Intracytoplasmic sperm injection in the treatment of male infertility due to obstructive or non-obstructive azoospermia

Objective: To evaluate the effects of intracytoplasmic sperm injection (ICSI) ontreatment of infertility due to obstructive and non-obstructive azoospermia..Methods: A retrospective analysis of fertilization, cleavage, embryo implantationand pregnancy rates was done in 158 ICSI cycles including 112 obstructive azoospermiaand 46 non-obstructive azoospermia. Ovarian hyperstimulation and ICSI procedureswere performed by conventional protocol. The sperm was collected by percutaneous epi-didymal sperm aspiration (PESA) or testicular sperm extraction (TESE).Results:The fertilization rate (73.1% vs. 67.0%), cleavage rate (88.6% vs. 86.3%), embryo implantation rate (20.7% vs. 11.4%), clinical pregnancy rate per trans-fer cycle (35.7% vs. 19.6%) were obtained for obstructive and non-obstructiveazoospermia, respectively.Conclusion: The results revealed that in the cases of obstructive azoospermia, ferti-lization rate, embryo implantation rate and clinical pregnancy rate were significantlyhigher than those of non-obstructive azoospermia. But there was no significant differ-ence of the cleavage rate between two groups.

Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility

We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia （100%; adjusted odds ratio： 0.033; 95% Ch 0.007-0.164; P 〈 0.001）. Live birth rates after sperm injections were lower in men with testicular failure （19.9%） compared with donor sperm （37.5%; adjusted OR： 0.377 （95% Ch 0.233-0.609, P 〈 0.001）） and obstructive azoospermia （34.2%; adjusted OR： 0.403 （95% CI： 0.241-0.676, P= 0.001）. Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection （ICSI） are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.

Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia

Aim： To evaluate the outcome of repetitive micro-surgical testicular sperm extraction （mTESE） attempts in non-obstructive azoospermia （NOA） cases, in relation to patients＇ initial testicular histology results. Methods： A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection （ICSI） attempts were reviewed. Results： Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 （64%） （Sp^＋）, and failed in the remaining 24 （36%） （Sp^-）. Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp^＋ but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two （n = 24）, three （n = 4） and four （n = 1） times. The second attempt yielded mature sperm in 3/5 patients from the Sp group and 16/19 patients from the Sp^＋ group. At the third and fourth trials, 4/4 and 1/1 of the original Sp^＋ patients were Sp^＋ again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome （16%）, maturation arrest （22%）, hypospermatogenesis （21%） and focal spermatogenesis （41%）. Overall, in repetitive mTESE, 24/29 （82%） of the attempts were finally Sp^＋. Conclusion： Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI.

Testicular fine needle aspiration for sperm retrieval in non-obstructive azoospermia

Objective: To investigate the feasibility of obtaining mature spermatozoa for intracytoplasmic sperm injection (ICSI) by testicular fine needle aspiration (TEFNA) in men diagnosed non-obstructive azoospermia. Methods: TEFNA was performed in 121 patients with a mean of 15 punctures and aspirations from each testis with a #23 butterfly needle connected to a 20 mL syringe with an aspiration handle. Results: One hundred and twenty-one patients underwent 176 TEFNA cycles. Testicular sperm were recovered in 56.3 % (99/176) cycles from 57 % (69/121) of patients. The sperm recovery rate was 46.7 % (21/45) in patients with Sertoli cell-only syndrome, 45.7 % (16/35) in patients with maturation arrest, 96.1 % (25/26) in patients with hypospermatogenesis and 63.6 % (7/11) in patients of non-mosaic Klinefelter's syndrome as judged by testicular histology. No sperm were found in 3 cases with post-irradiation fibrosis and one, after resection and chemotherapy of unilateral testicular cancer. In 87 cycles of ICSI using the husbands' sperm, 591 mature oocytes were injected, 218 (36.9 %) were normally fertilized and 202 embryos developed; 178 were transferred in 62 cycles resulting in 26 pregnancies (41.9 %) with 44 gestational sacs (implantation rate: 24.7 %). Conclusion: TEFNA was an efficient, easy to learn, safe and well tolerated treatment in patients with non-obstructive azoospermia.

