无精子症男性睾丸精子的卵胞浆内单精子注射

Intracytoplasmic sperm injection with testicular spermatozoa in men with azoospermia.

作者信息

Windt M L, Coetzee K, Kruger T F, Menkveld R, van der Merwe J P

机构信息

Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, South Africa.

出版信息

J Assist Reprod Genet. 2002 Feb;19(2):53-9. doi: 10.1023/a:1014487412975.

DOI:10.1023/a:1014487412975

PMID:11958505

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3468227/

Abstract

PURPOSE

The aim of the study was to gain an insight into the optimal management of the infertile couple with the husband suffering from azoospermia.

METHODS

One hundred and forty-two intracytoplasmic sperm injection (ICSI) cycles performed with testicular extracted spermatozoa were retrospectively analysed. The following factors were investigated for their possible influence on fertilization, cleavage, damage, pregnancy, and ongoing pregnancy rates: the use of fresh, cryopreserved, and preincubated (24 h) spermatozoa and the etiology of the husbands' azoospermia (obstructive and nonobstructive). All microinjections were performed with apparently normal spermatozoa--a head with a tail of normal length. In 116 cycles at least two embryos were available for transfer.

RESULTS

The overall fertilization, clinical pregnancy, and ongoing pregnancy rates obtained for the 116 cycles were 65.0, 30.2, and 22.4% respectively. Similar outcomes were obtained for cycles using fresh testicular and cryopreserved testicular spermatozoa. Similarly, no significant differences were obtained between the cycles using spermatozoa from obstructive or nonobstructive azoospermic patients. An increase in motility after a 24-h preincubation was observed, and although this group was relatively small (n = 17), a significant improvement in fertilization (73.7%) and pregnancy (53.9%) rate was obtained when the testicular sample was preincubated for 24 h. This improvement prevailed in the obstructive azoospermic group, but was less pronounced in nonobstructive patients.

CONCLUSIONS

This study shows that the outcome of fresh and frozen-thawed testicular spermatozoa in ICSI is comparable, obstructive and nonobstructive etiologies perform the same, and that preincubation of testicular spermatozoa results in increased fertilization and pregnancy rates. All testicular biopsies are therefore performed the day before oocyte retrieval, superfluous spermatozoa cryopreserved, and the remaining testicular homogenate preincubated for the 24 h prior to oocyte retrieval. With this regime, most azoospermic patients are treated successfully, irrespective of the use of fresh or frozen-thawed spermatozoa from obstructive or nonobstructive cases.

摘要

目的

本研究旨在深入了解丈夫患无精子症的不育夫妇的最佳治疗方案。

方法

对142个采用睾丸提取精子进行卵胞浆内单精子注射（ICSI）的周期进行回顾性分析。研究以下因素对受精、卵裂、损伤、妊娠及持续妊娠率的可能影响：新鲜、冷冻保存及预孵育（24小时）精子的使用，以及丈夫无精子症的病因（梗阻性和非梗阻性）。所有显微注射均使用外观正常的精子——头部带正常长度尾巴的精子。在116个周期中，至少有两个胚胎可供移植。

结果

116个周期的总体受精率、临床妊娠率和持续妊娠率分别为65.0%、30.2%和22.4%。使用新鲜睾丸精子和冷冻保存睾丸精子的周期获得了相似的结果。同样，梗阻性或非梗阻性无精子症患者精子的周期之间未发现显著差异。观察到预孵育24小时后精子活力增加，尽管该组相对较小（n = 17），但当睾丸样本预孵育24小时时，受精率（73.7%）和妊娠率（53.9%）有显著提高。这种改善在梗阻性无精子症组中更为明显，但在非梗阻性患者中不太显著。

结论

本研究表明，ICSI中新鲜和冻融睾丸精子的结果相当，梗阻性和非梗阻性病因表现相同，睾丸精子预孵育可提高受精率和妊娠率。因此，所有睾丸活检均在取卵前一天进行，多余的精子冷冻保存，剩余的睾丸匀浆在取卵前预孵育24小时。采用这种方案，大多数无精子症患者均可成功治疗，无论使用梗阻性或非梗阻性病例的新鲜或冻融精子。