Zitzmann Michael, Nordhoff Verena, von Schönfeld Victoria, Nordsiek-Mengede Annette, Kliesch Sabine, Schüring Andreas N, Luetjens Craig Marc, Kamischke Axel, Cooper Trevor, Simoni Manuela, Nieschlag Eberhard
Institute of Reproductive Medicine of the University, University of Münster, Münster, Germany.
Fertil Steril. 2006 Aug;86(2):339-47. doi: 10.1016/j.fertnstert.2005.12.058. Epub 2006 Jun 6.
To assess individual chances for a live-born child in azoospermic men by performance of testicular sperm extraction (TESE) followed by intracytoplasmatic sperm injection (ICSI).
A retrospective cohort study.
An academic fertility care center and research unit.
PATIENT(S): Two hundred three couples who wished to have a child; all men had azoospermia.
INTERVENTION(S): All men were operated for TESE; 112 men were found to have elongated spermatids (ES), and 209 ICSI cycles were performed in these men using cryopreserved tissue.
MAIN OUTCOME MEASURE(S): Predictors for the chances to obtain live sperm and for probabilities of fertilization, clinical pregnancies, and live births.
RESULT(S): Testicular volume, FSH, and inhibin B levels were predictors for the presence of ES. Intracytoplasmic sperm injection resulted in 23 pregnancies, leading to 20 live births. Despite the presence of ES and performance of ICSI in cases of FSH levels >or=20 IU/L, no pregnancy resulted in these men (n = 21). Receiver operating characteristics revealed FSH levels of >or=20 IU/L as cutoff for treatment success. The number of testicular tubuli containing ES served as a predictor for clinical pregnancy as well as for live birth. Cigarette smoking by the male partner exerted a significant negative influence on treatment success.
CONCLUSION(S): The degree of completely maintained spermatogenesis within the biopsy appears to reflect intrinsic abilities of spermatozoa to induce normal embryo development. Charts based on regression models are presented for counseling patients before TESE; these explain chances of finding ES and probability of successful ICSI. Obtaining offspring is unlikely in cases of azoospermia and of FSH levels of >or=20 IU/L.
通过睾丸精子提取（TESE）及随后的卵胞浆内单精子注射（ICSI）来评估无精子症男性生育活产儿的个体几率。
一项回顾性队列研究。
一个学术性生育护理中心及研究单位。
203对希望生育孩子的夫妇；所有男性均为无精子症。
所有男性均接受TESE手术；112名男性被发现有延长型精子细胞（ES），并对这些男性使用冷冻保存组织进行了209个ICSI周期。
获取活精子几率的预测因素以及受精、临床妊娠和活产的概率。
睾丸体积、促卵泡激素（FSH）和抑制素B水平是ES存在的预测因素。卵胞浆内单精子注射导致23例妊娠，最终有20例活产。尽管存在ES且在FSH水平≥20IU/L的情况下进行了ICSI，但这些男性（n = 21）均未妊娠。受试者工作特征曲线显示FSH水平≥20IU/L为治疗成功的临界值。含有ES的睾丸曲细精管数量可作为临床妊娠及活产的预测因素。男性伴侣吸烟对治疗成功有显著负面影响。
活检中完全维持的精子发生程度似乎反映了精子诱导正常胚胎发育的内在能力。给出了基于回归模型的图表，用于在TESE前为患者提供咨询；这些图表解释了找到ES的几率及ICSI成功的概率。在无精子症且FSH水平≥20IU/L的情况下，获得后代的可能性不大。
