睾丸组织学对分泌性无精子症亚组的预测价值以及新鲜和冻融精子与精子细胞显微注射后的临床结局

Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids.

作者信息

Sousa M, Cremades N, Silva J, Oliveira C, Ferraz L, Teixeira da Silva J, Viana P, Barros A

机构信息

Department of Medical Genetics, Faculty of Medicine, University of Porto, Portugal.

出版信息

Hum Reprod. 2002 Jul;17(7):1800-10. doi: 10.1093/humrep/17.7.1800.

DOI:10.1093/humrep/17.7.1800

PMID:12093843

Abstract

BACKGROUND

A retrospective study was carried out on 159 treatment cycles in 148 secretory azoospermic patients to determine whether histopathological secretory azoospermic subgroups were predictive for gamete retrieval, and to evaluate outcome of microinjection using fresh or frozen-thawed testicular sperm and spermatids.

METHODS

Sperm and spermatids were recovered by open testicular biopsy and microinjected into oocytes. Fertilization and pregnancy rates were assessed.

RESULTS

In hypoplasia, 97.7% of the 44 patients had late spermatids/sperm recovered. In maturation-arrest (MA; 47 patients), 31.9% had complete MA, and 68.1% incomplete MA due to a focus of early (36.2%) or late (31.9%) spermiogenesis. Gamete retrieval was achieved in 53.3, 41.2 and 93.3% of the cases respectively. In Sertoli cell-only syndrome (SCOS; 57 patients), 61.4% were complete SCOS, whereas incomplete SCOS cases showed one focus of MA (5.3%), or of early (29.8%) and late (3.5%) spermiogenesis. Only 29.8% of the patients had a successful gamete retrieval, 2.9% in complete and 77.3% in incomplete SCOS cases. In total, there were 87 ICSI, 39 elongated spermatid injection (ELSI) and 33 round spermatid injection (ROSI) treatment cycles, with mean values of fertilization rate of 71.4, 53.6 and 17%, and clinical pregnancy rates of 31.7, 26.3 and 0% respectively.

CONCLUSIONS

Histopathological subgroups were positively correlated with successful gamete retrieval. No major outcome differences were observed between testicular sperm and elongated spermatids, either fresh or frozen-thawed. However, injection of intact round-spermatids showed very low rates of fertilization and no pregnancies.

摘要

背景

对148例分泌性无精子症患者的159个治疗周期进行了一项回顾性研究，以确定组织病理学分泌性无精子症亚组是否可预测配子获取情况，并评估使用新鲜或冻融睾丸精子及精子细胞进行显微注射的结果。

方法

通过开放性睾丸活检回收精子和精子细胞，并将其显微注射到卵母细胞中。评估受精率和妊娠率。

结果

在发育不全组中，44例患者中有97.7%回收了晚期精子细胞/精子。在成熟停滞（MA；47例患者）组中，31.9%为完全成熟停滞，68.1%为不完全成熟停滞，原因是存在早期（36.2%）或晚期（31.9%）精子发生灶。配子获取成功率分别为53.3%、41.2%和93.3%。在唯支持细胞综合征（SCOS；57例患者）组中，61.4%为完全SCOS，而不完全SCOS病例表现为一个成熟停滞灶（5.3%），或早期（29.8%）和晚期（3.5%）精子发生灶。只有29.8%的患者成功获取了配子，完全SCOS病例为2.9%，不完全SCOS病例为77.3%。总共进行了87个卵胞浆内单精子注射（ICSI）、39个延长型精子细胞注射（ELSI）和33个圆形精子细胞注射（ROSI）治疗周期，受精率平均值分别为71.4%、53.6%和17%，临床妊娠率分别为31.7%、26.3%和0%。