Abhyankar Nikita, Kathrins Martin, Niederberger Craig
Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
Division of Urology, Brigham and Women's Hospital, Boston, Massachusetts.
Fertil Steril. 2016 Jun;105(6):1469-1475.e1. doi: 10.1016/j.fertnstert.2016.02.013. Epub 2016 Feb 28.
To examine outcomes of intracytoplasmic sperm injection (ICSI) using testicular versus ejaculated sperm among men with cryptozoospermia.
Meta-analysis.
Not applicable.
PATIENT(S): Men with cryptozoospermia undergoing consecutive ICSI cycles using ejaculated or testicular sperm.
INTERVENTION(S): A systematic search was performed using PubMed (inception to August 2015). Inclusion criteria were studies comparing ICSI outcomes among men with cryptozoospermia using ejaculated and testicular sperm.
MAIN OUTCOME MEASURE(S): Primary outcomes included ICSI fertilization or pregnancy rates (PRs). Secondary analysis included number of retrieved oocytes, maternal and paternal ages. Meta-analysis of weighted data using a random effects model was performed. Results are reported as relative risk or weighted mean differences (WMD) with 95% confidence intervals (CI).
RESULT(S): Five cohort studies were included, encompassing 272 ICSI cycles and 4,596 injected oocytes. There were no differences in ICSI PRs (relative risk [RR] 0.53, 95% CI 0.19-1.42, I(2) = 67%) or fertilization rates (RR 0.91, 95% CI 0.78-1.06, I(2) = 73%) between testicular and ejaculated sperm groups. There was a significant trend toward increasing maternal age (WMD 1.69 years, 95% CI -2.71 to -0.66) and paternal age (WMD 2.61 years, 95% CI -4.73 to -0.48) with testicular sperm. There was no difference between numbers of oocytes retrieved (WMD 0.95, 95% CI -0.15 to 2.05). Post-hoc power analysis revealed pβ <20% for PR analysis and pβ <10% for fertilization rate analysis.
CONCLUSION(S): The existing literature does not support a recommendation for men with cryptozoospermia to use testicular sperm in preference over ejaculated sperm for ICSI.
探讨在隐匿性无精子症男性中，采用睾丸精子与射出精子进行卵胞浆内单精子注射（ICSI）的结局。
荟萃分析。
不适用。
接受连续ICSI周期治疗的隐匿性无精子症男性，分别使用射出精子或睾丸精子。
利用PubMed（建库至2015年8月）进行系统检索。纳入标准为比较隐匿性无精子症男性使用射出精子和睾丸精子的ICSI结局的研究。
主要结局包括ICSI受精率或妊娠率（PRs）。次要分析包括回收的卵母细胞数量、产妇和父亲年龄。采用随机效应模型对加权数据进行荟萃分析。结果以相对风险或加权平均差（WMD）及95%置信区间（CI）表示。
纳入5项队列研究，共272个ICSI周期和4596个注射卵母细胞。睾丸精子组与射出精子组在ICSI妊娠率（相对风险[RR] 0.53，95% CI 0.19 - 1.42，I² = 67%）或受精率（RR 0.91，95% CI 0.78 - 1.06，I² = 73%）方面无差异。使用睾丸精子时，产妇年龄（WMD 1.69岁，95% CI -2.71至-0.66）和父亲年龄（WMD 2.61岁，95% CI -4.73至-0.48）有显著增加趋势。回收的卵母细胞数量无差异（WMD 0.95，95% CI -0.15至2.05）。事后效能分析显示，PR分析的pβ<20%，受精率分析的pβ<10%。
现有文献不支持推荐隐匿性无精子症男性在ICSI中优先使用睾丸精子而非射出精子。