Testicular sperm extraction and intracytoplasmic sperm injection in non obstructive azoospermia

Objective To report the experience in sperm extraction from testicular biopsies (TESE) performed from March 1996 to July 1998 in men with non obstructive azoospermia (NOA) Methods Comparisons of age, volume of both testes, serum FSH and testosterone in men, and histology of testicular samples in the first cycles between cycles with spermatozoa found and those without spermatozoa found were performed Comparisons of fertilization, cleavage and pregnancy rates between cycles with spermatozoa injected and those with spermatids injected were performed Results Spermatozoa were found in only 12 out of 26 first TESE cycles (46 2%) and other cycles had spermatids (round cells) only Age of men, history of mumps orchitis/oligozoospermia, volume of both testes and serum FSH/testosterone levels in men were not significantly different between cycles with and without spermatozoa The fertilization rate was significantly higher in cycles with spermatozoa injected than those with round cell injections (63 3% vs 23 2%, P <0 0001, Chi squared test) The pregnancy rate was 14 3% per cycle when spermatozoa were injected Conclusions TESE followed by Intracytoplasmic sperm injection (ICSI) is an effective treatment in patients with NOA Less than half of the patients undergoing TESE had spermatozoa recovered Age of men, volume of both testes and serum FSH/ testosterone levels in men were not useful in predicting successful recovery Compared to using ejaculated and epididymal spermatozoa, fertilization and pregnancy rates were achieved when testicular spermatozoa were used for ICSI

Clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection with fresh or cryopreserved sperm in patients with nonobstructive azoospermia

We performed this study to evaluate the clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection(micro-TESE-ICSI)treatment that used fresh or cryopreserved sperm in patients with nonobstructive azoospermia(NOA).A total of 338 NOA patients with 344 consecutive cycles received treatment in the reproductive medicine center of Peking University Third Hospital in Beijing,China,from January 2014 to December 2017.Fresh oocytes and fresh sperm were used in 222 patients with 234 cycles(Group A).Fresh oocytes and cryopreserved sperm were used in 116 patients with 110 cycles(Group B).We compared patient characteristics,embryonic development,and pregnancy outcomes between Groups A and B.There was no statistical difference in the patient characteristics,and no differences were observed with fertilization or quality embryo rates between Groups A and B.The rates of clinical pregnancy and live birth were both higher for Group A than those for Group B(both P<0.05).In conclusion,fresh testicular sperm appears to produce better ICSI outcomes than cryopreserved testicular sperm in patients with NOA.

Sperm retrieval rates and clinical outcomes for patients with different causes of azoospermia who undergo microdissection testicular sperm extraction-intracytoplasmic sperm injection

The aim of our study was to compare the sperm retrieval rates(SRRs)and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection(micro-TESE-ICSI).We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing,China,from January 2014 to December 2017.This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI.Patients with azoospermia were classified into Group A(Klinefelter syndrome,n=284,125 cycles),Group B(azoospermia Y chromosome factor c[AZFc]microdeletion,n=91,64 cycles),Group C(cryptorchidism,n=52,39 cycles),Group D(previous mumps and bilateral orchitis,n=23,23 cycles),and Group E(idiopathic azoospermia,n=319,96 cycles).Clinical characteristics,SRR,embryonic development,and pregnancy outcomes of the patients were compared between all groups.Patients in Group D had the highest and most successful SRR.The average SRR for all patients was 46.0%.The rates of clinical pregnancy,implantation,and live birth in Group D were 78.3%,65.0%,and 74.0%,respectively,which were higher than those in all other groups(P<0.05).Group B patients had the lowest clinical pregnancy,implantation,and live birth rates of all groups(P<0.05).No differences were found in the miscarriage rate or birth defects among the groups(P>0.05).Patients with orchitis had the highest SRR and best clinical outcomes.Although AZFc microdeletion patients had a higher SRR,their clinical outcomes were worse.

