梗阻性和非梗阻性无精子症患者附睾和睾丸精子体外受精及卵胞浆内单精子注射的结局

Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia.

作者信息

Pasqualotto Fabio F, Rossi-Ferragut Lia M, Rocha Cláudia C, Iaconelli Assumpto, Borges Edson

机构信息

Fertility-Centro de Reprodução Assistida, São Paulo, Brazil.

出版信息

J Urol. 2002 Apr;167(4):1753-6.

PMID:11912403

Abstract

PURPOSE

We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection.

MATERIALS AND METHODS

From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa.

RESULTS

The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p <0.05). The normal and abnormal fertilization rates were 58.7% and 21.4% for percutaneous epididymal sperm aspiration (PESA), 62.3% and 10.4% for PESA plus testicular sperm aspiration (TESA), and 57.3% and 14.5% for TESA, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 34.6%, 54.5% and 11.1% for PESA, 37.5%, 37.5% and 33.3% for PESA plus TESA, and 26.1%, 31% and 41% for TESA, respectively (PESA versus PESA plus TESA p >0.05, and PESA and PESA plus TESA versus TESA p <0.05). Epididymal or testicular motile sperm resulted in a lower abortion rate than epididymal or testicular immotile sperm (p = 0.03).

CONCLUSIONS

No differences were noted in the fertilization and embryo transfer rates irrespective of etiology (obstructive versus nonobstructive) and type of spermatozoa (epididymal versus testicular). Testicular sperm retrieval results in lower fertilization and pregnancy rates as well as higher abortion rates than epididymal sperm retrieval.

摘要

目的

我们评估了接受卵胞浆内单精子注射的梗阻性和非梗阻性无精子症患者的受精、妊娠和流产率。

材料与方法

1996年6月至2000年3月，对166例连续的无精子症患者（198个卵胞浆内单精子注射周期）进行了研究。在这198个周期中，68个周期因非梗阻性无精子症使用睾丸精子进行，130个周期因梗阻性无精子症使用附睾精子进行。

结果

梗阻性和非梗阻性无精子症的正常（2个原核）和异常（1 + 3个原核）受精率分别为60.5%和16.6%，以及54%和16.4%（p>0.05）。梗阻性无精子症的每个周期妊娠率、每个患者妊娠率和流产率分别为30%、39.8%和28%，非梗阻性无精子症分别为22%、28.3%和40%（p<0.05）。经皮附睾精子抽吸术（PESA）的正常和异常受精率分别为58.7%和21.4%，PESA加睾丸精子抽吸术（TESA）分别为62.3%和10.4%，TESA分别为57.3%和14.5%（p>0.05）。PESA的每个周期妊娠率、每个患者妊娠率和流产率分别为34.6%、54.5%和11.1%，PESA加TESA分别为37.5%、37.5%和33.3%，TESA分别为26.1%、31%和41%（PESA与PESA加TESA比较p>0.05，PESA和PESA加TESA与TESA比较p<0.05）。附睾或睾丸活动精子导致的流产率低于附睾或睾丸不活动精子（p = 0.03）。