192例男性因素不孕患者不同来源精子ICSI后临床结局分析

Analysis of ICSI outcome in 192 male factor infertility patients with sperm from different sources

目的探讨单纯男性因素不孕患者不同来源精子行卵胞浆内单精子显微注射术(intracytoplasmic sperm injection,ICSI)后的临床结局。方法回顾性分析2013年1月至2016年1月在我中心因单纯男性因素不孕行ICSI助孕治疗的192个新鲜移植周期患者病例资料。根据不同来源精子,将周期分为3组:射精组(严重少、弱、畸精子症)101周期,经皮附睾穿刺抽吸取精(PESA)组65周期,经皮睾丸穿刺抽吸取精(TESA)组26周期,分析比较3组实验室及临床资料。结果 3组患者在平均年龄,不孕年限,基础卵泡刺激素(FSH),促性腺激素(Gn)使用天数,Gn用药量,人绒毛膜促性腺激素(HCG)日黄体生成素(LH)、孕酮(P)、雌二醇(E2)水平,平均获卵数以及MII卵数均无差异(P>0.05)情况下,除PESA组受精率、2PN受精率高于射精组、TESA组,差异比较有统计学意义(P<0.01)外,3组2PN卵裂率、优质胚胎率、可移植胚胎率、胚胎种植率、临床妊娠率、流产率比较均无统计学差异(P>0.05)。结论单纯男性因素不孕患者用不同来源精子行ICSI,这对胚胎发育、胚胎种植率、临床妊娠率、流产率均无显著影响,可获得较好临床结局。

Objective To investigate the therapeutic outcome of intracytoplasmic sperm injection（ICSI） in male factor infertility patients with sperm from different sources. Methods Clinical data of 192 cases who received ICSI from January 2013 to January 2016 in Guiping People＇s Hospital, were retrospectively analyzed. According to the source of sperm, the patients were divided into Ejaculation Group（severe oligospermia and asthenospermia, n=101）, PESA group（percutaneous epididymal aspiration, n=65） and TESA group（testicular sperm aspiration, n=26）. Laboratory and clinical data of the above three groups were analyzed. Results There were no significant differences among the three groups in mean age, infertility years, basic FSH, days of undergoing Gn, Gn dosage, level of LH,P and E2 in HCG days, average number of oocytes retrieved and MII number（P〉 0.05）. The differences in 2PN cleavage rate, rate of high quality embryo, embryo transplantation, embryo implantation, pregnancy and abortion among three groups had no statistical significance（P〉0.05）. The fertility rate and 2PN fertility rate in PESA group were higher than those in Ejaculation Group and TESA group（P〈 0.01）. Conclusion Male factor infertility patients with sperm from different sources undergoing ICSI have no obvious impacts on embryonic development, embryo implantation rate, pregnancy rate and abortion rate, which can achieve good clinical outcomes.