Sperm origins and concentration do not impact the clinical outcomes in intracytoplasmic sperm injection cycles

In the present study, we evaluated the impact of sperm origins and concentration on the clinical outcomes of intracytoplasmic sperm injection （ICSI） cycles. A total of 1201 IC51 cycles were retrospectively analyzed for male azoospermia or oligozoospermia between January 2015 and December 2015 in the Peking University Third Hospital. Patients were divided into three groups （Group 1 vs Group 2/3; surgically extracted sperm vs ejaculated sperms）： Group 1 included 343 ICSI cycles and Group 2 analyzed 388 cycles on semen with sperm concentration 〈5 × 10^6 m1-1 （severe oligozoospermia group）. Group 3 included 470 cycles with sperm concentration between 5×10^6 m1-1 and 15 × 10^6 m1-1 （mild oligozoospermia group）. Fertilization rates, clinical pregnancy rates, and live birth rates were analyzed and compared among groups of different semen origins and concentrations on the oocyte retrieval day. Group 2 showed a lower fertilization rate than Group 3 （62.9%± 21.6% vs 66.8% ± 22.1%, P 〈 0.05）. There were no statistically significant differences in clinical pregnancy rate per transfer （51.3%, 46.7%, and 50.0%, respectively）, live birth rate per transfer （44.4%, 40.9%, and 41.4%, respectively）, accumulative live birth rate （58.3%, 51.0%, and 52.1%, respectively）, twin birth rate （18.4%, 10.6%, and 12.6%, respectively）, and birth defects rate （0, 0.3%, and 0.2%, respectively） among three groups. The results of this study indicated that sperm origins and concentration do not imDact the clinical outcomes in ICSI cycles.

Comparison of intracytoplasmic sperm injection(ICSI)outcomes in infertile men with spermatogenic impairment of differing severity

The extent of spermatogenic impairment on intracytoplasmic sperm injection(ICSI)outcomes and the risk of major birth defects have been little assessed.In this study,we evaluated the relationship between various spermatogenic conditions,sperm origin on ICSI outcomes,and major birth defects.A total of 934 infertile men attending the Center for Reproductive Medicine of Ren Ji Hospital(Shanghai,China)were classified into six groups:nonobstructive azoospermia(NOA;n=84),extremely severe oligozoospermia(esOZ;n=163),severe oligozoospermia(sOZ,n=174),mild oligozoospermia(mOZ;n=148),obstructive azoospermia(OAZ;n=155),and normozoospermia(NZ;n=210).Rates of fertilization,embryo cleavage,high-quality embryos,implantation,biochemical and clinical pregnancies,abortion,delivery,newborns,as well as major birth malformations,and other newborn outcomes were analyzed and compared among groups.The NOA group showed a statistically lower fertilization rate(68.2%vs esOZ 77.3%,sOZ 78.0%,mOZ 73.8%,OAZ 76.6%,and NZ 79.3%,all P<0.05),but a significantly higher implantation rate(37.8%)than the groups esOZ(30.1%),sOZ(30.4%),mOZ(32.6%),and OAZ(31.0%)(all P<0.05),which was similar to that of Group NZ(38.4%).However,there were no statistically significant differences in rates of embryo cleavage,high-quality embryos,biochemical and clinical pregnancies,abortions,deliveries,major birth malformations,and other newborn outcomes in the six groups.The results showed that NOA only negatively affects some embryological outcomes such as fertilization rate.There was no evidence of differences in other embryological and clinical outcomes with respect to sperm source or spermatogenic status.Spermatogenic failure and sperm origins do not impinge on the clinical outcomes in ICSI treatment.

Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens

Recent data suggest that cystic fibrosis transmembrane conductance regulator(CFTR)gene alterations negatively impact male fertility beyond obstruction.We sought to compare gene alterations,sperm retrieval rates,and intracytoplasmic sperm injection(ICSI)outcomes among men with cystic fibrosis(CF)disease and congenital bilateral absence of the vas deferens(CBAVD)only.We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic,high-volume andrology centers from 2010 to 2018.Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included.Differences between groups for CFTR abnormality,sperm retrieval,and ICSI outcomes were statistically analyzed.Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups.Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−1),P=0.02)and total motile sperm count(2.9 million vs 11.4 million,P=0.01).This difference was only predicted by homozygous delta F508 CFTR mutations(P<0.05).The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction(70.0%vs 27.6%,P<0.03)and lower fertilization rate with ICSI(32.5%vs 68.9%,P<0.01).In conclusion,those with CF demonstrated lower sperm quality,greater difficulty with sperm retrieval,and worse ICSI outcomes compared with CBAVD-only patients.Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.

