Berger Alexandra Joice, Raup Valary, Abou Ghayda Ramy, Lanes Andrea, Kathrins Martin
Division of Urology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis St ASB-II, Boston, MA 02115 USA.
Department of Obstetrics and Gynecology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.
Fertil Res Pract. 2020 Aug 11;6:14. doi: 10.1186/s40738-020-00082-3. eCollection 2020.
Azoospermia is present in 10% of men presenting with infertility and surgical sperm retrieval rates for men with azoospermia due to spermatogenic dysfunction remain low. We investigated the incidence of failed fresh IVF cycles due to inability to obtain sperm and describe predictors for subsequent IVF.
A national IVF database was used to identify fresh IVF cycles in which there was failure to obtain sperm. Patient linkage was utilized to determine outcomes of subsequent IVF.
243,291 fresh IVF cycles were identified; 719 (0.3%) listed "inability to obtain sperm" as reason for embryo non-transfer. Male infertility was a factor in 537 (75%) and ejaculation was the most common anticipated sperm source (414, 57%). 713 (99.2%) cycles resulted in retrieved oocytes, but only 627 (87.2%) cryopreserved oocytes. 265 (37%) of couples underwent subsequent IVF. On multivariable analysis, lack of initial oocyte cryopreservation (OR 0.34, = 0.01) and male infertility (OR 0.14, p = 0.01) were associated with having no subsequent cycles. Partner sperm was used in 213 (80%) second cycles and sperm retrieval method was largely conserved (181/213, 85%). Embryos were transferred in 186 (70%) second cycles. Failed embryo transfers were due to repeat inability to obtain sperm in 5 (6%) cycles.
Failure to obtain sperm during fresh IVF is rare, but most affected couples will not pursue further cycles of IVF after their initial failed attempt.
在不育男性中，无精子症的发生率为10%，因生精功能障碍导致无精子症的男性手术取精率仍然较低。我们调查了因无法获取精子而导致新鲜体外受精（IVF）周期失败的发生率，并描述了后续IVF的预测因素。
使用一个全国性的IVF数据库来识别未能获取精子的新鲜IVF周期。通过患者关联来确定后续IVF的结果。
共识别出243,291个新鲜IVF周期；719个（0.3%）将“无法获取精子”列为胚胎未移植的原因。男性不育是537个（75%）周期中的一个因素，射精是最常见的预期精子来源（414个，57%）。713个（99.2%）周期获得了卵母细胞，但只有627个（87.2%）进行了卵母细胞冷冻保存。265对（37%）夫妇接受了后续IVF。多变量分析显示，缺乏初始卵母细胞冷冻保存（比值比[OR]0.34，P = 0.01）和男性不育（OR 0.14，P = 0.01）与没有后续周期相关。在213个（80%）第二次周期中使用了配偶的精子，取精方法基本保持不变（181/213，85%）。在186个（70%）第二次周期中进行了胚胎移植。胚胎移植失败是由于5个（6%）周期中再次无法获取精子。
新鲜IVF过程中无法获取精子的情况很少见，但大多数受影响的夫妇在首次尝试失败后不会继续进行IVF周期。
