梗阻性间隔时间预测了接受手术精子获取的输精管结扎后患者行 ICSI 的妊娠率。

The obstructive interval predicts pregnancy rates in post-vasectomy patients undergoing ICSI with surgical sperm retrieval.

机构信息

Fertility Medical Group, Av. Brigadeiro Luis Antônio, 4545, Jardim Paulista, São Paulo, SP 01401-002, Brazil; Instituto Sapientiae - Centro de Estudos e Pesquisa em Reprodução Assistida, Rua Vieira Maciel, 62, São Paulo, SP 04203-040, Brazil.

出版信息

Reprod Biomed Online. 2019 Jul;39(1):134-140. doi: 10.1016/j.rbmo.2019.02.002. Epub 2019 Feb 27.

DOI:10.1016/j.rbmo.2019.02.002

PMID:31097323

Abstract

RESEARCH QUESTION

Are the outcomes of (i) surgical sperm retrieval (SSR) and (ii) intracytoplasmic sperm injection (ICSI) influenced by the obstructive interval (time elapsed since vasectomy)?

DESIGN

Medical records from 148 patients (194 cycles) with secondary azoospermia due to vasectomy, who presented for percutaneous epididymal sperm aspiration (PESA) and ICSI in a private university-affiliated IVF centre, from January 2012 to February 2017, were analysed in this historical cohort study. The obstructive interval was recorded for each couple, and its influences on the outcomes of SSR and ICSI treatment were investigated using general mixed models with adjustment for potential confounders. Clinical pregnancy rate was the main outcome measure.

RESULTS

The obstructive interval was negatively correlated with the presence of spermatozoa (β = -0.032, P = 0.009) and motile spermatozoa (β = -0.031, P = 0.010) during PESA. The need to convert to testicular sperm aspiration was significantly influenced by the obstructive interval (β = 0.012, P = 0.003). The blastocyst development rate on day 5 was inversely correlated with the obstructive interval (β = -0.011, P = 0.014). Implantation and clinical pregnancy rates were negatively influenced by the obstructive interval (β = -1.107, P = 0.039 and β = -0.016, P = 0.031, respectively). The receiver operating characteristic curve analysis demonstrated that the obstructive interval has a predictive value on the achievement of clinical pregnancy (area under the curve = 0.667, P = 0.001, Youden index 0.3385, associated criterion >17 years).

CONCLUSIONS

Men undertaking vasectomy should be made aware of the long-term effects and their implications for future reproductive treatment.

摘要

研究问题

（i）手术取精（SSR）和（ii）胞浆内单精子注射（ICSI）的结果是否受梗阻间隔（输精管结扎后至行经皮附睾精子抽吸术[PESA]和 ICSI 的时间）的影响？

设计

对 2012 年 1 月至 2017 年 2 月期间在一所私立大学附属 IVF 中心因输精管结扎后出现继发性无精子症而就诊行 PESA 和 ICSI 的 148 名患者（194 个周期）的病历进行了这项历史队列研究。记录了每对夫妇的梗阻间隔，并使用具有潜在混杂因素调整的一般混合模型来研究其对 SSR 和 ICSI 治疗结果的影响。主要结局指标为临床妊娠率。

结果

梗阻间隔与 PESA 中精子（β= -0.032，P= 0.009）和活动精子（β= -0.031，P= 0.010）的存在呈负相关。需要转换为睾丸精子抽吸术与梗阻间隔显著相关（β= 0.012，P= 0.003）。第 5 天的囊胚发育率与梗阻间隔呈负相关（β= -0.011，P= 0.014）。着床率和临床妊娠率受到梗阻间隔的负面影响（β= -1.107，P= 0.039 和β= -0.016，P= 0.031）。受试者工作特征曲线分析表明，梗阻间隔对临床妊娠的获得具有预测价值（曲线下面积= 0.667，P= 0.001，Youden 指数 0.3385，相关标准>17 岁）。