在ICSI时应用SperMagic对无精子症患者辅助生殖结局的影响

目的:探究在卵胞浆内单精子显微注射(ICSI)时应用SperMagic对无精子症患者的临床效果。方法:选取2019年1月至2021年1月佛山市妇幼保健院收治的200例移植周期的无精子症患者,遵循随机数字表法将纳入对象随机分为观察组及对照组,各100例。其中对照组患者精子处理后行ICSI,观察组患者在精子处理后添加精子激动剂SperMagic。比较两组患者精子活力以及辅助生殖结局等相关指标差异。结果:精子在经相应处理后,观察组患者的精子活力为(92.6±3.6)%,与对照组精子活力(67.6±11.4)%相比,差异具有统计学意义(P<0.05)。与对照组相比,观察组患者的受精率、优胚率、种植率、妊娠率及流产率等辅助生殖结局指标显著更优,差异具有统计学意义(P<0.05)。结论:在ICSI时加入精子激动剂SperMagic,可显著提高精子活力,改善妊娠结局。

Clinical management of infertile men with nonobstructive azoospermia

The clinical management of men with nonobstructive azoospermia （NOA） seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.

Y-chromosome microdeletions in nonobstructive azoospermia and severe oligozoospermia

The aim of the present work was to present the outcomes of the patients with Y-chromosome microdeletions treated by intracytoplasmic sperm injection （ICSI）, either using fresh （TESE） or frozen-thawed （TESE-C） testicular sperm and ejaculated sperm （EJAC）. The originality of this work resides in the comparisons between the different types of Y-microdeletions （AZFa, AZFb, and AZFc） and treatments, with detailed demographic, stimulation, embryological, clinical, and newborn （NB） outcomes. Of 125 patients with Y-microdeletions, 33 patients presented severe oligozoospermia （18 performed ICSI with ejaculated sperm） and 92 secretory azoospermia （65 went for TESE with 40 having successful sperm retrieval and performed ICSI）. There were 51 TESE treatment cycles and 43 TESE-C treatment cycles, with a birth of 19 NB （2 in AZFa/TESE-C, 12 in AZFc/TESE, and 5 in AZFc/TESE-C）. Of the 29 EJAC cycles, there was a birth of 8 NB （in AZFc）. In TESE and EJAC cycles, there were no significant differences in embryological and clinical parameters. In TESE-C cycles, there was a significant lower oocyte maturity rate, embryo cleavage rate and mean number of embryos transferred in AZFb, and a higher mean number of oocytes and lower fertilization rate in AZFc. In conclusion, although patients with AZFc microdeletions presented a high testicular sperm recovery rate and acceptable clinical outcomes, cases with AZFa and AZFb microdeletions presented a poor prognosis. Due to the reported heredity of microdeletions, patients should be informed about the infertile consequences on NB and the possibility of using preimplantation genetic diagnosis for female sex selection.

Application of seminal germ cell morphology and semen biochemistry in the diagnosis and management of azoospermic subjects

Aim: To evaluate whether the study of seminal germ cell morphology (SGCM) and semen biochemistry could befruitfully utilized for the diagnosis and management of azoospermic subjects. Methods: In the semen, mature andimmature germ cells are contributed by the testes, 70% of glycerylphosphoryl choline (GPC) by the epididymis, fruc-tose mostly or solely by the seminal vesicles and acid phosphate (ACP) by the prostate. In 16 normal volunteers, 12vasectomized subjects and 186 azoospennic subjects, these parameters have been studied and the data have been ana-lyzed. Results: Both mature and immature germ cells are absent in the semen of vasectomized subjects as well as inobstructive azoospennia; GPC level is also significantly decreased in both these groups. In cases with non-obstructiveazoospermia immature germ cells are present and seminal GPC, ACP and fructose levels are normal. The diagnosis ofobstructive and non-obstructive azoospermia based on these parameters correlated well with 'correct' testicular biopsyfindings. In some cases of azoospermia due to hypospermatogenesis or spermatogenic developmental arrest, the SGCMstudies were very helpful in objectively monitoring the response of the germinal tissue to specific treaunents. Conclu-sion: SGCM and semen biochemical parameters are very valuable non-invasive markers for differentiating obstructivefrom non-obstructive azoospermia. The SGCM findings serve as a dependable non-invasive testicular marker with highpredictive value. (Asian J Androl 2001 Mar; 3: 55-62)

A comparison of the relative efficiency of ICSI and extended culture with epididymal sperm versus testicular sperm in patients with obstructive azoospermia

