不同来源精子ICSI妊娠结局的初步探讨

Initial analysis on pregnancy outcomes of ICSI with sperm from different sources

目的:探讨不同来源精子行卵胞浆内单精子注射(ICSI)的治疗结局。方法:回顾性分析2007年9月至2013年4月在我院行ICSI治疗的3398个新鲜移植周期。根据精子来源不同分为三组:射精组(A组),经皮附睾抽吸取精(PESA)组(B组),睾丸切开取精(TESE)组(C组)。比较A、B、C三组的受精率、卵裂率、优质胚胎率、流产率、宫外孕率和早产率,同时评估三组新生儿的低出生体重(LBW)率和出生缺陷的发病率。结果:A、B、C组的入选患者数分别为2726个、409个、263个;C组的受精率(77.0%)、卵裂率(96.6%)显著低于A组(81.2%与97.7%)和B组(80.8%与98.2%),均为P<0.05;B组的优质胚胎率(53.2%)显著高于A组(49.8%)和C组(47.9%),均为P<0.05;B组的临床妊娠率(48.2%)显著高于A组(40.6%),P<0.05。A、B、C三组间流产率(20.1%、16.2%、21.4%)、宫外孕发生率(3.1%、1.0%、0.0%)、早产率(16.9%、17.2%、21.6%)、新生儿低出生体重(LBW)率(17.9%、17.8%、25.6%)和出生缺陷率(0.8%、0.0%、2.5%)比较均无统计学差异,(P>0.05)。结论:采用不同来源精子行ICSI可获得相近的妊娠结局,未额外增加子代出生缺陷的风险。

Objectives： To investigate the therapeutic outcomes of intracytoplasmic sperm injection （ICSI） with sperm from different sources. Methods： The data of 3398 cases received ICSI, from September 2007 to April 2013 in Jin- ghua hospital was retrospectively analyzed. Three groups were divided according to the source of sperm, ejaculation group （group A）, percutaneous epididymal sperm aspiration （PESA） group （group B） and testicle sperm extraction （TESE） group （group C）. The embryo devdopment, pregnancy complications and birth outcomes were compared in the three groups. Results： The patient number of group A, B and C were 2726, 409 and 263 respectively. The fertilization rate （77.0%） and cleavage rate （96.6%） in group C were significantly lower than these in group A （81.2% and 97.7% ） and group B （80. 8% and 98.2% ）, P 〈 0. 05. Good - quality embryo rate （53. 2% ） of group B was significantly higher than that in group A （49.8%） and group C （47.9%）, P 〈0. 05. Clinical pregnancy rate （48.2%） of group B was sig- nificantly higher than that in group A （40. 6% ）, P 〈0. 05. There were no significant differences in abortion rate （ 20.1% vs 16. 2% vs 21.4% ）, ectopic pregnancy rate （3. 1% vs 1.0% vs 0% ）, premature delivery rate （ 16.9% vs 17.2% vs 21.6% ）,low birth weight （LBW） rate （17.9% vs 17.8% vs 25.6% ） and birth defects （0. 8% vs 0% vs 2.5% ） an^ng the three groups （P 〉0. 05）. Conlusions ： The therapeutic outcoraes of ICSI with different sperm sources are similar and there is no increased risk of additional birth defects.