Hendriks S, Hessel M, Mochtar M H, Meissner A, van der Veen F, Repping S, Dancet E A F
Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
Hum Reprod. 2016 Aug;31(8):1738-48. doi: 10.1093/humrep/dew095. Epub 2016 Apr 29.
Would couples diagnosed with non-obstructive azoospermia (NOA) consider two future treatments with artificial gametes (AGs) as alternatives for testicular sperm extraction followed by ICSI (TESE-ICSI)?
Most couples with NOA (89%) would opt for treatment with AGs before attempting TESE-ICSI and/or after failed TESE-ICSI.
Couples with NOA who undergo TESE-ICSI have a 25% chance of conceiving a child. Two future treatments that are being developed are 'ICSI with artificial sperm formed from somatic cells' (ICSI with AGs) and 'natural conception after autotransplantation of in vitro proliferated spermatogonial stem cells' (natural conception with AGs). It is unknown what treatment preferences patients have.
STUDY DESIGN, SIZE, DURATION: A cross-sectional survey conducted in 2012-2013, addressing all 921 couples diagnosed with NOA and treated with TESE-ICSI in Dutch fertility clinics between 2007 and 2012. The coded questionnaires were sent by mail and followed up with two reminders.
PARTICIPANTS/MATERIALS, SETTING, METHODS: We developed the questionnaire based on a literature review and previous qualitative interviews, and included treatment preference and the valuation of nine treatment characteristics. We assessed reliability of the questionnaires and calculated mean importance scores (MISs: 0-10) of each treatment characteristic. We assessed which patient and treatment characteristics were associated with a couple's hypothetical treatment preference using binominal regression.
The vast majority (89%) of the 494 responding couples (response rate: 54%) would potentially opt for AGs as a first and/or a last resort treatment option. More specifically, as a first treatment couples were likely (67%) to prefer natural conception with AGs over TESE-ICSI and less likely to prefer ICSI with AGs over TESE-ICSI (34%). After failed TESE-ICSI, the majority of couples (75%) would want to attempt ICSI with AGs as a last resort option. The most important characteristics of treatment were safety for children (MIS: 8.2), pregnancy rates (MIS: 7.7) and curing infertility (MIS: 6.8). Costs, burden, naturalness and technological sophistication were of about equal importance (MIS: 3.1-4.0). The majority of patients rated conception at home and moral acceptability as not important (MIS: 1.7 and 0.8, respectively), but the importance attributed to these variables did still affect patients' likeliness to opt for AGs.
Couples with NOA not opting for TESE-ICSI were not included and might have other perspectives. Couples' hypothetical choices for AGs might differ from their actual choices once data on the costs, safety and pregnancy rates become available from these new treatment options.
The interest of couples with NOA in potential future treatments with AGs encourages further pre-clinical research. Priority setting for research and future decision-making on clinical application of AGs should take all characteristics important to patients into account.
STUDY FUNDING/COMPETING INTERESTS: The authors report no financial or other conflict of interest relevant to the subject of this article.
被诊断为非梗阻性无精子症（NOA）的夫妇会将未来两种人工配子（AGs）治疗视为睾丸精子提取后行卵胞浆内单精子注射（TESE - ICSI）的替代方案吗？
大多数NOA夫妇（89%）会在尝试TESE - ICSI之前和/或TESE - ICSI失败后选择AGs治疗。
接受TESE - ICSI的NOA夫妇有25%的几率受孕。正在研发的两种未来治疗方法分别是“利用体细胞形成的人工精子进行ICSI”（利用AGs进行ICSI）和“体外增殖的精原干细胞自体移植后自然受孕”（利用AGs自然受孕）。患者的治疗偏好尚不清楚。
研究设计、规模、持续时间：2012 - 2013年进行的一项横断面调查，对象为2007年至2012年期间在荷兰生育诊所被诊断为NOA并接受TESE - ICSI治疗的所有921对夫妇。编码问卷通过邮件发送，并跟进两次提醒。
参与者/材料、环境、方法：我们基于文献综述和之前的定性访谈制定了问卷，包括治疗偏好和对九种治疗特征的评估。我们评估了问卷的信度，并计算了每种治疗特征的平均重要性得分（MISs：0 - 10）。我们使用二项回归评估了哪些患者和治疗特征与夫妇的假设治疗偏好相关。
494对回复夫妇（回复率：54%）中的绝大多数（89%）可能会将AGs作为首选和/或最后手段的治疗选择。更具体地说，作为首选治疗，夫妇们可能（67%）更倾向于利用AGs自然受孕而非TESE - ICSI，而更倾向于利用AGs进行ICSI而非TESE - ICSI的可能性较小（34%）。TESE - ICSI失败后，大多数夫妇（75%）会希望尝试将利用AGs进行ICSI作为最后手段。治疗的最重要特征是对孩子的安全性（MIS：8.2）、妊娠率（MIS：7.7）和治愈不孕症（MIS：6.8）。成本、负担、自然性和技术复杂性的重要性大致相同（MIS：3.1 - 4.0）。大多数患者认为在家受孕和道德可接受性不重要（MIS分别为1.7和0.8），但这些变量的重要性确实仍会影响患者选择AGs的可能性。
未纳入未选择TESE - ICSI的NOA夫妇，他们可能有其他观点。一旦这些新治疗方案的成本、安全性和妊娠率数据可用，夫妇们对AGs的假设选择可能与实际选择不同。
NOA夫妇对未来可能的AGs治疗的兴趣鼓励了进一步的临床前研究。AGs临床应用的研究优先级设定和未来决策应考虑对患者重要的所有特征。
研究资金/利益冲突：作者报告与本文主题无关的任何财务或其他利益冲突。
