采用睾丸精子行 ICSI 治疗在非严重少弱精子症且既往 ICSI 失败和无活产史的复发不孕患者中的结局。

ICSI outcomes using testicular spermatozoa in non-azoospermic couples with recurrent ICSI failure and no previous live births.

机构信息

MUHC Reproductive Centre, McGill University Health Centre, Montreal, QC, Canada.

The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.

出版信息

Andrology. 2019 May;7(3):281-287. doi: 10.1111/andr.12591. Epub 2019 Feb 7.

DOI:10.1111/andr.12591

PMID:30734539

Abstract

BACKGROUND

The use of testicular over ejaculated spermatozoa for ICSI has been presented as an alternative to overcome infertility in men with poor semen parameters or high levels of sperm DNA fragmentation.

OBJECTIVE

To evaluate the efficacy of testicular ICSI outcomes in couples with no previous live birth and recurrent ICSI failure using ejaculated spermatozoa by comparison to the outcomes of couples with similar history of recurrent ICSI using ejaculated spermatozoa only.

MATERIALS AND METHODS

A total of 145 couples undergoing ejaculated or testicular ICSI cycles with no previous live births and with at least two previous failed ICSI cycles with ejaculated spermatozoa were evaluated retrospectively. ICSI was performed either with ejaculated (E-ICSI) or with testicular (T-ICSI) spermatozoa. Semen parameters and sperm DNA quality were assessed prior to the oocyte collection day. Primary outcomes included cumulative live birth and pregnancy rates. Secondary analysis included percentage of DNA fragmentation in ejaculated spermatozoa (SCSA and TUNEL).

RESULTS

Patients undergoing T-ICSI (n = 77) had a significantly higher clinical pregnancy rate/fresh embryo transfer (ET) (27.9%; 17/61) and cumulative live birth rate (23.4%; 15/64) compared to patients using E-ICSI (n = 68) (clinical pregnancy rate/fresh ET: 10%; 6/60 and cumulative live birth rate: 11.4%; 7/61). Further, T-ICSI yield significantly better cumulative live birth rates than E-ICSI for men with high TUNEL (≥36%) (T-ICSI: 20%; 3/15 vs. E-ICSI: 0%; 0/7, p < 0.025), high SCSA (≥25%) scores (T-ICSI: 21.7%; 5/23 vs. E-ICSI: 9.1%; 1/11, p < 0.01), or abnormal semen parameters (T-ICSI: 28%; 7/25 vs. E-ICSI: 6.7%; 1/15, p < 0.01).

CONCLUSIONS

The use of testicular spermatozoa for ICSI in non-azoospermic couples with no previous live births, recurrent ICSI failure, and high sperm DNA fragmentation yields significantly better live birth outcomes than a separate cohort of couples with similar history of ICSI failure entering a new ICSI cycle with ejaculated spermatozoa.

摘要

背景

使用睾丸中已射出精液之外的精子进行 ICSI 已被提出作为一种替代方法，以克服精液参数差或精子 DNA 碎片化程度高的男性的不育问题。

目的

通过比较既往仅使用射出精液进行 ICSI 后反复失败的具有相似病史的夫妇的结果，评估既往无活产且反复 ICSI 失败的夫妇中使用睾丸 ICSI 的结果。

材料和方法

对 145 对既往无活产且至少有 2 次既往使用射出精液进行 ICSI 后反复失败的夫妇进行回顾性分析。ICSI 分别采用射出精液（E-ICSI）或睾丸（T-ICSI）精子进行。在卵母细胞采集日之前评估精液参数和精子 DNA 质量。主要结局包括累积活产率和妊娠率。二次分析包括射出精液中 DNA 碎片化的百分比（SCSA 和 TUNEL）。

结果

接受 T-ICSI（n=77）的患者临床妊娠率/新鲜胚胎移植（ET）（27.9%；17/61）和累积活产率（23.4%；15/64）明显高于接受 E-ICSI（n=68）的患者（临床妊娠率/新鲜 ET：10%；6/60 和累积活产率：11.4%；7/61）。此外，对于 TUNEL 水平较高（≥36%）（T-ICSI：20%；3/15 vs. E-ICSI：0%；0/7，p<0.025）、SCSA 评分较高（≥25%）（T-ICSI：21.7%；5/23 vs. E-ICSI：9.1%；1/11，p<0.01）或精液参数异常（T-ICSI：28%；7/25 vs. E-ICSI：6.7%；1/15，p<0.01）的患者，T-ICSI 的累积活产率明显优于 E-ICSI。