Fertilization of in vitro matured human oocytes by intracytoplasmic sperm injection (ICSI) using ejaculated and testicular spermatozoa

Aim: To evaluate the fertilization competence of spermatozoa from ejaculates and testicle when the oocytes were matured in vitro following intracytoplasmic sperm injection (ICSI). Methods: Fifty-six completed cycles in 46 women with polycystic ovarian syndrome were grouped according to the semen parameters of their male partners. Group 1 was 47 cycles that presented motile and normal morphology spermatozoa in ejaculates and Group 2 was the other nine cycles where male partners were diagnosed as obstructive azoospermia and spermatozoa could only be found in testicular tissue fragment. All female patients received minimal stimulation with gonadotropin. Immature oocytes were matured in vitro and inseminated by ICSI. The spermatozoa from testes were retrieved by testicular fine needle aspiration. Results: A total of 449 and 78 immature oocytes were collected and cultured for 48 hours, 75.5 % (339/449) and 84.6 % (66/78) oocytes were matured in Groups 1 and 2, respectively. The percentage of oocytes achieving normal fertilization was significantly higher in Group 1 than that in Group 2 (72.9 % vs. 54.5 %, P < 0.05). There were no significant differences in the rates of oocytes cleavage and clinical pregnancies in these two groups [87.4 % (216/247) vs. 88.9 % (32/36); 21.3 % (10/47) vs. 44.4 % (4/9)]. A total of 15 babies in the two groups were healthy delivered at term. Conclusion: It appears that IVM combined with ICSI using testicular spermatozoa can produce healthy infants, while the normal fertilization rate of in vitro matured oocytes after ICSI using testicular spermatozoa was significantly lower than using the ejaculated spermatozoa.

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.

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.

Use of testicular sperm for intracytoplasmic sperm injection in men with high sperm DNA fragmentation： a SWOT analysis

Spermatozoa retrieved from the testis of men with high levels of sperm DNA fragmentation （SDF） in the neat semen tend to have better DNA quality. Given the negative impact of SDF on the outcomes of Assisted Reproductive Technology （ART）, an increased interest has emerged about the use of testicular sperm for intracytoplasmic sperm injection （Testi-ICSI）. In this article, we used a SWOT （strengths, weaknesses, opportunities, and threats） analysis to summarize the advantages and drawbacks of this intervention. The rationale of Testi-ICSI is bypass posttesticular DNA fragmentation caused by oxidative stress during sperm transit through the epididymis. Hence, oocyte fertilization by genomically intact testicular spermatozoa may be optimized, thus increasing the chances of creating a normal embryonic genome and the likelihood of achieving a live birth, as recently demonstrated in men with high SDF. However, there is still limited evidence as regards the clinical efficacy of Testi-ICSI, thus creating opportunities for further confirmatory clinical research as well as investigation of Testi-ICSI in clinical scenarios other than high SDF. Furthermore, Testi-ICSI can be compared to other laboratory preparation methods for deselecting sperm with damaged DNA. At present, the available literature supports the use of testicular sperm when performing ICSI in infertile couples whose male partners have posttesticular SDF. Due to inherent risks of sperm retrieval, Testi-ICSI should be offered when less invasive treatments for alleviating DNA damage have failed. A call for continuous monitoring is nonetheless required concerning the health of generated offspring and the potential complications of sperm retrieval.

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

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.

Follow-up of children born after intracytoplasmic sperm injection with epididymal and testicular spermatozoa

Background To evaluate the safety of intracytoplasmic sperm injection （ICSI） with epididymal or testicular sperm, this study compared children born after ICSI treatment with epididymal or testicular sperm with children conceived after ICSI with ejaculated sperm. Methods This retrospective study included 317 children born after ICSI with percutaneous epididymal sperm aspiration （PESA）, 103 children born after ICSI with testicular sperm aspiration （TESA）, and a control group of 1008 children born after ICSI with ejaculated sperm. All of the patients received their assisted reproductive treatment in the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2004 to December 2011. Data, such as the rate of stillbirths, perinatal mortality, gestational age, birth weight, and the rate of congenital malformations of the three groups, were compared. Results PESA and TESA children were not different from ICSI children in the rate of stillbirths, perinatal mortality, infant mortality rate, gestational age, the rate of prematurity, and the rate of malformations （P〉0.05）. A slight increase in birth defects was reported in the TESA group compared with those in the control group, but there was no significant difference between the groups （P〉0.05）. Conclusion ICSI with epididymal or testicutar sperm does not lead to more stillbirths or congenital malformations compared with ICSI using ejaculated sperm.

