Kovac Jason R, Lehmann Kyle J, Fischer Marc Anthony
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, 77030, USA.
McMaster Institute of Urology, St. Joseph's Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
Urol Ann. 2014 Jan;6(1):41-5. doi: 10.4103/0974-7796.127026.
Obstructive azoospermia (OA) is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization (IVF) combined with PESA in cases of men with OA.
To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens.
The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years (2002-2010) were retrospectively reviewed. Patients requiring testicular intervention were excluded (n = 17).
Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients (78.4%) simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer (12.5%). Pregnancies were confirmed in 48.6% (17/35). Twin gestations occurred in 11.8% (2/17) of cases. Frozen-thawed spermatozoa were used in 11 patients (21.6%). In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% (6/11). No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens.
PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process.
梗阻性无精子症（OA）的特征是精子发生正常但射精中无精子。据报道，在OA男性患者中，体外受精（IVF）联合经皮附睾精子抽吸术（PESA）的成功率各不相同。
确定经PESA获取的精子的受精和妊娠结局，并确定冷冻精子与新鲜标本相比是否产生相似的结果。
回顾性分析了连续68对夫妇在8年（2002 - 2010年）内进行的68个OA精子采集周期的病历。排除需要睾丸干预的患者（n = 17）。
100%的男性中鉴定出有活力的精子，40例患者（78.4%）在取卵同时获得新鲜精子。平均受精率为77.7%，5个胚胎未存活至移植阶段（12.5%）。48.6%（17/35）的患者确认怀孕。11.8%（2/17）的病例发生双胎妊娠。11例患者（21.6%）使用了冻融精子。在该亚组中，平均受精率为73.6%，54.5%（6/11）的患者确认怀孕。未发生多胎妊娠，也未出现并发症。与冷冻标本相比，使用新鲜精子进行PESA在结局方面没有显著改善。
PESA是一种非常有效、简单且安全的获取用于IVF精子的方法。使用新鲜和冷冻的经PESA获取的精子所获得的结果相似，因此在IVF过程中两者均可使用。
