Monzó A, Kondylis F, Lynch D, Mayer J, Jones E, Nehchiri F, Morshedi M, Schuffner A, Muasher S, Gibbons W, Oehninger S
Jones Institute for Reproductive Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
Urology. 2001 Jul;58(1):69-75. doi: 10.1016/s0090-4295(01)01012-3.
To analyze the outcome of intracytoplasmic sperm injection (ICSI) cycles in infertile couples in whom the main diagnosis of infertility was azoospermia of obstructive and nonobstructive origin.
Eighty-three consecutive ICSI cycles were carried out with retrieved testicular or epididymal spermatozoa, 60 cycles in 32 patients with obstructive azoospermia and 23 cycles in 12 patients with nonobstructive azoospermia. Fifty-four testicular biopsies (testicular sperm extraction) and 18 epididymal aspirations (microepididymal sperm aspiration) were performed.Results. Motile spermatozoa were recovered in 65 cycles (90.3%). In another 3 (4.2%), nonmotile spermatozoa were retrieved. In 4 patients (5.5%), sperm could not be recovered. In 11 cycles, frozen sperm from a previous procedure were used. A significantly lower fertilization rate (64% versus 73%, P = 0.02), clinical pregnancy rate (13% versus 47%, P <0.001), and good embryo quality rates (35% versus 56%, P = 0.009) were observed in patients with nonobstructive azoospermia. In patients with obstructive azoospermia, no significant differences were observed when the outcome was analyzed on the basis of the sperm origin (ie, from testicular sperm extraction or microepididymal sperm aspiration).
When combining testicular sperm extraction or microepididymal sperm aspiration with ICSI in patients with obstructive azoospermia, the results in terms of fertilization, implantation, and pregnancy rates were similar to those found in patients with nonazoospermic obstruction who underwent ICSI with ejaculated sperm. Patients with nonobstructive azoospermia had lower fertilization, embryo quality, and pregnancy rates than did those with obstructive azoospermia, probably because of severe defects in spermatogenesis, leading to poor gamete quality. The urologist and reproductive endocrinologist now have an excellent therapeutic option to offer men with previously intractable infertility.
分析主要诊断为梗阻性和非梗阻性无精子症的不育夫妇进行卵胞浆内单精子注射（ICSI）周期的结局。
连续进行了83个ICSI周期，使用获取的睾丸或附睾精子，其中32例梗阻性无精子症患者进行了60个周期，12例非梗阻性无精子症患者进行了23个周期。进行了54次睾丸活检（睾丸精子提取）和18次附睾抽吸（显微附睾精子抽吸）。结果：65个周期（90.3%）中获得了活动精子。另外3个周期（4.2%）中获取了不活动精子。4例患者（5.5%）未能获取精子。11个周期使用了先前操作冷冻的精子。非梗阻性无精子症患者的受精率（64%对73%，P = 0.02）、临床妊娠率（13%对47%，P <0.001）和优质胚胎率（35%对56%，P = 0.009）显著较低。在梗阻性无精子症患者中，根据精子来源（即来自睾丸精子提取或显微附睾精子抽吸）分析结局时，未观察到显著差异。
对于梗阻性无精子症患者，将睾丸精子提取或显微附睾精子抽吸与ICSI相结合时，受精、着床和妊娠率方面的结果与使用射出精子进行ICSI的非无精子症梗阻患者相似。非梗阻性无精子症患者的受精率、胚胎质量和妊娠率低于梗阻性无精子症患者，可能是由于精子发生严重缺陷，导致配子质量差。泌尿外科医生和生殖内分泌学家现在有了一个很好的治疗选择，可以为以前难以治疗的不育男性提供帮助。
