Bromage Stephen J, Douglas Jamie, Falconer Debbie A, Lieberman Brian A, Payne Stephen R
Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
World J Urol. 2007 Oct;25(5):519-24. doi: 10.1007/s00345-007-0182-7. Epub 2007 Jul 3.
There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ICSI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner's behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.
关于输精管结扎术与用于胞浆内单精子注射（ICSI）的手术取精（SSR）之间的间隔时间是否与临床妊娠率（CPR）和活产率（LBR）相关，存在相互矛盾的报道。本研究旨在评估可能影响既往输精管结扎术导致继发性无精子症男性ICSI结局的因素。我们分析了1997年至2005年间由一名泌尿外科医生为198例输精管结扎术后无精子症男性进行经皮附睾精子抽吸术（PESA）和/或睾丸精子提取术（TeSE）的病历，这些男性的精子随后被冷冻，以便代表其伴侣用于体外受精治疗方案。144例（73%）男性PESA结果为阳性，其余54例（27%）TeSE结果为阳性。44%无附睾扩张临床证据的男性仍成功获取了附睾精子。128例患者进行了ICSI，共进行了237个周期。总体CPR和LBR分别为29%和27%。使用逻辑回归分析，输精管结扎术后的时间与CPR（P = 0.17）或LBR（P = 0.31）之间无关联。输精管复通术尝试史对取精率、CPR和LBR没有负面影响。SSR的成功率和使用冷冻精子的ICSI结局与男性年龄和输精管结扎术后的时间无关。在无附睾扩张临床证据的男性中，超过40%的人可能获取附睾精子。
