Al-Malki A H, Alrabeeah K, Mondou E, Brochu-Lafontaine V, Phillips S, Zini A
Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.
OVO Fertility Clinic, Montreal, QC, Canada.
Andrology. 2017 Mar;5(2):226-231. doi: 10.1111/andr.12317. Epub 2017 Feb 10.
The aim of the study was to evaluate reproductive outcomes in a cohort of infertile couples with severe and complete asthenozoospermia undergoing TESA (testicular sperm aspiration) with ICSI. We conducted a retrospective study of 28 couples with complete or severe asthenozoospermia who underwent TESA between January 2010 and December 2015. We compared TESA-ICSI outcomes of these couples to ejaculate ICSI outcomes of 40 couples with severe asthenozoospermia treated during the same time period at our institution. Couples with female factor infertility and/or female aged ≥39 were excluded. Sperm retrieval rates and ICSI outcomes [(MII oocytes, fertilization rate, good embryo rate (transferred and frozen), couples with embryo transfer (per cycle started), clinical pregnancy (per embryo transfer)] were recorded. Patients were grouped based on whether they had ejaculated (Ej-group) or testicular (TESA-group) spermatozoa used. Testicular sperm patients were further classified based on whether they had complete asthenozoospermia (0% total motility) (Tc-group) or severe asthenozoospermia (≤1% progressive motility) (Ts-group). Mean (±SD) male and female ages were 36 ± 6 and 32 ± 4, respectively. Sperm recovery by testicular sperm aspiration (TESA) was successful in 100% (28/28) of the men. The overall clinical pregnancy rate (CPR) per cycle started was 34% (23/68) with a mean of 1.1 ± 0.4 embryos transferred per transfer. Fertilization rates were significantly lower in TESA-group compared to Ej-group (52% vs. 67%, respectively; p = 0.001), while male age was significantly higher in TESA-group compared to Ej-group (34 ± 6 vs. 37 ± 6, respectively; p = 0.03). Moreover, female age was significantly higher in Tc-group compared to Ts-group (30 ± 4 vs. 33 ± 3, respectively; p = 0.0285). However, there were no significant difference in clinical pregnancy rate per embryo transfer in the Tc-group, Ts-group, and Ej-group (50% vs. 45% vs. 57%, respectively; p = 0.8219). The data suggest that testicular sperm-ICSI is no better than ejaculated sperm-ICSI in couples with severe or complete asthenozoospermia. Randomized, controlled trials comparing ejaculated vs. testicular spermatozoa are needed to assess the true benefit of TESA-ICSI in these couples.
本研究的目的是评估一组患有严重和完全无精子症的不育夫妇在接受睾丸精子抽吸术（TESA）联合卵胞浆内单精子注射（ICSI）后的生殖结局。我们对2010年1月至2015年12月期间接受TESA的28对患有完全或严重无精子症的夫妇进行了一项回顾性研究。我们将这些夫妇的TESA-ICSI结局与同期在我们机构接受治疗的40对患有严重无精子症夫妇通过射精精子进行ICSI的结局进行了比较。排除有女性因素不孕症和/或女性年龄≥39岁的夫妇。记录精子获取率和ICSI结局[（MII期卵母细胞、受精率、优质胚胎率（移植和冷冻）、进行胚胎移植的夫妇（每个开始周期）、临床妊娠（每次胚胎移植）]。根据患者使用的是射精精子（Ej组）还是睾丸精子（TESA组）进行分组。睾丸精子患者进一步根据是否患有完全无精子症（总活力0%）（Tc组）或严重无精子症（进行性活力≤1%）（Ts组）进行分类。男性和女性的平均（±标准差）年龄分别为36±6岁和32±4岁。通过睾丸精子抽吸术（TESA）成功获取精子的男性比例为100%（28/28）。每个开始周期的总体临床妊娠率（CPR）为34%（23/68），每次移植平均移植1.1±0.4个胚胎。与Ej组相比，TESA组的受精率显著较低（分别为52%和67%；p = 0.001），而与Ej组相比，TESA组的男性年龄显著较高（分别为34±6岁和37±6岁；p = 0.03）。此外，与Ts组相比，Tc组的女性年龄显著较高（分别为30±4岁和33±3岁；p = 0.0285）。然而，Tc组、Ts组和Ej组每次胚胎移植的临床妊娠率无显著差异（分别为50%、45%和57%；p = 0.8219）。数据表明，在患有严重或完全无精子症的夫妇中，睾丸精子ICSI并不优于射精精子ICSI。需要进行比较射精精子与睾丸精子的随机对照试验，以评估TESA-ICSI在这些夫妇中的真正益处。
