Zhan Xu-Xin, Wan Chang-Chun, Li Hai-Bo, Gou Jiang, Cai Hong-Cai, Zhao Jing, Yan Chun-Fang, Diao Zhen-Yu, Shang Xue-Jun
Department of Reproductive Medicine, Xi'an No.4 Hospital, Xi'an, Shaanxi 710004, China.
Center of Laboratory Medicine， Jinhu County People's Hospital, Jinhu, Jiangsu 211600, China.
Zhonghua Nan Ke Xue. 2016 Dec;22(12):1122-1130.
To assess the effects of testicular sperm and epididymal sperm on the outcomes of ICSI for patients with obstructive azoospermia.
We searched PubMed, MEDLINE, EMBASE, Cochrane, CNKI, VIP, CBM, and Wanfang Database up to December 2015 for published literature relevant to ICSI with testicular or epididymal sperm for obstructive azoospermia patients. According to the inclusion and exclusion criteria, two reviewers independently conducted literature screening, data extraction and quality assessment of the included trials, followed by meta-analysis with the RevMan 5.3 software.
A total of 14 studies were identified, involving 1 278 patients and 1 553 ICSI cycles. ICSI with epididymal sperm exhibited a significantly higher fertilization rate than that with testicular sperm (RR = 1.08, 95% CI 1.05－1.11, P<0.01). No statistically significant differences were observed between the epididymal and testicular sperm groups in the rates of cleavage (RR = 1.04, 95% CI 0.99－1.10, P = 0.13), good-quality embryo (RR = 1.01, 95% CI 0.93－1.09,P = 0.85), implantation (RR = 1.14, 95% CI 0.75－1.73, P = 0.55), clinical pregnancy (RR = 1.14, 95% CI 0.98－1.31, P = 0.08), and miscarriage (RR = 0.86, 95% CI 0.53－1.39,P = 0.54).
ICSI with epididymal sperm yields a markedly higher fertilization rate than that with testicular sperm, but has no statistically significant differences from the latter in the rates of cleavage, good-quality embryo, implantation, clinical pregnancy, and miscarriage in the treatment of obstructive azoospermia.
评估睾丸精子和附睾精子对梗阻性无精子症患者卵胞浆内单精子注射（ICSI）结局的影响。
检索截至2015年12月的PubMed、MEDLINE、EMBASE、Cochrane、中国知网（CNKI）、维普资讯（VIP）、中国生物医学文献数据库（CBM）和万方数据库，查找与梗阻性无精子症患者采用睾丸或附睾精子进行ICSI相关的已发表文献。根据纳入和排除标准，两名研究者独立进行文献筛选、数据提取及对纳入试验的质量评估，随后使用RevMan 5.3软件进行荟萃分析。
共纳入14项研究，涉及1278例患者和1553个ICSI周期。附睾精子ICSI的受精率显著高于睾丸精子ICSI（RR = 1.08，95%CI 1.05－1.11，P<0.01）。附睾精子组和睾丸精子组在卵裂率（RR = 1.04，95%CI 0.99－1.10，P = 0.13）、优质胚胎率（RR = 1.01，95%CI 0.93－1.09，P = 0.85）、种植率（RR = 1.14，95%CI 0.75－1.73，P = 0.55）、临床妊娠率（RR = 1.14，95%CI 0.98－1.31，P = 0.08）及流产率（RR = 0.86，95%CI 0.53－1.39，P = 0.54）方面未观察到统计学显著差异。
梗阻性无精子症治疗中，附睾精子ICSI的受精率明显高于睾丸精子ICSI，但在卵裂率、优质胚胎率、种植率、临床妊娠率及流产率方面与后者无统计学显著差异。