Use of testicular sperm in couples with SCSA-defined high sperm DNA fragmentation and failed intracytoplasmic sperm injection using ejaculated sperm

Sperm DNA fragmentation(SDF)has been linked with male infertility,and previous studies suggest that SDF can have negative influence on pregnancy outcomes with assisted reproduction.We performed a retrospective review of consecutive couples with a high SDF level that had intracytoplasmic sperm injection(ICSI)using testicular sperm(T-ICSI).We compared the T-ICSI outcomes to that of two control groups:87 couples with failed first ICSI cycle and who had a second ICSI cycle using ejaculated sperm(Ej-ICSI),and 48 consecutive couples with high sperm chromatin structure assay(SCSA)-defined SDF(>15%)that underwent an ICSI cycle using ejaculated sperm after one or more failed ICSI cycles(Ej-ICSI-high SDF).The mean number of oocytes that were retrieved and the total number of embryos were not different among the three groups.The mean number of transferred embryos in the T-ICSI group was higher than the Ej-ICSI group but not significantly different than the Ej-ICSI-high SDF group(1.4,1.2,and 1.3,respectively,P<0.05).Clinical pregnancy rate in the T-ICSI group was not significantly different than the Ej-ICSI and Ej-ICSI-high SDF groups(48.6%,48.2%,and 38.7%,respectively,P>0.05).No significant difference was found in live birth rate when comparing T-ICSI to Ej-ICSI and Ej-ICSI-high SDF groups.The results suggest that pregnancy outcomes and live birth rates with T-ICSI are not significantly superior to Ej-ICSI in patients with an elevated SCSA-defined sperm DNA fragmentation and prior ICSI failure(s).

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.

严重少弱畸精子症患者精液和睾丸中精子的ICSI临床结局比较

目的 探讨睾丸取精能否改善严重少弱畸精子症的男性不育患者行卵胞浆内单精子注射(ICSI)的临床结局。方法 回顾性分析2016年1月至2020年6月因男性严重少弱畸形精子症于保定市妇幼保健院生殖医学科行ICSI助孕的58对夫妇的临床资料。按照获取精子的方式不同,将患者分为两组:射出精子ICSI组(E-ICSI组,56个周期)和睾丸精子ICSI组(T-ICSI组,42个周期)。比较两组患者的基础资料、促排卵情况、授精及胚胎发育情况和临床妊娠结局的差异。结果 58对夫妇共接受了98个ICSI周期,56个周期(57.14%)使用射精精子,42个周期(42.86%)使用睾丸精子。两组患者的基础资料、促排卵方案、Gn用量、HCG日E2及P水平、成熟卵数、获卵数比较,均无统计学差异(P>0.05)。E-ICSI组与T-ICSI组的2PN受精率(56.4%vs. 53.4%)、优质胚胎率(8.5%vs. 6.1%)、卵母细胞利用率(25.9%vs. 24.2%)均无统计学差异(P>0.05)。E-ICSI组与T-ICSI组的新鲜周期临床妊娠率(22.7%vs. 27.0%)、冻融周期临床妊娠率(35.7%vs. 66.7%)和一次控制性卵巢刺激(COS)累积活产率(25.0%vs. 40.5%)均无统计学差异(P>0.05)。结论 基于本研究的结果,暂不推荐严重少弱畸精子症患者直接选择睾丸精子进行ICSI,只有当射出精液离心后未发现正常形态活精子的情况下,选择睾丸精子作为继续ICSI的补救性手段。

不同病因的非梗阻性无精子症显微镜下睾丸取精术结局研究(附1355例报道)

目的:分析不同病因的非梗阻性无精子症(non⁃obstructive azoospermia,NOA)患者经显微镜下睾丸取精术(microdis⁃section testicular sperm extraction,micro⁃TESE)的治疗结局。方法:回顾性分析上海市第一人民医院2015年3月—2022年1月1355例接受micro⁃TESE的患者,病因/危险因素包括克氏综合征(Klinefelter syndrome,KS)、Y染色体AZFc缺失、隐睾、腮腺炎性睾丸炎、放化疗、精索静脉曲张以及特发性NOA,研究分析各组患者精子获取率(sperm retrieval rate,SRR),并比较各组取精成功的妊娠结局。结果:NOA患者的总体SRR为26.2%(355/1355),其中腮腺炎性睾丸炎SRR最高(75.9%,22/29),其次分别为隐睾(70.5%,43/61)、Y染色体AZFc缺失(55.6%,30/54)、KS(47.6%,71/149)、特发性NOA(18.6%,167/897)、放化疗(15.4%,2/13),精索静脉曲张SRR最低(13.2%,20/152)。根据手术结局,将NOA患者分为取精成功组及取精失败组。特发性NOA及放化疗类型中,取精成功组卵泡刺激素(follicle⁃stimulating hormone,FSH)和黄体生成素(luteinizing hormone,LH)水平显著高于取精失败组;Y染色体AZFc缺失类型中,取精成功组FSH、LH水平显著低于取精失败组;腮腺炎性睾丸炎类型中,取精成功组睾丸体积高于取精失败组。回归分析发现年龄可作为预测特发性NOA患者取精结局的因素,年龄较高者拥有较好的取精结局。卵胞浆内单精子注射治疗的妊娠率为51.4%(200/389),活产率为73.5%(147/200)。结论:不同病因/危险因素NOA患者的SRR具有显著差异,是影响micro⁃TESE取精结局的重要指标。

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.

