Erdem E, Karacan M, Usta A, Arvas A, Cebi Z, Camlibel T
Department of Urology, Ota-Jinemed Hospital, Istanbul, Turkey.
Assisted Reproduction Unit, Ota-Jinemed Hospital, Istanbul, Turkey.
J Gynecol Obstet Hum Reprod. 2017 May;46(5):405-410. doi: 10.1016/j.jogoh.2017.03.009. Epub 2017 Mar 31.
To determine the relationship between AFC, basal FSH level, woman's age, the number of oocytes retrieved and the outcome of ICSI with testicular spermatozoa obtained with microscopically assisted testicular sperm extraction.
In this retrospective cohort study, a total of 340 couples who underwent ICSI treatment with testicular sperm were enrolled. Women aged?40years and the first cycles of couples were included. ICSI was performed with motile testicular spermatozoa obtained from 89 men with obstructive azoospermia and 251 men with nonobstructive azoospermia. GnRH-antagonist protocol was used for ovulation induction. Simple linear regression was carried out to analyze relationship between the AFC, basal FSH, woman's age, the number of oocytes, and the live birth rate (LBR). Receiver operator characteristic curves (ROC) were formed to detect cut-off values below which LBR was significantly decreased. ROC curve analysis demonstrated that the cut-off level of the number of oocytes retrieved to predict the LBR was 7. According to this cut-off level, all patients were divided into two groups. Women with retrieved<7 oocytes were included in Group 1 and women with retrieved?7 oocytes were included in Group 2.
The mean age of men was 35.1±4.9years. The mean age, mean FSH level and mean AFC of women were 32.1±4.9years, 6.9±2.7 IU/L, 7.6±3.4, respectively. Significant correlations were found between AFC, the number of oocytes retrieved, and the LBR per ICSI cycle with testicular spermatozoa. The LBR was significantly lower in women with AFC<8 than those with AFC?8. Independently, the LBR was significantly lower in cycles with<7 oocytes retrieved compared to those with ?7. Embryo transfer was not achieved in 37 cycles with<7 oocytes (37/167, 22.1%) and 18 cycles with?7 (18/173, 10.4%) because of the absence of transfer-quality embryos (P=0.005). The LBRs were the lowest in cycles with one or two oocytes available (8.3 and 8.3%, respectively), but these rates were not statistically different than those in cycles with 3, 4, 5 and 6 oocytes (14.2, 17.2, 18.5, 17.6%, respectively, P=0.810).
AFC and the number of oocytes retrieved are important prognostic factors in an ICSI cycle with testicular sperm in women ?40years, yielding significantly diminished LBRs with<8 antral follicles and/or<7 oocytes retrieved.
确定卵泡刺激素（FSH）水平、女性年龄、获取的卵母细胞数量与经显微镜辅助睾丸精子提取获得的睾丸精子胞浆内单精子注射（ICSI）结局之间的关系。
在这项回顾性队列研究中，共纳入340对接受睾丸精子ICSI治疗的夫妇。纳入年龄≤40岁的女性及夫妇的首个周期。对89例梗阻性无精子症男性和251例非梗阻性无精子症男性获取的活动睾丸精子进行ICSI。采用促性腺激素释放激素（GnRH）拮抗剂方案进行促排卵。进行简单线性回归分析，以分析窦卵泡计数（AFC）、基础FSH、女性年龄、卵母细胞数量与活产率（LBR）之间的关系。绘制受试者工作特征曲线（ROC）以检测低于该值LBR显著降低的临界值。ROC曲线分析表明，预测LBR的获取卵母细胞数量的临界水平为7。根据该临界水平，将所有患者分为两组。获取卵母细胞<7个的女性纳入第1组，获取卵母细胞≥7个的女性纳入第2组。
男性的平均年龄为35.1±4.9岁。女性的平均年龄、平均FSH水平和平均AFC分别为32.1±4.9岁、6.9±2.7 IU/L、7.6±3.4。发现AFC、获取的卵母细胞数量与每个使用睾丸精子的ICSI周期的LBR之间存在显著相关性。AFC<8的女性的LBR显著低于AFC≥8的女性。独立来看，获取卵母细胞<7个的周期的LBR显著低于获取卵母细胞≥7个的周期。由于缺乏可用于移植的胚胎，167个获取卵母细胞<7个的周期中有37个（37/167，22.1%）以及173个获取卵母细胞≥7个的周期中有18个（18/173，10.4%）未实现胚胎移植（P=0.005）。有1个或2个可用卵母细胞的周期的LBR最低（分别为8.3%和8.3%），但这些比率与有3、4、5和6个卵母细胞的周期的LBR（分别为14.2%、17.2%、18.5%、17.6%）相比无统计学差异（P=0.810）。
在年龄≤40岁的女性进行的使用睾丸精子的ICSI周期中，AFC和获取的卵母细胞数量是重要的预后因素，当窦卵泡<8个和/或获取的卵母细胞<7个时，LBR会显著降低。
