Raman Jay D, Schlegel Peter N
James Buchanan Brady Urology Foundation, Department of Urology, Center for Male Reproductive Medicine and Microsurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
J Urol. 2003 Oct;170(4 Pt 1):1287-90. doi: 10.1097/01.ju.0000080707.75753.ec.
We evaluated the results of testicular sperm extraction (TESE) with intracytoplasmic sperm injection (ICSI) in men with nonobstructive azoospermia (NOA) associated with cryptorchidism.
A total of 321 TESE attempts were done in 275 men with confirmed nonobstructive azoospermia to recover spermatozoa for ICSI between November 1995 and December 2001. Of these patients 38 with a diagnosis of cryptorchidism underwent 47 sperm extraction attempts. The remaining 237 men with a total of 274 associated TESE attempts had various other etiologies for NOA. The outcome measures studied were the sperm retrieval, fertilization, pregnancy and miscarriage rates after ICSI. Serum follicle stimulating hormone (FSH), testicular volume and age at orchiopexy (in the cryptorchid group) were examined as predictive factors for sperm recovery.
In the cryptorchid cohort spermatozoa were successfully retrieved at 35 of 47 TESE attempts (74%) with fertilization in 214 of 347 metaphase II oocytes (62%). Clinical pregnancies resulted for 16 of 35 cycles (46%) when sperm were retrieved, with ongoing pregnancies or deliveries in 15 of the 35 (43%). Spermatozoa recovery correlated with testicular volume (p <0.05) and patient age at orchiopexy (p <0.001) but it was independent of serum FSH. In the noncryptorchid subgroup spermatozoa were successfully retrieved at 160 of 274 TESE attempts (58%) with fertilization in 983 of 1,657 metaphase II oocytes (59%). Clinical pregnancies were documented for 71 of 160 cycles (44%) when sperm were retrieved, with ongoing pregnancies or deliveries in 58 of 160 the (36%). Spermatozoa recovery was independent of testicular volume and serum FSH. Patients with a history of cryptorchidism had better TESE sperm retrieval rates (p <0.05) but no significant difference in the fertilization, pregnancy or miscarriage rate.
TESE with ICSI is a successful treatment modality for men with NOA associated with cryptorchidism. Spermatozoa were retrieved in 74% of attempts with a resulting clinical pregnancy in 46% of these cases. These results are comparable if not better to those in noncryptorchid patients with NOA. Testicular volume and age at orchiopexy were identified as independent predictors of sperm retrieval for men with a history of cryptorchidism.
我们评估了睾丸精子提取术（TESE）联合卵胞浆内单精子注射术（ICSI）治疗与隐睾症相关的非梗阻性无精子症（NOA）男性患者的效果。
1995年11月至2001年12月期间，对275例确诊为非梗阻性无精子症的男性患者进行了总共321次TESE尝试，以获取精子用于ICSI。其中38例诊断为隐睾症的患者接受了47次精子提取尝试。其余237例男性患者共进行了274次相关TESE尝试，其NOA病因各不相同。研究的观察指标为ICSI术后的精子获取率、受精率、妊娠率和流产率。检测血清卵泡刺激素（FSH）、睾丸体积以及隐睾组患者的睾丸固定术年龄，作为精子恢复的预测因素。
在隐睾症队列中，47次TESE尝试中有35次成功获取精子（74%），347个中期II卵母细胞中有214个受精（62%）。当获取到精子时，35个周期中有16个临床妊娠（46%），35个中有15个持续妊娠或分娩（43%）。精子恢复与睾丸体积（p<0.05）和睾丸固定术时的患者年龄（p<0.001）相关，但与血清FSH无关。在非隐睾症亚组中，274次TESE尝试中有160次成功获取精子（58%），1657个中期II卵母细胞中有983个受精（59%）。当获取到精子时，160个周期中有71个记录有临床妊娠（44%），160个中有58个持续妊娠或分娩（36%）。精子恢复与睾丸体积和血清FSH无关。有隐睾症病史的患者TESE精子获取率更高（p<0.05），但受精率、妊娠率或流产率无显著差异。
TESE联合ICSI是治疗与隐睾症相关的NOA男性患者的一种成功治疗方式。74%的尝试成功获取了精子，其中46%的病例实现了临床妊娠。这些结果即便不比非隐睾症的NOA患者更好，也与之相当。睾丸体积和睾丸固定术年龄被确定为有隐睾症病史男性精子获取的独立预测因素。