双侧输精管结扎术后不同来源精子对卵胞浆内单精子显微注射助孕结局的影响

目的探讨双侧输精管结扎术后不同来源精子对卵胞浆内单精子显微注射(ICSI)助孕结局的影响。方法回顾性分析2012年1月至2020年6月中国人民解放军陆军第七十三集团军医院生殖医学中心诊治的双侧输精管结扎术后或复通失败后患者行ICSI治疗的76个新鲜取卵移植周期,依据精子来源分为经皮附睾精子抽吸术(PESA)组(36个周期)和经皮睾丸精子抽吸术(TESA)组(40个周期)。比较两组的相关指标和妊娠结局。结果两组男方年龄、结扎年限、女方年龄、女方卵泡刺激素(FSH)及女方抗苗勒管激素(AMH)比较,差异无统计学意义(P>0.05);PESA组的正常受精率高于TESA组,差异具有统计学意义(P<0.05);两组2PN卵裂率、胚胎平均评分、优质胚胎率及囊胚养出率比较,差异无统计学意义(P>0.05);TESA组的临床妊娠率和活产率均高于PESA组,差异无统计学意义(P>0.05);两组的胚胎种植率和流产率比较,差异无统计学意义(P>0.05)。结论TESA来源精子的妊娠结局优于PESA来源精子,因此,当输精管结扎术后患者行ICSI助孕时,可优先选择睾丸内精子,以期获得更好的临床妊娠结局。

卵子激活剂A23187对睾丸精子卵胞浆内单精子显微注射后妊娠结局的影响

目的评估卵子激活剂在临床中能否改善睾丸取精患者行卵胞浆内单精子显微注射(ICSI)后的妊娠结局。方法本研究选取2014年1月至2020年4月期间在西北妇女儿童医院生殖中心睾丸取精术(TESA)后行ICSI的374对不孕夫妇作为研究对象,按照ICSI后是否采用卵子激活剂A23187行人工卵子激活术(AOA)随机分为卵子激活组(n=47)和常规对照组(n=327)。以女方年龄、促排卵方案、移植的胚胎类型、胚胎质量、胚胎数量作为匹配条件,按照1∶3进行倾向评分匹配后,对两组的实验室指标和妊娠结局进行比较。结果匹配前,卵子激活组女方年龄较小,成熟卵子数较多,差异有统计学意义(t值分别为2.72、-2.56,P<0.05);匹配后,两组间基线资料均无显著性差异(P>0.05);匹配前,两组间在受精率、优质胚胎率、可用胚胎率和囊胚形成率之间无显著性差异(P>0.05);匹配后,卵子激活组的可用胚胎率低于对照组(χ^(2)=47.68,P<0.05);采用Logistic回归模型评估卵子激活处理对临床妊娠率的独立作用,结果发现匹配后未调整模型、调整模型均无统计学差异,其OR值及95%CI分别为1.26(0.63~2.52)、1.55(0.67~3.56),P>0.05。结论卵子激活剂A23187可能对新鲜睾丸精子取精后行ICSI的患者临床妊娠率没有影响,可以用于临床。

微量冷冻睾丸精子复苏后行卵胞浆内单精子显微注射的临床结局

目的探讨微量冷冻睾丸精子复苏后行卵胞浆内单精子显微注射(ICSI)的临床结局。方法选取2017年1月至2021年12月于赣州市妇幼保健院接受睾丸组织活检且证实存在存活精子的无精症患者的113个周期资料,依据精子保存方式不同分为A组(61个周期)和B组(52个周期)。A组采用微量冷冻睾丸精子,B组采用新鲜精子。比较两组患者的妊娠结局以及新生儿情况。结果两组患者的获卵数、正常卵成熟率、正常受精率、优质胚胎率、囊胚形成率、妊娠率以及流产率比较,差异均无统计学意义(P>0.05)。两组新生儿的性别、体重、身长及畸形情况比较,差异无统计学意义(P>0.05)。结论微量冷冻睾丸精子复苏后行卵胞浆内单精子显微注射在保证临床结局良好同时减少反复、不必要的对卵巢与睾丸的刺激。

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 )。

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。

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。

经皮附睾精子抽吸术和睾丸精子获取术在无精子症诊断和治疗中的应用

目的 :研究附睾和睾丸精子抽吸术对无精子症患者的诊断和治疗价值。 方法 :应用经皮附睾精子抽吸术(PESA)和睾丸精子获取术 (TESE)两种方法对 385例无精子症患者进行穿刺检查。 结果 :其中 6 4例附睾中存在精子 (1 6 .6 2 %) ;4 5例患者睾丸中存在精子 (1 1 .6 9%) ;对其中 6 4例睾丸或附睾中发现精子的患者采取PESA或TESE取精后行卵细胞胞质内单精子注射 (ICSI)治疗。胚胎移植后妊娠率为 39.0 7%。 结论 :PESA和TESE为部分无精子症患者提供了生育的机会 ,也是针对无精子症的有效的治疗手段。