Pasqualotto Fabio F, Braga Daniela P A F, Figueira Rita C S, Setti Amanda S, Iaconelli Assumpto, Borges Edson
Fertility-Assisted Fertilization Center, Av Brigadeiro Luís Antônio, São Paulo, SP 01401-002, Brazil.
J Androl. 2012 Mar-Apr;33(2):239-43. doi: 10.2164/jandrol.110.011932. Epub 2011 Apr 7.
There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n = 79) and men who underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P = .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was in group 2 (2.5 ± 0.14; P = .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively; P = .138), sperm motility (38.2% ± 2.69% and 38.7% ± 2.08%, respectively; P = .881), and morphology according to Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%, respectively; P = .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2 (14.9 ± 1.04; P = .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P = .9806), implantation rates (22.1% vs 17.3%; P = .5882), or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.
文献中有许多研究表明，精索静脉曲张会导致后天性、明显渐进性的不育。事实上，精索静脉结扎术已成为最常施行的男性不育手术。诸如卵胞浆内单精子注射（ICSI）等辅助生殖技术对于患有与精索静脉曲张相关的男性因素不育的夫妇也很重要。因此，本研究的目的是评估精索静脉结扎术对精子质量和ICSI妊娠率的影响。对2000年至2008年间患有精索静脉曲张或曾接受过精索静脉结扎术并接受ICSI治疗的248例患者的数据进行了分析。患有精索静脉曲张的患者被分为两组：临床精索静脉曲张男性（第1组，n = 79）和在ICSI前接受过精索静脉结扎术的男性（第2组，n = 169）。在所有病例中，均未检测到女性不育。我们根据世界卫生组织和泰格堡严格标准评估并比较了两组的精液特征：女性伴侣的年龄；取卵数量；以及受精、着床、妊娠和流产率。我们使用威尔科克森符号秩检验或曼 - 惠特尼检验进行这些分析。第1组女性伴侣的年龄（33.0 ± 0.46岁）与第2组（33.8 ± 0.38岁；P = 0.1872）之间未检测到差异。第1组的精液量（3.3 ± 0.3 mL）高于第2组（2.5 ± 0.14；P = 0.0043）。第1组和第2组在精子浓度（分别为30.08 ± 4.01百万/mL和24.1 ± 2.42百万/mL；P = 0.138）、精子活力（分别为38.2% ± 2.69%和38.7% ± 2.08%；P = 0.881）以及根据泰格堡严格标准的形态学（分别为2.6% ± 0.44%和2.4% ± 0.37%；P = 0.7202）方面均未检测到差异。此外，第1组（14.8 ± 1.74）和第2组（14.9 ± 1.04；P = 0.9515）之间在取卵数量上也未检测到差异。第1组的受精率（73.2%）高于第2组（64.9%；P = 0.0377）；然而，第1组和第2组在妊娠率（31.1%对30.9%；P = 0.9806）、着床率（22.1%对17.3%；P = 0.5882）或流产率（21.7%对23.9%；P = 0.8401）方面均未检测到差异。尽管在进行辅助生殖之前应始终施行精索静脉结扎术，但该手术并不会提高ICSI后的妊娠率或降低流产率。