This is a retrospective cohort study comparing blastocyst transfer outcomes following intracytoplasmic sperm injection utilizing epididymal versus testicular sperm for men with obstructive azoospermia.All cases at a single center between 2012 and 2016 were included.Operative approach was selected at the surgeon’s discretion and included microepididymal sperm aspiration or testicular sperm extraction.Blastocyst culture was exclusively utilized prior to transfer.The primary outcome was live birth rate.Secondary outcomes included fertilization rate,blastulation rate,euploidy rate,and implantation rate.A mixed effects model was performed.Seventy-six microepididymal sperm aspiration cases and 93 testicular sperm extraction cases were analyzed.The live birth rate was equivalent(48.6%vs 50.5%,P=0.77).However,on mixed effects model,epididymal sperm resulted in a greater likelihood of fertilization(adjusted OR:1.37,95%CI:1.05–1.81,P=0.02)and produced a higher blastulation rate(adjusted OR:1.41,95%CI:1.1–1.85,P=0.01).As a result,the epididymal sperm group had more supernumerary blastocysts available(4.3 vs 3,P<0.05).The euploidy rate was no different.Pregnancy rates were no different through the first transfer cycle.However,intracytoplasmic sperm injection following microepididymal sperm aspiration resulted in a greater number of usable blastocysts per patient.Thus,the true benefit of epididymal sperm may only be demonstrated via a comparison of cumulative pregnancy rates after multiple transfers from one cohort.

无精子症病人100例取精方法及妊娠结局

目的 :回顾性分析 2 0 0 1年 1月～ 2 0 0 2年 1月在生殖中心行卵胞质内单精子注射 (ICSI)治疗的 10 0例无精子症男性的治疗结果。 方法 :经皮附睾精子抽吸术 (PESA)或睾丸精子抽提术 (TESE)获得精子 ,女方进行常规超排卵。分析激素水平 ,行睾丸组织学检查 ,评估取精的成功率、受精率、种植率和临床妊娠率。 结果 :76例(76 % )经PESA获得精子 ,2 3例 (2 3% )通过TESE获得精子。PESA和TESE组的受精率、种植率和临床妊娠率分别为 71.3%和 75 .18% ,2 0 .35 %和 2 2 .0 5 % ,4 2 .11%和 4 1.6 0 %。PESA组有 32例临床妊娠 ,其中 15例继续妊娠 ,15例已分娩 ,2例流产。TESE组有 10例临床妊娠 ,其中 6例继续妊娠 ,2例已分娩 ,2例流产。两组的受精率、种植率和临床妊娠率差异无显著性。在TESE组有 1例取精失败而放弃治疗。 结论 :激素水平和睾丸组织学检查不能预测附睾或睾丸取精的成功 ,PESA和TESE获得精子进行单精子注射是治疗男性无精子症的有效方法 ,两组的受精率 ,种植率和临床妊娠率差异无显著性 (P >0 .0 5 )。

附睾及睾丸精子行ICSI治疗无精子症妊娠结局

目的 :回顾性分析 5 0例无精子症患者利用附睾或睾丸精子行卵细胞胞质内单精子注射 (ICSI)的治疗结局。 方法 :经皮附睾精子抽吸术 (PESA)或睾丸切开取精术 (TESE)获得精子行ICSI,评估取精的成功率 ,ICSI后的受精率、种植率及临床妊娠率 ,以精液精子ICSI组作为对照。 结果 :PESA、TESE与精液精子组分别注射MⅡ期成熟卵子 2 86、36 0、15 6 9个 ,受精率 3组差异无显著性 (74 .8% ,75 .2 %vs 77.5 % ,P >0 .0 5 )。种植率、妊娠率TESE与精液精子组差异无显著性 (2 9.87%vs 2 9.5 4 % ;4 8.15 %vs 5 2 .6 0 % ,P >0 .0 5 ) ,PESA组显著高于TESE组及精液精子组 (5 0 .85 %vs 2 9.87% ,2 9.5 4 % ;6 8%vs 4 8.15 % ,5 2 .6 0 % ,P <0 .0 5 )。PESA组共妊娠 17例 ,已分娩 6例 ,继续妊娠 9例 ,流产 2例 ;TESE组共妊娠 13例 ,已分娩 7例 ,继续妊娠 4例 ,流产 2例。 结论 :采用附睾或睾丸精子行ICSI是治疗男性无精子症的有效方法。

