梗阻性无精子症患者不同来源精子ICSI助孕前药物疗效及安全性分析

Analysis of the drug efficacy and safety before ICSI from different sources of sperm in patients with obstructive azoospermia

目的探讨梗阻性无精子症(OA)患者不同来源精子行卵胞质内单精子注射(ICSI)前予左卡尼汀治疗效果、安全性及对助孕结局的影响。方法141例OA患者口服左卡尼汀治疗3个月后,分别采用睾丸精子抽吸术(TESA)、经皮附睾精子抽吸术(PESA)获取精子,根据精子来源不同分为TESA组(78例)和PESA组(63例),均行ICSI助孕。比较2组患者的基线资料、精子质量、胚胎发育及临床结局。结果2组OA患者予左卡尼汀治疗3个月后精子DNA断裂率(DFI)和自发顶体反应率均低于治疗前,顶体完整率高于治疗前(P<0.05);2组间精子DFI、顶体完整率及自发顶体反应率差异均无统计学意义(P>0.05)。2组配偶ICSI受精率、2PN受精率、卵裂率、优胚率、种植率、临床妊娠率、活产率、早产率、流产率及新生儿畸形率差异均无统计学意义(P>0.05)。共获103个新鲜移植周期,989枚MII卵,受精卵子数773个,临床妊娠49例,活产分娩39例(其中TESA组17例,PESA组22例)。出生后3个月随访发现,TESA组1例新生儿患有心脏畸形,其余新生儿均无畸形。结论OA患者行TESA-ICSI及PESA-ICSI助孕前予左卡尼汀治疗均可优化精子质量,改善临床结局,且用药安全。

Objective icacy,safety and the influence on pregnancy outcome of L-carnitir intracytoplasmic sperm injection(ICSI)from different sources of sperm in patients with obstructive azoospermia(OA).Methods A total of 141 patients with OA were treated with L-carnitine for three months,and sperms were obtained by testicular sperm aspiration(TESA)and percutaneous epididymal sperm aspiration(PESA)respectively.According to the source of sperm,they were divided into the two groups:the TESA group(n=78)and the PESA group(n=63).The general clinical data,sperm quality,embryonic development and clinical outcome of the two groups were compared.Results In the TESA/PESA group,sperm DFI and sperm spontaneous acrosome reaction rate were significantly lower than those before treatment,and sperm acrosome integrity rate was significantly higher than that before treatment(P<0.05).There were no significant differences in sperm DFI,sperm acrosome integrity rate and sperm spontaneous acrosome reaction rate between the two groups(P>0.05).There were no significant differences in the fertilization rate,2PN fertilization rate,cleavage rate,excellent embryo rate,implantation rate,clinical pregnancy rate,live birth rate,premature birth rate,abortion rate and neonatal malformation rate between the two groups(P>0.05).A total of 103 fresh transplant cycles,989 MII oocytes,773 zygotes,49 clinical pregnancies and 39 live births were obtained(including 17 in the TESA group and 22 in the PESA group).During a 3-month follow-up after birth,it was found that one newborn had cardiac abnormalities in the TESA group,while the other newborns had no abnormalities.Conclusion In OA patients,L-carnitine before TESA-ICSI and PESA-ICSI can improve the sperm quality,optimize clinical outcome,and the medication is safe.