The number of spermatozoa collected with testicular sperm extraction is a novel predictor of intracytoplasmic sperm injection outcome in non-obstructive azoospermic patients

The purpose of this study was to determine the relationships between monitors of spermatogenesis and predictors of the intracytoplasmic sperm injection （ICSI） outcome in patients with non-obstructive azoospermia （NOA） undergoing testicular sperm extraction （TESE）. Seventy-nine patients with NOA （mean age： 43.6±5.2 years）, each of whom yielded （97 000±3040） spermatozoa with conventional TESE, were considered in our analysis. Their partners （mean age： 35.8±5.1 years） underwent a total of 184 ICSI cycles; 632 oocytes were collected, 221 oocytes were injected, 141 oocytes were fertilized, 121 embryos were obtained, 110 embryos were transferred, 14 clinical pregnancies were achieved and only one miscarriage occurred. Multivariate regression analysis indicated relationships between the percentage of fertilized oocytes, transferred embryos and clinical pregnancies with the following variable values： female partner＇s age, number of spermatozoa collected, testicular volume, male partner＇s levels of follicle stimulating hormone （FSH）, number of oocytes collected, number of oocytes injected and number of ICSI cycles. A significant inverse relationship was found between female partner＇s age or male partner＇s FSH levels and biochemical pregnancies. A significant direct relationship emerged between the number of ICS! cycles and the percentage of oocytes fertilized, embryos transferred and biochemical pregnancies, and between the number of spermatozoa collected per testicular biopsy and biochemical pregnancies. The number of spermatozoa was positively linked to the number of clinical pregnancies, independent of the number of ICSI cycles and the number of oocytes collected/injected. The number of spermatozoa collected, FSH level and testicular volume are monitors of spermatogenesis linked to ICSI success.

男性特发性少、畸、死精症(英文)

大约30%的不育男性受特发性少、畸、死精(iOAT)的影响,本文回顾了近期这一领域的相关数据。年龄、睾丸后器官非炎性功能改变、传染介质(沙眼衣原体、疱疹病毒、腺病毒伴随病毒)、配子基因组改变、线粒体改变、环境污染、"细微"的激素改变都可能是 iOAT 的发病原因。增加生精小管和精浆中的活性氧细胞、促进细胞凋亡被公认为会影响精子的浓度、活性和形态。iOAT 常用排除法来诊断,但睾丸主动脉的光谱踪迹也可用来诊断 iOAT。可采用以下方法来治疗 iOAT:1)枸橼酸他莫昔芬(20 mg/d)+十一酸睾丸素(120 mg/d)(每月每对夫妻怀孕率[prcm]:3.8%):2)叶酸(66 mg/d)+硫酸锌(5 mg/d);3)左旋肉碱(2 g/d)单独使用或联合乙酰基肉碱(1 g/d)(prcm:2.3%);4)每4天使用肉碱+30 mg cinnoxicam 栓剂(prcm:8.5%)。Alpha-抑制药物会增加精子浓度,但不能改变精子形态和活性,也无法改变怀孕率。在一项初始性非对照研究中,曲尼司特(300 mg/d)能提高各项精子参数和怀孕率,它对于精子浓度的作用在其后发表的一些报告中得到证实(不包括对精子活性、形态和怀孕率的作用),其它方法的疗效仍在讨论当中。