Department of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
BJU Int. 2011 Apr;107(7):1124-8. doi: 10.1111/j.1464-410X.2010.09545.x.
• To compare the outcome of first-attempt intracytoplasmic sperm injection (ICSI) ICSI--embryo transfer (ET) cycles using frozen-thawed testicular sperm (FTTS), fresh testicular sperm (FTS), frozen-thawed epididymal sperm (FTES) and fresh epididymal sperm (FES) so as to determine which of these has the most successful ICSI outcome with respect to fertilization rate (FR), pregnancy rate (PR) and birth rate. • To assess the outcomes according to the underlying aetiology of azoospermia.
• The records of 493 patients undergoing first-attempt ICSI between 1993 and 2008 were reviewed retrospectively. FTS was used in 112 cycles, FTTS in 43 cycles, FES in 279 cycles, and FTES in 59 cycles. • Within each group, the aetiology of the azoospermia was recorded according to history, clinical examination and histological analysis (n = 316). • The FR, clinical PR and delivery rate were calculated for each group with respect to the type of sperm retrieval used.
• Analysis of the data showed no significant differences between any of the four groups in the FR, PR or delivery rate (P > 0.05). • There were no significant differences seen between fresh sperm (FTS and FES) and frozen sperm (FTTS and FTES) or between epididymal sperm (FES and FTES) and testicular sperm (FTS and FTTS) in any of the outcomes measured (P > 0.05). However, subset analysis showed a statistically higher FR and PR for FTTS over fresh sperm. • When comparing aetiologies, there was no significant difference in the FR, clinical PR and delivery rate between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) groups. However, sub-set analysis showed a higher PR and birth rate for FTTS over fresh sperm in both OA and NOA groups.
• The results of the present study suggest that using frozen sperm in ICSI cycles is a reliable and favourable method with the same outcome as fresh sperm. • Testicular and epididymal sperm have similar ICSI outcomes for both fresh and frozen samples. However, results suggest a tendency for higher PRs and birth rates for frozen than for fresh testicular sperm in both OA and NOA aetiologies. • The aetiology of azoospermia does not significantly affect the outcome of first-attempt ICSI. The higher rates in the frozen groups suggest that these patients have had better quality semen when they were initially harvested and frozen.
比较使用冷冻-解冻睾丸精子（FTTS）、新鲜睾丸精子（FTS）、冷冻-解冻附睾精子（FTES）和新鲜附睾精子（FES）进行首次胞浆内单精子注射（ICSI）-胚胎移植（ET）周期的结果，以确定哪种方法在受精率（FR）、妊娠率（PR）和出生率方面具有最成功的 ICSI 结果。
根据无精子症的潜在病因评估结果。
回顾性分析了 1993 年至 2008 年间进行的 493 例首次 ICSI 患者的记录。FTS 用于 112 个周期，FTTS 用于 43 个周期，FES 用于 279 个周期，FTES 用于 59 个周期。
在每个组中，根据病史、临床检查和组织学分析记录无精子症的病因（n=316）。
计算了每个组中使用的精子采集方法的 FR、临床 PR 和分娩率。
数据分析显示，在 FR、PR 或分娩率方面，四个组之间没有显著差异（P>0.05）。
在任何测量结果中，新鲜精子（FTS 和 FES）与冷冻精子（FTTS 和 FTES）之间或附睾精子（FES 和 FTES）与睾丸精子（FTS 和 FTTS）之间均无显著差异（P>0.05）。然而，亚组分析显示，FTTS 的 FR 和 PR 显著高于新鲜精子。
在比较病因时，梗阻性无精子症（OA）和非梗阻性无精子症（NOA）组的 FR、临床 PR 和分娩率无显著差异。然而，亚组分析显示，OA 和 NOA 组中，FTTS 的 PR 和出生率均高于新鲜精子。
本研究结果表明，在 ICSI 周期中使用冷冻精子是一种可靠且有利的方法，其结果与新鲜精子相同。
新鲜和冷冻样本中，睾丸和附睾精子的 ICSI 结果相似。然而，结果表明，OA 和 NOA 病因中，冷冻睾丸精子的 PR 和出生率均高于新鲜睾丸精子。
无精子症的病因并不显著影响首次 ICSI 的结果。冷冻组的较高比例表明，这些患者在最初采集和冷冻时精液质量较好。
