梗阻性无精症取精部位对早期胚胎发育的影响

Influence of spermatozoa extraction site on early embryo development in obstructive azoospermia

目的研究卵胞浆内单精子注射(ICSI)选取睾丸来源精子和附睾来源精子对受精、卵裂、胚胎形成的影响。方法回顾性分析2017年1月至2021年6月邢台不孕不育专科医院收治的行ICSI或部分卵细胞浆内注射(Half-ICSI)治疗的患者作为研究对象,共231个周期。根据精子来源不同分为A组(附睾精组,梗阻性无精子症经附睾穿刺术取精,59个周期)、B组(睾丸精组,梗阻性无精子症经睾丸穿刺术取精,49个周期)、C组(对照组,正常精子患者因不射精、手淫取精困难于女方取卵日行睾丸穿刺术取精,14个周期)、D组(射精组,正常精子患者行Half-ICSI,109个周期)。比较四组的受精率、卵裂率、可用胚胎率及优质胚胎率。结果四组受精率、可用胚胎率比较,差异无统计学意义(P>0.05);四组优质胚胎率比较,差异具有统计学意义(P<0.05),其中A组与D组、B组与C组比较,差异无统计学意义(P>0.05),A组与B组、B组与D组、A组+D组与B组+C组比较,差异具有统计学意义(P<0.05)。结论ICSI采用睾丸来源精子和附睾来源精子的受精率、卵裂率、可用胚胎率无明显差别,但附睾来源精子和射精来源精子的优质胚胎率优于睾丸来源精子,附睾来源精子和射精来源精子的成熟度更高,在优质胚胎形成方面具有优势。

Objective To compare fertilization,cleavage and embryonic outcomes between epididymal and testicular spermatozoa undergoing intracytoplasmic sperm injection(ICSI).Methods A total of 231 cycles of patients undergoing ICSI or partial intracytoplasmic injection(Half-ICSI)in Xingtai Infertility Specialist Hospital was analyzed retrospectively.According to different sources of sperm,the patients were divided into four groups:group A(epididymal sperm,sperm collection via epididymal puncture in obstructive azoospermia,n=59),group B(testicular sperm,sperm collection via testicular puncture in obstructive azoospermia,n=49),group C(testicular sperm,anejaculation or cannot get semen by masturbating,n=14),and group D(normal semen,Half-ICSI,n=109).The rates of fertilization,cleavage,transferable embryo and high-quality embryo were compared among the four groups.Results There were no statistically significant differences in the rate of fertilization,rate of transferable embryo among the four groups(P>0.05).The high-quality embryo rate among the four groups are statistically significant differences(P<0.05),while group A vs.group D and group B vs.group C were not significant(P>0.05);group A vs.group B,group B vs.group D,and group A+D vs.group B+C had statistically significant difference(P<0.05).Conclusions Spermatozoa from testis and epididymis had no significant differences in the rate of fertilization,cleavage and transferable embryo.However,the high-quality embryo rates of spermatozoa from epididymis and semen were significantly higher than that from testis,and the epididymal sperm and ejaculatory sperm were more mature.The advantages of epididymal sperm and semen sperm in the rate of high-quality embryo may be due to higher maturity.