3106个不同来源精子ICSI周期临床妊娠结局分析

Clinical Outcome Analysis of 3 106 Intracytoplasmic Sperm Injection Cycles Using Spermatozoa of Different Origin

目的:分析精子的来源对卵胞质内单精子注射(ICSI)治疗结局的影响。方法:回顾性分析因男性不育行ICSI的3 106个新鲜周期,按精子来源分为:射精组(A组)、附睾穿刺取精(PESA)组(B组)、睾丸穿刺取精(TESA)组(C组)、冻融PESA精子组(D组)及冻融TESA精子组(E组),比较各组ICSI后胚胎发育及妊娠结局情况。结果:C组2PN受精率、卵裂率显著低于A组及B组;B组临床妊娠率、胚胎植入率显著高于A组及C组,A组、B组及C组间分娩率、异位妊娠率、流产率及新生儿畸形率无统计学差异(P>0.05);E组2PN受精率显著低于D组,但B组与D组之间、C组与E组间2PN受精率、优质胚胎率、多胎率、流产率及异位妊娠率均无统计学差异(P>0.05)。结论:PESA/TESA-ICSI、冻融PESA/TESA精子技术是治疗梗阻性无精子症安全有效的方法,建议首先选择附睾取精,并可将剩余PESA/TESA精子冻存。

Objective： To analyze the effect of sperm origin on pregnancy outcome after intracytoplasmic sperm injection （ICSI）. Methods： A retrospective study was carried out on 3 106 fresh cycles which had under- gone ICSI treatment. Patients were divided into five groups according to the source of sperm： ejaculated sperm group （group A）, percutaneous epididymal aspiration （PESA） group （group B）, testicular sperm aspiration （TESA） group （group C）, frozen-thawed epididymal sperm group （group D） and frozen-thawed testicular sperm group （group E）. The embryonic development and pregnancy outcomes and other indicators were compared. Results： The rates of 2PN fertilization and cleavage were significantly higher in group A and group B than in group C. The rates of clinical pregnancy and embryo implantation were significantly higher in group B than in group A and group C. There was no significant difference among groups A, B, C in the rates of good-quality embryo, parturition, ectopic pregnancy, single fetal birth, multiple birth, miscarriage and neonatal malformation. The rate of 2PN fertilization was significantly higher in group D than in group E. There was no significant difference between groups D and E in the rates of 2PN fertilization, good-quality embryo, ectopic pregnancy and multiple birth and miscarriage. Conclusion： PESA/TESA-ICSI and ICSI using frozen-thawed sperm from PESA/TESA are effective methods to treat obstructive azoospermia, while PESA should be the first choice, and the rest of sperm from PESA/TESA should be cryopreserved.