严重的睾丸萎缩并不影响显微镜下睾丸精子提取的成功率。
Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction.
机构信息
Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
出版信息
J Urol. 2014 Jan;191(1):175-8. doi: 10.1016/j.juro.2013.07.065. Epub 2013 Aug 1.
PURPOSE
Men with azoospermia and severe testicular atrophy may be counseled to avoid sperm retrieval due to perceived limited success. We evaluated the outcomes of microdissection testicular sperm extraction in men with severe testicular atrophy (volume 2 ml or less).
MATERIALS AND METHODS
We reviewed the records of 1,127 men with nonobstructive azoospermia who underwent microdissection testicular sperm extraction followed by intracytoplasmic sperm injection. They were classified into 3 groups based on average testicular volume, including 2 ml or less, greater than 2 to less than 10 and 10 or greater. Sperm retrieval, clinical pregnancy and live birth rates were calculated. Clinical features evaluated included age, follicle-stimulating hormone level, cryptorchidism history, Klinefelter syndrome, varicocele and testicular histology on diagnostic biopsy.
RESULTS
Testicular sperm were successfully retrieved in 56% of the men. The sperm retrieval rate in those with a testicular volume of 2 ml or less, greater than 2 to less than 10 and 10 or greater was 55%, 56% and 55%, respectively. Clinical pregnancy and live birth rates were similar in men in the 3 groups who underwent sperm retrieval (55.2%, 50.0% and 47.0%, and 47.2%, 43.0% and 42.2%, respectively). Of the 106 men with an average testis volume of 2 ml or less those from whom sperm were retrieved were younger (31.1 vs 35.2 years) and more likely to have a history of Klinefelter syndrome (82.2% vs 55.6%) than men in whom sperm were not found (p <0.05). Men in this group had a higher prevalence of Klinefelter syndrome than men with a testis volume of greater than 2 ml (72.6% vs 5.3%, p <0.0001). Men younger than 30 years with Klinefelter syndrome had a higher sperm retrieval rate than men older than 30 years without Klinefelter syndrome (81.8% vs 33%, p <0.01). There was no cutoff point for age beyond which sperm could not be retrieved in men with small testes. On multivariable analysis younger age was the only preoperative factor associated with successful sperm retrieval in men with small testes (2 ml or less).
CONCLUSIONS
Testicular volume does not affect the sperm retrieval rate at our center for microdissection testicular sperm extraction. Of men with the smallest volume testes those who were younger with Klinefelter syndrome had the highest sperm retrieval rate. Severe testicular atrophy should not be a contraindication to microdissection testicular sperm extraction.
目的
由于认为成功几率有限，无精子症和严重睾丸萎缩的男性可能会被建议避免精子提取。我们评估了严重睾丸萎缩（体积 2 毫升或以下）男性进行微切割睾丸精子提取后的结果。
材料和方法
我们回顾了 1127 名非梗阻性无精子症男性的记录，他们接受了微切割睾丸精子提取，随后进行了胞浆内精子注射。根据平均睾丸体积将他们分为 3 组，包括 2 毫升或以下、大于 2 至小于 10 和 10 或更大。计算精子提取、临床妊娠和活产率。评估的临床特征包括年龄、卵泡刺激素水平、隐睾病史、克氏综合征、精索静脉曲张和诊断性活检的睾丸组织学。
结果
56%的男性成功提取了精子。睾丸体积为 2 毫升或以下、大于 2 至小于 10 和 10 或更大的男性的精子提取率分别为 55%、56%和 55%。在接受精子提取的 3 组中，临床妊娠率和活产率相似（55.2%、50.0%和 47.0%，47.2%、43.0%和 42.2%）。在平均睾丸体积为 2 毫升或以下的 106 名男性中，那些能提取精子的男性比那些不能提取精子的男性更年轻（31.1 岁 vs 35.2 岁），更有可能患有克氏综合征（82.2% vs 55.6%）（p<0.05）。该组男性的克氏综合征患病率高于睾丸体积大于 2 毫升的男性（72.6% vs 5.3%，p<0.0001）。年龄小于 30 岁且患有克氏综合征的男性的精子提取率高于年龄大于 30 岁且未患克氏综合征的男性（81.8% vs 33%，p<0.01）。在睾丸体积较小的男性中，没有年龄的截止点表明无法提取精子。多变量分析显示，在睾丸体积较小的男性中，年龄是与精子提取成功相关的唯一术前因素（2 毫升或以下）。
结论
在我们的中心，睾丸体积不会影响微切割睾丸精子提取的精子提取率。在睾丸体积最小的男性中，年龄较轻且患有克氏综合征的男性精子提取率最高。严重睾丸萎缩不应成为微切割睾丸精子提取的禁忌症。
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