2种类型非梗阻性无精子症患者行显微睾丸取精术联合辅助生殖技术助孕结局分析

Outcomes of microdissection testicular sperm extraction combined with assisted reproductive technology in patients with two types of non-obstructive azoospermia

目的比较特发性非梗阻性无精子症(idiopathic non-obstructive azoospermia, iNOA)、纯合型克氏综合征患者行显微镜下睾丸取精术(microdissection testicular sperm extraction, micro-TESE),配偶同周期行卵胞质内单精子显微注射技术(intracytoplasmic sperm injection, ICSI)助孕的妊娠结局。方法 iNOA患者41例为iNOA组,纯合型克氏综合征患者42例为克氏综合征组,均行micro-TESE成功获取精子。2组患者配偶同周期取卵行ICSI助孕。比较2组患者年龄、体质量指数、双侧睾丸体积及血清卵泡刺激素、黄体生成素、总睾酮水平;比较2组配偶年龄、体质量指数、基础窦卵泡数及血清抗苗勒管激素、卵泡刺激素、黄体生成素、总睾酮水平;比较2组患者手术时间、有活动精子比率;比较2组妊娠结局及配偶双原核率、卵裂率、胚胎种植率、临床妊娠率。结果 2组患者年龄、体质量指数,配偶年龄、体质量指数、基础窦卵泡数及血清抗苗勒管激素、卵泡刺激素、黄体生成素、总睾酮水平比较差异均无统计学意义(P>0.05)。克氏综合征组患者左、右侧睾丸体积[(1.45±0.77)、(1.36±0.53)mL]均小于iNOA组[(6.78±4.05)、(7.15±3.91)mL](P<0.05),血清卵泡刺激素[(40.13±17.07)u/L]、黄体生成素[(21.31±7.60)u/L]水平均高于iNOA组[(21.16±14.93)、(10.77±7.54)u/L](P<0.05),血清总睾酮水平[(2.42±1.28)nmol/L]低于iNOA组[(3.44±2.10)nmol/L](P<0.05)。克氏综合征组患者手术时间[(69.0±16.9)min]短于iNOA组[(82.0±23.8)min](P<0.05),有活动精子比率(16.7%)与iNOA组(9.8%)比较差异无统计学意义(P>0.05)。克氏综合征组活产率(68.4%)高于iNOA组(44.4%)(P<0.05),配偶双原核率(62.9%)、卵裂率(94.0%)、胚胎种植率(60.3%)、临床妊娠率(76.3%)、早期流产率(10.3%)与iNOA组(63.7%、92.5%、47.6%、63.9%、13.0%)比较差异均无统计学意义(P>0.05)。结论 iNOA与克氏综合征患者采用micro-TESE,配偶同周期行ICSI助孕均可获得亲生子代,克氏综合征患者活产率较高。

Objective To compare the pregnancy outcomes of microdissection testicular sperm extraction(micro-TESE)in patients with azoospermia caused by idiopathic non-obstructive azoospermia(iNOA)or homozygous Klinefelter syndrome(KS),and intracytoplasmic sperm injection(ICSI)in their spouses in the same period.Methods The sperms were successfully obtained by micro-TESE from 41 patients with iNOA(iNOA group)and 42 patients with homozygous KS(KS group).The oocytes were retrieved from the spouses of the patients in the same period for ICSI.The age,body mass index,bilateral testicular volume,and levels of serum follicle stimulating hormone,luteinizing hormone and total testosterone of the patients,as well as the age,body mass index,number of basal antral follicles,and levels of serum anti-Müllerian hormone,follicle stimulating hormone,luteinizing hormone and total testosterone of the spouses were compared between two groups.The operation time,motile sperm rate and pregnancy outcomes of the patients,as well as the double pronucleus,cleavage rate,embryo implantation rate and clinical pregnancy rate of the spouses were compared between two groups.Results There were no significant differences in the age and body mass index of the patients,as well as the age,body mass index,basal antral follicle number,serum anti-Müllerian hormone level,follicle stimulating hormone level,luteinizing hormone level and total testosterone level of the spouses between two groups(P>0.05).The left and right testicular volumes were smaller in KS group((1.45±0.77),(1.36±0.53)mL)than those in iNOA group((6.78±4.05),(7.15±3.91)mL)(P<0.05),the levels of serum follicle stimulating hormone and luteinizing hormone were higher in KS group((40.13±17.07),(21.31±7.60)u/L)than those in iNOA group((21.16±14.93),(10.77±7.54)u/L)(P<0.05),and the serum total testosterone level was lower in KS group((2.42±1.28)nmol/L)than that in iNOA group((3.44±2.10)nmol/L)(P<0.05).The operation time was shorter in KS group((69.0±16.9)min)than that in iNOA group((82.0±23.8)min)(P<0.05),and the rate of motile sperm showed no significant difference between two groups(16.7%vs.9.8%)(P>0.05).The live birth rate was higher in KS group(68.4%)than that in iNOA group(44.4%)(P<0.05),and the rates of double pronucleus,cleavage,embryo implantation,clinical pregnancy and early abortion showed no significant differences between KS group(62.9%,94.0%,60.3%,76.3%,10.3%)and iNOA group(63.7%,92.5%,47.6%,63.9%,13.0%)(P>0.05).Conclusion Both iNOA and KS patients can obtain biological offspring by micro-TESE combined with ICSI assisted pregnancy in the same period,and the live birth rate is higher in KS patients undergoing micro-TESE.