AZFc缺失非梗阻性无精子症患者非同步micro-TESE后ICSI临床结局分析

Analysis of clinical outcome of asynchronous micro-TESE and ICSI in patients with non-obstructive aoospermia caused by AZFc deletion

目的评价显微镜下睾丸切开取精术(micro-dissection testicular sperm extraction,micro-TESE)结合卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)技术的治疗效果,指导无精子症因子(azoospermia factor,AZF)c区缺失导致的非梗阻性无精子症(non-obstructive aoospermia,NOA)的临床诊治。方法通过回顾性研究分析了自2015年1月至2019年12月期间于北京大学第三医院生殖医学中心因AZFc缺失所致NOA行非同步micro-TESE患者的临床资料,随访了手术成功获取精子的患者行ICSI助孕的临床结局,包括受精率、优质胚胎率、临床妊娠率、流产率和活产率等。结果共47例AZFc缺失NOA患者行非同步micro-TESE,28例术中成功发现精子,获精率(sperm retrieval rate,SRR)为59.6%(28/47),术后25例冷冻保存精子。15例后期行解冻精子-ICSI助孕,14例找到足够精子行ICSI助孕。14个解冻精子-ICSI周期后进行了11个周期移植,1例成功活产1子;后11例患者进行第二次同步手术且均成功发现精子,行11个新鲜精子-ICSI周期和11个周期移植,3例成功活产,生育1子2女。结论AZFc缺失NOA患者有较大的概率通过micro-TESE在睾丸中成功获取精子,并结合ICSI孕育具有自己生物学特征的子代,对首次非同步方案使用冷冻精子ICSI助孕失败的患者,可考虑第二次同步手术、使用新鲜精子进行ICSI,以提高精子的利用率和最终的活产率。

Objective To evaluate the therapeutic effect of micro-dissection testicular extraction(micro-TESE)combined with intracytoplasmic sperm injection(ICSI)technology,and guide the clinical treatment of non-obstructive azoospermia(NOA)with azoospermia factor(AZF)c-region deletion.Methods Through retrospective study,the clinical data of NOA patients with AZFc deletion were analyzed who underwent asynchronous micro-TESE in Reproductive Medicine Centre of Peking University Third Hospital from January 2015 to December 2019.The clinical outcomes of ICSI in patients who successfully obtained sperm were followed up,including fertilization rate,good-quality embryo rate,clinical pregnancy rate,abortion rate and live birth rate.Results A total of 47 patients with NOA caused by AZFc deletion underwent asynchronous micro-TESE and 28 cases successfully found spermatozoa during the operation.The sperm retrieval rate(SRR)was 59.6%(28/47).Totally 25 cases cryopreserved testicular spermatozoa and 15 cases underwent thawed-sperm ICSI and 14 of them found enough spermatozoa for ICSI.Among the 28 patients who successfully found sperm during the first micro-TESE operation,14 gave up the use of sperm and another 14 later used the thawed sperm for ICSI.A total of 14 cryopreserved sperm ICSI cycles were carried out,followed by 11 embryo transfer cycles.Only one patient successfully gave birth to one health boy.After that 11 patients underwent the second synchronous micro-TESE and spermatozoa were all successfully found during the operation.Eleven cycles used fresh sperm for ICSI followed by 11 embryo transfer cycles.Finally,3 patients successfully gave birth to 1 boy and 2 girls.Conclusion Patients of NOA caused by AZFc deletion have a high probability of successfully obtaining spermatozoa in testis through micro-TESE for ICSI to breed offspring with their own biological characteristics.For patients failed in the first asynchronous procedure,the second synchronous micro-TESE with fresh spermatozoa for ICSI can be considered to improve the utilization rate of sperm and the final live birth rate.