手术获取精子用于辅助生殖技术：2004-2015 年美国的趋势和围产期结局。
Surgically acquired sperm use for assisted reproductive technology: trends and perinatal outcomes, USA, 2004-2015.
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 550 Peachtree Street, Suite 1800, Atlanta, GA, 30308, USA.
出版信息
J Assist Reprod Genet. 2018 Jul;35(7):1229-1237. doi: 10.1007/s10815-018-1178-5. Epub 2018 Apr 26.
PURPOSE
To compare national trends and perinatal outcomes following the use of ejaculated versus surgically acquired sperm among IVF cycles with male factor infertility.
METHODS
This retrospective cohort includes US fertility clinics reporting to the National ART Surveillance System between 2004 and 2015. Fresh, non-donor IVF male factor cycles (n = 369,426 cycles) were included. We report the following outcomes: (1) Trends in surgically acquired and ejaculated sperm. (2) Adjusted risk ratios comparing outcomes for intracytoplasmic sperm injection (ICSI) cycles using surgically acquired (epididymal or testicular) versus ejaculated sperm. (3) Outcomes per non-canceled cycle: biochemical pregnancy, intrauterine pregnancy, and live birth (≥ 20 weeks). (4) Outcomes per pregnancy: miscarriage (< 20 weeks) and singleton pregnancy. (5) Outcomes per singleton pregnancy: normal birthweight (≥ 2500 g) and full-term delivery (≥ 37 weeks).
RESULTS
Percentage of male factor infertility cycles that used surgically acquired sperm increased over the study period, 9.8 (2004) to 11.6% (2015), p < 0.05. The proportion of cycles using testicular sperm increased significantly over the study period, 4.9 (2004) to 6.5% (2015), p < 0.05. Among fresh, non-donor male factor ART cycles which used ICSI (n = 347,078 cycles), cycle, pregnancy, and perinatal outcomes were statistically significant but clinically similar with confidence intervals approaching one between cycles involving epididymal versus ejaculated sperm and between testicular versus ejaculated sperm. Results were similar among cycles with a sole diagnosis of male factor (no female factors), and for the subset in which the female partner was < 35 years old.
CONCLUSION
Among couples undergoing ART for treatment of male factor infertility, pregnancy and perinatal outcomes were similar between cycles utilizing ejaculated sperm or surgically acquired testicular and epididymal sperm.
目的
比较在男性因素不育的体外受精（IVF）周期中，使用射出精子与通过手术获得的精子后，全国范围内的趋势和围产期结局。
方法
本回顾性队列纳入了 2004 年至 2015 年间向国家 ART 监测系统报告的美国生育诊所。纳入新鲜的、非供体 IVF 男性因素周期（n=369426 个周期）。我们报告以下结果：（1）通过手术获得的精子和射出精子的趋势。（2）比较使用通过手术获得的（附睾或睾丸）精子与射出精子的 ICSI 周期的结局的调整风险比。（3）每非取消周期的结局：生化妊娠、宫内妊娠和活产（≥20 周）。（4）每妊娠的结局：流产（<20 周）和单胎妊娠。（5）每单胎妊娠的结局：正常出生体重（≥2500g）和足月分娩（≥37 周）。
结果
在研究期间，使用通过手术获得的精子的男性因素不育周期的百分比从 9.8%（2004 年）增加到 11.6%（2015 年），p<0.05。使用睾丸精子的周期比例在研究期间显著增加，从 4.9%（2004 年）增加到 6.5%（2015 年），p<0.05。在新鲜的、非供体男性因素 ART 周期中使用 ICSI 的周期（n=347078 个周期）中，周期、妊娠和围产期结局具有统计学意义，但置信区间接近 1，在涉及附睾精子与射出精子的周期之间，以及在睾丸精子与射出精子的周期之间，结果相似。在仅诊断为男性因素（无女性因素）的周期中，以及在女性伴侣年龄<35 岁的亚组中，结果相似。
结论
在接受 ART 治疗男性因素不育的夫妇中，使用射出精子或通过手术获得的睾丸和附睾精子的周期，妊娠和围产期结局相似。
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