的临床结局。方法:回顾性的分析2008年1月～2011年12月在我中心行ICSI助孕的患者,选取不孕原因为单纯性严重少、弱、畸精症和无精症的,且年龄在35岁或35岁以下的153例患者入组本研究,共完成165个取卵周期,146个移植周期。按精子来源分为两组:射出精子组(严重少、弱、畸精症组)和睾丸精子组,比较两组间的女方平均年龄、不孕年限、基础FSH值、Gn支数、Gn天数、HCG日E2值、内膜厚度、MII卵数、受精、卵裂、可移植胚胎、优质胚胎、临床妊娠及流产情况。结果:两组间的女方平均年龄、不孕年限、基础FSH值、Gn支数、Gn天数、HCG日E2值、子宫内膜厚度、MII卵数、2PN卵裂率、可移植胚胎率、优质胚胎率、流产率、多胎率无统计学差异;睾丸精子组的受精率、2PN受精率较射出精子组高(72.3%vs 82.0%,P<0.01;67.9%vs72.9%,P<0.05),差异均有统计学意义;虽然睾丸精子组的临床妊娠率、种植率(60.7%、42.0%)高于射出精子组(50.0%、35.6%),但是两组间的差异无统计学意义(P>0.05)。结论:睾丸精子行ICSI助孕可以得到较好的临床结局,不比严重少、弱、畸精子症患者精液中的精子差。

Objectives： To compare the clinical outcome between intracytoplasmic sperm injection （ICSI） with ejaculated sperm for sever oligo - astheno - teratozoospermia（OAT） and the injection with testicular sperm for azoospermia patients. Meth-ods： This study retrospectively studied one hundred and fifty - three samples, whose infertility was solely caused by their male partners and who aged younger than thirty - five years. They finished 165 ICSI cycles and were divided into two groups according to their sperm source： severe OAT sperm group （n = 104） and testicular sperm group （n =61）. The two groups were compared in female age, infertile years, base FSH level, Gn dosage, Gn Days, E2 level on HCG day, endometrial thickness, MII oocyte number, fertilization, cleavage, embryo quality, clinical pregnancy rate, implantation rate, fetal abortion and multiple pregnancy rate. Results： The demographic and clinical factors, including female age, infertile years, base FSH level, Gn dosage, Gn Days, E2 level on HCG day, endometrial thickness, MII oocyte number, cleavage rate, embryo quality, fetal abortion rate and multiple pregnancy rate were similar between two groups. Tile fertilization rate, 2PN fertilization rate of testicular sperm group were higher than those of the OAT sperm group（72.3% vs 82.0% ,P 〈 0. 01 ; 67.9% vs72.9%, P 〈 0.05 ）, the differences having statistical significance. Though the clinical pregnancy rate and implantation rate of testicular sperm group （60.7%, 42.0% ） are higher than those of the OAT sperm group （50.0%, 35.6% ）, but no statistical differences were seen （ P 〉 0. 05 ）. Conclusions： The clinical outcome of ICSI cycles with testicular sperm is as good as the outcome of injection with ejaculated se- vere OAT sperm.