睾丸新鲜精子与冷冻复苏精子临床妊娠结局的比较

Comparion of testicular fresh sperm and cryopreserved sperm on clinical pregnancy outcomes

目的比较无精子症患者睾丸穿刺取精(testicular aspiration, TESA)与睾丸显微取精(microdissection testicular speron extraction, m-TESE)新鲜与冷冻复苏精子进行卵胞质内单精子注射(intracytoplasmic sperm injection, ICSI)治疗的结局,以及新鲜、冷冻复苏胚胎移植的妊娠结局。方法选取2019年6月至2021年3月在华中科技大学同济医学院生殖医学中心接受ICSI助孕的1 116个周期,常规超排卵和经阴道B超引导下取成熟卵子进行ICSI,梗阻性无精子症(obstructive azoospermia, OA)患者行TESA,非梗阻性无精子症(nonobstructive azoospermia, NOA)患者行m-TESE,比较TESA新鲜精子组和冷冻复苏精子组,m-TESE新鲜精子组和冷冻复苏精子组的受精率、卵裂率、优质胚胎率、临床妊娠率、流产率和活产率,以及OA、NOA患者新鲜和复苏胚胎移植的临床妊娠率、流产率和活产率。结果在受精率方面,TESA新鲜精子组明显高于TESA冷冻复苏精子组(69.96%vs 49.33%,P<0.05),m-TESE新鲜精子组明显高于m-TESE冷冻复苏精子组(71.86%vs 52.62%,P<0.05);在优质胚胎率方面,TESA新鲜精子组明显高于TESA冷冻复苏精子组(58.93%vs 24.32%,P<0.05),m-TESE新鲜精子组明显高于m-TESE冷冻复苏精子组(59.09%vs 49.77%,P<0.05);在临床妊娠率方面,OA患者移植新鲜胚胎明显高于NOA患者(63.79%vs 42.86%,P<0.05)。其余指标差异无统计学意义(P>0.05)。结论新鲜精子可以提高受精成功率和胚胎质量,但对临床妊娠率没有影响;OA患者移植新鲜胚胎可以获得比NOA患者更高的临床妊娠率。

Objective To compare intracytoplasmic sperm injection(ICSI) outcomes of fresh sperm and frozen-thawed sperm of azoospermia patients with testicular sperm aspiration(TESA) and microdissection testicular sperm extraction(m-TESE),and pregnancy outcomes of patients after fresh embryo and frozen-thawed embryo transplantation.Methods 1 116 cycles of ICSI assisted pregnancy were selected from June 2019 to March 2021 in the Reproductive Medicine Center of Tongji Medical College of Huazhong University of Science & Technology.Conventional superovulation and transvaginal B-mode ultrasound were used for the women to obtain mature ovum for ICSI.TESA was used in patients with obstructive azoospermia(OA) and m-TESE was used in patients with nonobstructive azoospermia(NOA).Fertilization rate, cleavage rate, good-quality embryo rate, clinical pregnancy rate, abortion rate and live birth rate of TESA fresh sperm group and TESA frozen-thawed sperm group, m-TESE fresh sperm group and m-TESE frozen-thawed sperm group were compared.And clinical pregnancy rate, abortion rate and live birth rate of OA and NOA patients after fresh embryo and frozen-thawed embryo transplantation were compared.Results In terms of fertilization rate, TESA fresh sperm group was significantly higher than TESA frozen-thawed sperm group(69.96% vs 49.33%,P<0.05),and m-TESE fresh sperm group was significantly higher than m-TESE frozen-thawed sperm group(71.86% vs 52.62%,P<0.05).In terms of good-quality embryo rate, TESA fresh sperm group was significantly higher than TESA frozen-thawed sperm group(58.93% vs 24.32%,P<0.05),and m-TESE fresh sperm group was significantly higher than m-TESE frozen-thawed sperm group(59.09% vs 49.77%,P<0.05).In terms of clinical pregnancy rate, OA transplanted with fresh embryo group was significantly higher than NOA transplanted with fresh embryo group(63.79% vs 42.86%,P<0.05).There were no significant differences in other indexes(P>0.05).Conclusion Fresh sperm can improve the success rate of fertilization and embryo quality, but has no effect on clinical pregnancy rate.OA patients transplanted with fresh embryos can achieve a higher clinical pregnancy rate than NOA patients.