Hauser Ron, Yogev Leah, Amit Ami, Yavetz Haim, Botchan Amnon, Azem Fuad, Lessing Joseph B, Ben-Yosef Dalit
Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
J Androl. 2005 Nov-Dec;26(6):772-8. doi: 10.2164/jandrol.05044.
The aim of this comparative clinical study was to examine whether the fertilizing potential of frozen-thawed testicular sperm in the most severe cases of hypospermatogenesis is reduced compared with fresh testicular sperm. The results could determine the necessity of using fresh testicular sperm cells, which mandates involving the spouse by performing simultaneous in vitro fertilization intracytoplasmic sperm injection (IVF-ICSI) treatment in this subgroup of nonobstructive azoospermia (NOA) patients. We studied 13 couples in which the husband was diagnosed as having NOA and few motile testicular sperm cells or only immotile testicular sperm cells were isolated by testicular sperm extraction (TESE). Each couple underwent both an ICSI cycle, in which fresh testicular sperm that were retrieved shortly beforehand were injected, and a consecutive cycle, which used frozen-thawed sperm that were retrieved in the original TESE procedure but were cryopreserved and stored until use. We found that motility was lost during the freezing and thawing process in some cases, which resulted in significantly more cycles with only immotile sperm cells for injection in the frozen-thawed sperm group (38.5%) than in the fresh sperm group (7.7%; P < .05). Availability of only immotile sperm cells significantly reduced fertilization rates in both fresh and frozen-thawed groups, but the respective overall fertilization rate (44.9% vs 41.1%) and quality of embryos and pregnancy rate (18.2% vs 15.4%) were not significantly different between groups. Implantation rates were more favorable in the fresh sperm group (10.5% vs 5.9%), but not significantly so. We conclude that, although cryopreservation does impair motility, which results in significantly more cycles with only immotile sperm cells for ICSI in the most severe forms of hypospermatogenesis, fertilization and pregnancy rates are not significantly compromised.
这项比较临床研究的目的是检验，在精子发生过少的最严重病例中，经冷冻解冻的睾丸精子的受精潜力与新鲜睾丸精子相比是否降低。研究结果可以确定使用新鲜睾丸精子细胞的必要性，这就要求在这一非梗阻性无精子症（NOA）患者亚组中，通过同时进行体外受精胞浆内单精子注射（IVF-ICSI）治疗让配偶参与进来。我们研究了13对夫妇，其丈夫被诊断为患有NOA，通过睾丸精子提取（TESE）仅分离出少量有活力的睾丸精子细胞或只有无活力的睾丸精子细胞。每对夫妇都接受了两个ICSI周期，一个周期注射的是预先不久取出的新鲜睾丸精子，另一个连续周期使用的是在最初TESE程序中取出但经冷冻保存直至使用的冷冻解冻精子。我们发现，在某些情况下，精子在冷冻和解冻过程中活力丧失，这导致冷冻解冻精子组中只有无活力精子细胞用于注射的周期数（38.5%）显著多于新鲜精子组（7.7%；P <.05）。只有无活力精子细胞可用显著降低了新鲜组和冷冻解冻组的受精率，但两组各自的总体受精率（44.9%对41.1%）、胚胎质量和妊娠率（18.2%对15.4%）并无显著差异。新鲜精子组的着床率更有利（10.5%对5.9%），但差异不显著。我们得出结论，虽然冷冻保存确实会损害精子活力，这导致在精子发生过少的最严重形式中，显著更多的ICSI周期只能使用无活力精子细胞，但受精率和妊娠率并未受到显著影响。
