Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
Department of Urology, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
Fertil Steril. 2014 Mar;101(3):653-5. doi: 10.1016/j.fertnstert.2013.11.123. Epub 2014 Jan 11.
To evaluate the effect of male age on the outcome of microdissection testicular sperm extraction (micro-TESE) and assisted reproductive technology.
Clinical retrospective study.
Center for reproductive medicine at a tertiary university hospital.
PATIENT(S): One thousand sixty-seven men with nonobstructive azoospermia.
INTERVENTION(S): Micro-TESE, with intracytoplasmic sperm injection when sperm found.
MAIN OUTCOME MEASURE(S): Sperm retrieval and clinical pregnancy.
RESULT(S): Sperm were successfully retrieved by micro-TESE in 605 men (56.6%) overall. Sperm retrieval rates (SRRs) were higher in men ≥50 years old than men <50, (73% in men ≥50, 56% in men <50). Of the 44 men ≥50 years old, men who had successful micro-TESE had larger mean testis volume (20.8 cc vs. 12.5 cc), a higher frequency of hypospermatogenesis (5.6% vs. 0%), and a lower frequency of Sertoli cells only (12.5% vs. 80%) on diagnostic biopsy. Clinical pregnancy rates were lower in partners of men ≥50 than in partners of men <50 (48% in men <50, 25% in men ≥50). Lower pregnancy rates may be at least partially explained by older female partners for men ≥50 compared to men <50 (mean age 38.0 vs. 36.2 years). Sperm were successfully retrieved across all age groups, and there was no upper male age limit above which sperm could not be retrieved.
CONCLUSION(S): Overall, SRRs in men undergoing micro-TESE are not negatively affected by age. Despite successful sperm retrieval in older men with micro-TESE, couples have the best chance of clinical pregnancy with a female partner <35 years old. Some older men with azoospermia may have secondary azoospermia with hypospermatogenesis, explaining the high sperm retrieval rate.
评估男性年龄对微创睾丸精子提取（micro-TESE）和辅助生殖技术结局的影响。
临床回顾性研究。
三级大学医院生殖医学中心。
1067 名非梗阻性无精子症男性。
micro-TESE，发现精子时行卵胞浆内单精子注射。
精子获取和临床妊娠。
总体而言，605 名男性（56.6%）通过 micro-TESE 成功获取精子。≥50 岁男性的精子获取率（SRR）高于<50 岁男性（≥50 岁男性为 73%，<50 岁男性为 56%）。在≥50 岁的 44 名男性中，micro-TESE 成功的男性睾丸体积更大（20.8 cc 比 12.5 cc），少精症的发生率更高（5.6%比 0%），而唯支持细胞综合征的发生率更低（12.5%比 80%）。与<50 岁男性的配偶相比，≥50 岁男性的配偶临床妊娠率较低（<50 岁男性为 48%，≥50 岁男性为 25%）。≥50 岁男性的配偶年龄较大，可能至少部分解释了妊娠率较低的原因，与<50 岁男性相比，≥50 岁男性的配偶年龄更大（平均年龄 38.0 岁比 36.2 岁）。精子在所有年龄组中均被成功获取，而且不存在无法获取精子的男性年龄上限。
总体而言，micro-TESE 中男性的 SRR 不受年龄影响。尽管在年龄较大的男性中通过 micro-TESE 成功获取了精子，但对于女性伴侣<35 岁的夫妇，获得临床妊娠的机会最好。一些患有非梗阻性无精子症的老年男性可能患有继发性少精症伴少精症，这可以解释高精子获取率。
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