Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, The Netherlands.
Hum Reprod Update. 2010 Jan-Feb;16(1):12-9. doi: 10.1093/humupd/dmp030.
For men with azoospermia, it is possible to father their own progeny by intracytoplasmic sperm injection (ICSI) with epididymal or testicular sperm. Some studies show that children born after assisted reproductive technology (ART) are at increased risk of birth defects, other studies suggest that there is no extra concern about ICSI children conceived with epididymal or testicular sperm.
Studies about the karyotypes of fetuses, congenital anomalies and the follow-up of the children born after ICSI with non-ejaculated sperm were identified by means of a systematic literature search.
Eight relevant studies were identified; two studies reported karyotype, five reported malformations and one reported follow-up of children after ICSI. In total, there were 55 out of 1973 (2.8%) abnormal karyotypes in the ICSI with ejaculated sperm group, 0 out of 31 in the ICSI with epididymal sperm group and 5 out of 191 (2.6%) in the ICSI with testicular sperm group. Major malformations were found in 543 out of 12 377 (4.4%) in the ICSI with ejaculated sperm group, 17 out of 533 (3.2%) in the ICSI with epididymal sperm group and 31 out of 670 (4.6%) in the ICSI with testicular sperm group.
Although there were no statistical differences, the study groups were small and heterogenic, with a number of potential biases. We therefore recommend a standardized methodology of follow-up studies after ART, with well-defined groups of ICSI with ejaculated sperm, ICSI with epididymal sperm and ICSI with testicular sperm, and a control group of naturally conceived children.
对于无精子症患者，可以通过卵胞浆内单精子注射（ICSI）使用附睾或睾丸精子使自己的后代受精。一些研究表明，通过辅助生殖技术（ART）出生的儿童有更高的出生缺陷风险，而其他研究则表明，使用附睾或睾丸精子进行 ICSI 所孕育的婴儿没有额外的担忧。
通过系统文献检索，确定了关于非射出精液 ICSI 后胎儿染色体核型、先天性畸形以及对儿童的随访研究。
共确定了 8 项相关研究；其中 2 项研究报告了核型，5 项研究报告了畸形，1 项研究报告了 ICSI 后儿童的随访情况。在射出精液 ICSI 组中，有 55 例（2.8%）染色体核型异常，在附睾精液 ICSI 组中无异常，在睾丸精液 ICSI 组中有 5 例（2.6%）异常。在射出精液 ICSI 组中，有 543 例（4.4%）发现严重畸形，在附睾精液 ICSI 组中，有 17 例（3.2%），在睾丸精液 ICSI 组中，有 31 例（4.6%）。
尽管没有统计学差异，但研究组规模较小且异质性较大，存在一些潜在的偏倚。因此，我们建议采用标准化的 ART 后随访研究方法，明确定义射出精液 ICSI、附睾精液 ICSI 和睾丸精液 ICSI 组以及自然受孕儿童对照组。
