Dafopoulos Konstantinos, Griesinger Georg, Schultze-Mosgau Askan, Orief Yasser, Schöpper Beate, Nikolettos Nikos, Diedrich Klaus, Al-Hasani Safaa
Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Campus Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany.
Reprod Biomed Online. 2005 Apr;10(4):455-60. doi: 10.1016/s1472-6483(10)60820-6.
There is a lack of data regarding variables affecting the treatment outcome for non-obstructive azoospermia when spermatozoa from cryopreserved testicular specimens are utilized for ICSI. The objective of the present retrospective analysis was to investigate the effect of various parameters on treatment outcome in such cases. One hundred and sixty-five couples with non-obstructive azoospermic males undergoing a total of 297 cycles were included. In all cases the testicular tissue retrieved by multiple open-biopsy testicular sperm extraction was stored in liquid nitrogen and, after thawing, only mature spermatozoa were used for ICSI. When no motile spermatozoa were recovered, immotile spermatozoa were used. In 159 cycles, motile spermatozoa were utilized for ICSI, while in 138 cycles immotile spermatozoa were utilized. Higher normal fertilization rate (60.4 +/- 3.1 versus 51.3 +/- 1.6%, P < 0.05), number of embryos transferred (2.8 +/- 0.06 versus 2.6 +/- 0.04, P < 0.05), modified cumulative embryo score (31.2 +/- 1.6 versus 23.9 +/- 0.8, P < 0.001), and proportion of motile spermatozoa injected (67.8 versus 49.8%, P < 0.05) were observed in cycles that resulted in clinical pregnancies. Binary logistic regression analysis showed that sperm motility (odds ratio 2.06, 95% CI 1.1-3.9, P < 0.05), but not woman's age, number of treatment cycle, type of GnRH-analogue used for pituitary suppression, number of oocytes retrieved or number of embryos transferred was a significant determinant of the likelihood of clinical pregnancy. In conclusion, sperm motility after freeze/thawing of testicular tissue is the major determinant of the success of ICSI in non-obstructive azoospermia.
当利用冷冻保存的睾丸标本中的精子进行卵胞浆内单精子注射（ICSI）治疗非梗阻性无精子症时，关于影响治疗结果的变量的数据尚缺乏。本回顾性分析的目的是研究各种参数对此类病例治疗结果的影响。纳入了165对患有非梗阻性无精子症男性的夫妇，共进行了297个周期的治疗。在所有病例中，通过多次开放式活检睾丸精子提取获得的睾丸组织储存在液氮中，解冻后，仅将成熟精子用于ICSI。当未回收活动精子时，则使用不活动精子。在159个周期中，活动精子用于ICSI，而在138个周期中，不活动精子被使用。临床妊娠的周期中观察到较高的正常受精率（60.4±3.1%对51.3±1.6%，P<0.05）、移植胚胎数（2.8±0.06对2.6±0.04，P<0.05）、改良累积胚胎评分（31.2±1.6对23.9±0.8，P<0.001）以及注射的活动精子比例（67.8%对49.8%，P<0.05）。二元逻辑回归分析表明，精子活力（优势比2.06，95%可信区间1.1 - 3.9，P<0.05），而非女性年龄、治疗周期数、用于垂体抑制的促性腺激素释放激素类似物类型、回收的卵母细胞数或移植的胚胎数，是临床妊娠可能性的显著决定因素。总之，睾丸组织冻融后的精子活力是ICSI治疗非梗阻性无精子症成功的主要决定因素。
