冻融和新鲜PESA精子行ICSI治疗梗阻性无精子症临床结局比较

Comparison of clinical outcome of freeze-thawed and fresh PESA sperm for ICSI treatment of obstructive azoospermia

目的比较经皮附睾穿刺取精(PESA)获得的冻融和新鲜精子行卵细胞质内单精子注射(ICSI)治疗梗阻性无精子症患者的临床结局。方法回顾性分析2013年4月至2019年11月海南医学院第二附属医院生殖科经皮附睾穿刺取精行卵细胞质内单精子注射治疗161周期梗阻性无精子症患者的临床资料。根据是否冻融分为冻融PESA精子组(A组,55周期)和新鲜PESA精子组(B组,106周期)。比较两组间正常受精率、正常卵裂率、可利用胚胎率、优质胚胎率、着床率、临床妊娠率和流产率。结果A组患者的正常受精率为82.32%,明显高于B组的69.01%,差异具有统计学意义(P<0.05);但A组和B组间的正常卵裂率(97.98%vs 95.42%)、可利用胚胎率(59.93%vs 59.96%)、优质胚胎率(36.30%vs 37.08%)、着床率(35.18%vs 35.43%)、妊娠率(45.71%vs 47.22%)和流产率(12.50%vs 11.76%)比较差异均无统计学意义(P>0.05)。结论PESA行ICSI治疗梗阻性无精子症,冻融附睾精子比新鲜附睾精子显示出更高的受精率,而在正常卵裂率、可利用胚胎率、优质胚胎率、着床率、妊娠率、流产率方面,两者的临床结局相似。

Objective To compare the clinical outcome of patients with obstructive azoospermia treated with intra cytoplasmic sperm injection(ICSI)with frozen-thawed and fresh sperm obtained percutaneous epididymal sperm aspiration(PESA).Methods From April 2013 to November 2019,the clinical data of 161 cycles of obstructive azo-ospermia treated by percutaneous epididymal puncture in the Reproductive Department of the Second Affiliated Hospital of Hainan Medical College were retrospectively analyzed.According to the classification of freezing and thawing,they were divided into the frozen-thawed PESA sperm group(group A,55 cycles)and a fresh PESA sperm group(group B,106 cycles).Then,the normal fertilization rate,normal cleavage rate,available embryo rate,high quality embryo rate,im-plantation rate,clinical pregnancy rate,abortion rate were compared between the two groups.Results The normal fertil-ization rate of patients in group A was 82.32%,which was significantly higher than 69.01%in group B(P<0.05).But there was no significant difference in the normal cleavage rate(97.98%vs 95.42%),available embryo rate(59.93%vs 59.96%),high-quality embryo rate(36.30%vs 37.08%),implantation rate(35.18%vs 35.43%),pregnancy rate(45.71%vs 47.22%),and abortion rate(12.50%vs 11.76%)between group A and group B(all P>0.05).Conclusion In the way of PESA sperm for ICSI treatment of obstructive azoospermia,frozen-thawed epididymal sperm shows a higher fertilization rate than fresh epididymal sperm,while there are similar clinical outcomes in the aspect of the normal cleavage rate,usable embryo rate,high-quality embryo rate,implantation rate,pregnancy rate,and abortion rate.