Greco Ermanno, Scarselli Filomena, Iacobelli Marcello, Rienzi Laura, Ubaldi Filippo, Ferrero Susanna, Franco Giorgio, Anniballo Nazareno, Mendoza Carmen, Tesarik Jan
Centre for Reproductive Medicine, European Hospital, Via Portuense 700, 00149 Rome, Italy.
Hum Reprod. 2005 Jan;20(1):226-30. doi: 10.1093/humrep/deh590. Epub 2004 Nov 11.
Sperm DNA damage (fragmentation) is a recently discovered cause of male infertility for which no efficient treatment has yet been found. Previous findings have suggested that clinically relevant sperm DNA damage may occur at the post-testicular level. This study was undertaken to assess the clinical usefulness of ICSI with testicular spermatozoa in this indication.
The percentage of spermatozoa with fragmented DNA, assessed by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labelling assay, and ICSI outcomes were compared in two sequential attempts performed, respectively, with ejaculated and testicular spermatozoa in 18 men with increased sperm DNA fragmentation.
The incidence of DNA fragmentation was markedly lower in testicular spermatozoa as compared with ejaculated spermatozoa. No differences in fertilization and cleavage rates and in embryo morphological grade were found between the ICSI attempts performed with ejaculated and with testicular spermatozoa. However, eight ongoing clinical pregnancies (four singleton and four twin) were achieved by ICSI with testicular spermatozoa (44.4% pregnancy rate; 20.7% implantation rate), whereas ICSI with ejaculated spermatozoa led to only one pregnancy which was spontaneously aborted.
These data show that ICSI with testicular spermatozoa provides the first efficient assisted reproduction treatment option for men with high levels of sperm DNA damage.
精子DNA损伤（片段化）是最近发现的男性不育原因，目前尚未找到有效的治疗方法。先前的研究结果表明，临床上相关的精子DNA损伤可能发生在睾丸后水平。本研究旨在评估在这种情况下使用睾丸精子进行卵胞浆内单精子注射（ICSI）的临床实用性。
通过末端脱氧核苷酸转移酶介导的dUTP缺口末端标记法评估精子DNA片段化的百分比，并比较了18例精子DNA片段化增加的男性分别使用射出精子和睾丸精子进行的两次连续ICSI尝试的结果。
与射出精子相比，睾丸精子中DNA片段化的发生率明显更低。使用射出精子和睾丸精子进行的ICSI尝试之间，在受精率、卵裂率和胚胎形态学等级方面未发现差异。然而，使用睾丸精子进行ICSI获得了8例持续临床妊娠（4例单胎和4例双胎）（妊娠率44.4%；着床率20.7%），而使用射出精子进行ICSI仅导致1例妊娠且自发流产。
这些数据表明，对于精子DNA损伤程度高的男性，使用睾丸精子进行ICSI提供了首个有效的辅助生殖治疗选择。
