Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri, United States of America.
PLoS One. 2013 Jul 29;8(7):e69838. doi: 10.1371/journal.pone.0069838. Print 2013.
Determine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation.
One hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm.
Successful sperm recovery defined as 1-2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n = 60), non-obstructive azoospermia (n = 39), cancer (n = 14), paralysis (n = 7) and other (n = 10). Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n = 22), vasectomy or failed vasectomy reversal (n = 37) and "other"(n = 1). Sperm recovery was also evaluated by surgical site including infertility clinic (n = 54), hospital operating room (n = 67) and physician's office (n = 11). Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm.
Testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p = <0.0001) compared to other male diagnoses (66%, p = <0.0001, 59% p = 0.015). No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p = 0.0371) compared to diagnoses of cancer, paralysis or other (16.7%). Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p = 0.007) compared to those with other diagnoses (44%).
Testicular sperm extraction is a safe and effective option regardless of the etiology of the azoospermia. The type of surgical center and/or its distance from the laboratory was not related to success. Men with non-obstructive azoospermia have a lower chance of successful sperm retrieval and fertilization.
确定睾丸精子提取和妊娠结局是否受男性和女性不孕诊断、手术中心位置以及冷冻保存时间的影响。
130 名接受睾丸精子提取的男性和 76 对接受 123 个睾丸精子体外受精周期的夫妇。
成功精子回收定义为 1-2 个精子/0.5ml，根据诊断包括梗阻性无精子症（n=60）、非梗阻性无精子症（n=39）、癌症（n=14）、瘫痪（n=7）和其他（n=10）。梗阻性无精子症分析为先天性输精管缺失（n=22）、输精管结扎或失败输精管再通（n=37）和“其他”（n=10）。还通过手术部位评估精子回收情况，包括不孕诊所（n=54）、医院手术室（n=67）和医生办公室（n=11）。根据男性诊断、女性诊断以及使用新鲜或冷冻保存的睾丸精子，评估治疗周期的卵母细胞数量、受精、胚胎质量、着床率和临床/持续妊娠情况。
所有诊断的无精子症男性的睾丸精子回收率较高（70%至 100%），除非梗阻性无精子症（31%）外，与手术中心到实验室的距离无关。体外受精后，非梗阻性无精子症的受精率明显较低（43%，p<0.0001），与其他男性诊断（66%，p<0.0001，59%，p=0.015）相比。男性诊断对临床妊娠率无差异，但梗阻性无精子症的每周期分娩率明显较高（38%，p=0.0371），与癌症、瘫痪或其他诊断（16.7%）相比。诊断为卵巢储备功能减退的女性的临床妊娠率降低（7.4%，p=0.007），与其他诊断（44%）相比。
无论无精子症的病因如何，睾丸精子提取都是一种安全有效的选择。手术中心的类型及其与实验室的距离与成功无关。非梗阻性无精子症男性成功精子回收和受精的机会较低。
