Bromage Stephen J, Falconer Debbie A, Lieberman Brian A, Sangar Vijay, Payne Stephen R
Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.
Eur Urol. 2007 Feb;51(2):534-9; discussion 539-40. doi: 10.1016/j.eururo.2006.08.032. Epub 2006 Sep 5.
Men presenting with primary infertility and azoospermia may be offered surgical sperm retrieval (SSR) as a prelude to intracytoplasmic sperm injection (ICSI). We evaluated sperm retrieval rates in subgroups of men with azoospermia, based on obstructive aetiology, testicular volume and FSH.
106 patients with primary infertility underwent clinical evaluation and SSR with percuataneous epididymal aspiration (PESA) and/or testicular sperm extraction (TeSE) by a single urologist over a five year period. Ten percent of this group (11 patients) had a clear cause of obstruction, congenital absence of the vas deferens (CBAVD), labelled group A. Ninety percent (95 patients) had no definite cause of obstruction, labelled group B.
All eleven patients in group A had adequate sperm retrieved, compared with 56% of 95 men in group B. Clinical pregnancy and live birth rates were 47% and 44% for group A respectively compared with 21% and 20% for group B. Twenty-one men had testes <4 cm and FSH>10; a significantly lower sperm retrieval rate was seen in this subgroup (29%) compared to men with normal testicular volume and FSH (77%), p=0.0001, which corresponded to a LBR of 28% and 14% respectively.
In the absence of testicular histology prior to SSR clinical parameters can be used to aid in counselling. Azoospermic males with normal sized testes and normal FSH can expect acceptable numbers of sperm to be retrieved by SSR for ICSI. Less than one third of men with raised FSH and small testes will have successful SSR.
对于原发性不育且无精子症的男性，可采用手术取精（SSR）作为胞浆内单精子注射（ICSI）的前奏。我们根据梗阻病因、睾丸体积和卵泡刺激素（FSH），评估了无精子症男性亚组的取精率。
在五年期间，一名泌尿外科医生对106例原发性不育患者进行了临床评估，并采用经皮附睾穿刺抽吸术（PESA）和/或睾丸精子提取术（TeSE）进行SSR。该组中有10%（11例患者）有明确的梗阻原因，即先天性输精管缺如（CBAVD），标记为A组。90%（95例患者）没有明确的梗阻原因，标记为B组。
A组的所有11例患者均成功取出足够的精子，而B组95例男性中这一比例为56%。A组的临床妊娠率和活产率分别为47%和44%，而B组分别为21%和20%。21名男性的睾丸<4 cm且FSH>10；与睾丸体积和FSH正常的男性相比，该亚组的取精率显著较低（29%），p = 0.0001，其相应的活产率分别为28%和14%。
在进行SSR之前，如果没有睾丸组织学检查结果，临床参数可用于辅助咨询。睾丸大小正常且FSH正常的无精子症男性可预期通过SSR为ICSI取出足够数量的精子。FSH升高且睾丸较小的男性中，成功进行SSR的比例不到三分之一。