附睾或睾丸精子对梗阻性无精子症ICSI治疗结局影响的系统评价

目的:系统评价梗阻性无精子症患者选择附睾精子或睾丸精子行ICSI治疗对其临床结局的影响。方法:通过计算机检索Pub Med、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2015年12月有关梗阻性无精子症患者采用附睾精子或睾丸精子行ICSI治疗的文献,由2位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用Rev Man5.3软件进行meta分析。结果:共纳入14项试验研究,包括梗阻性无精子症患者1 278例,共计1 552个周期。Meta分析结果显示:梗阻性无精子症患者行ICSI治疗,附睾精子比睾丸精子具有更好的受精率[RR=1.08,95%CI(1.05,1.11),P<0.01];附睾精子和睾丸精子的卵裂率[RR=1.04,95%CI(0.99,1.10),P=0.13]、优质胚胎率[RR=1.01,95%CI(0.93,1.09),P=0.85]、种植率[RR=1.14,95%CI(0.75,1.73),P=0.55]、临床妊娠率[RR=1.14,95%CI(0.98,1.31),P=0.08]以及流产率[RR=0.86,95%CI(0.53,1.39),P=0.54]差异均无统计学意义。结论:梗阻性无精子症患者行ICSI治疗,附睾精子显示出更高的受精率,而在卵裂率、优质胚胎率、种植率、临床妊娠率以及流产率方面,两者临床结局差异不大。

反复附睾或睾丸取精的无精子症病人妊娠结局

目的 :分析反复附睾或睾丸取精进行卵胞质内单精子注射治疗的妊娠结局。 方法 :收集 2 0 0 1年 1月～2 0 0 2年 12月进行 2周期以上附睾或睾丸取精进行卵胞质内单精子注射治疗的无精子症病人 31例 (共 4 3个周期 ) ,对取精情况及受精、种植和妊娠结局进行总结。 结果 :2 4例病人顺利从附睾取精 ,7例病人从睾丸取精 ,无 1例出现感染、血肿或局部的功能障碍。与第 1周期附睾或睾丸取精 15 4例 (共 15 4个周期 )的受精率、种植率和临床妊娠率比较 ,结果分别是 78.39%与 73.6 4 % ,19.6 8%与 18.38%和 34.88%与 37.91% ,差异无显著性 (P >0 .0 5 )。 结论 :无精子症病人进行反复附睾或睾丸取精 ,是安全和可耐受的 ,其妊娠结局与第 1周期比较无统计学差异。

不同生精功能障碍无精子症患者行ICSI后胚胎发育潜能的研究

目的:分析不同生精功能障碍的无精子症患者行ICSI后其胚胎发育潜能。方法:149例患者分为生精功能正常组,轻度、中度和重度生精功能障碍组,采用经皮附睾精子抽吸术(PESA)或经皮睾丸精子抽吸术(TESA)抽取不同生精功能障碍患者的精子行ICSI,记录和分析胚胎的正常受精率、卵裂率、优良胚胎形成率以及妊娠率。结果:PESA与TESA组比较,正常受精率(%)为74.9±19.6 vs 66.3±22.7(P>0.05),卵裂率(%)为96.7±8.6 vs 92.8±19.8(P>0.05),优良胚胎率(%)为43.5±26.2 vs 35.0±29.4(P>0.05)以及妊娠率(%)为44.0 vs 52.0(P>0.05),均无统计学差异。生精功能障碍从正常组到重度组的正常受精率(%)变化依次为77.8±18.4、68.4±18.5、73.5±19.8、51.4±27.9,其中轻度生精功能障碍与正常生精组有差异(P<0.05),重度生精功能障碍组与其他各组有统计学差异(P<0.05);胚胎卵裂率(%)变化依次为96.7±9.2、96.5±15.0、93.9±12.1、93.7±11.1,各组无统计学差异;优良胚胎率(%)变化依次为47.1±25.8、40.3±27.6、36.2±23.1、15.0±24.6,重度生精障碍组与其他各组有统计学差异(P<0.05);妊娠率(%)依次为54.8%、50.0%、13.6%、10.0%,有统计学差异(P<0.05)。结论:采用PESA或TESA行ICSI在正常受精率,卵裂率,优良胚胎率以及妊娠率上较均无明显差异。随着患者生精障碍程度的加重,受精率、优良胚胎率以及妊娠率均显著下降,而卵裂率却无明显区别。