Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Urology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Andrology. 2021 Mar;9(2):599-609. doi: 10.1111/andr.12943. Epub 2020 Nov 29.
In patients with azoospermia, pregnancy can be achieved after surgical techniques using sperm retrieved from the testis or epididymis, which can impact on DNA integrity and epigenetics. DNA of the fetus and placenta is equally derived from both parents; however, genes important for placental development are expressed from the paternal alleles. Therefore, the origin of sperm may affect fetal and placental development.
To investigate whether first-trimester trajectories of embryonic and placental development of pregnancies conceived after intracytoplasmic sperm injection (ICSI) with testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA), are different from pregnancies after ICSI with ejaculated sperm or natural conceptions.
A total of 147 singleton ICSI pregnancies, including pregnancies conceived after TESE (n = 23), MESA (n = 25) and ejaculated sperm (n = 99), and 380 naturally conceived and 140 after IVF treatment without ICSI were selected from the prospective Rotterdam periconception cohort. Crown-rump length (CRL), embryonic volume (EV), Carnegie stages, and placental volume (PV) at 7, 9, and 11 weeks of gestation were measured using 3D ultrasound and virtual reality technology.
Linear mixed model analysis showed no differences in trajectories of CRL, EV, and Carnegie stages between pregnancies conceived after ICSI with testicular, epididymal, and ejaculated sperm. A significantly positive association was demonstrated for PV between pregnancies conceived after TESE-ICSI (adjusted beta: 0.28(95%CI: 0.05-0.50)) versus ICSI with ejaculated sperm. Retransformation to original values showed that the PV of pregnancies after TESE-ICSI is 14.6% (95%CI: 1.4%-25.5%) larger at 11 weeks of gestation compared to ICSI pregnancies conceived with ejaculated sperm.
Here we demonstrate that the first-trimester growth trajectory of the placenta is increased in pregnancies conceived after TESE-ICSI compared to those conceived after ICSI with ejaculated sperm. Findings are discussed in the light of known differences in sperm DNA integrity, epigenetics, and placental gene expression.
在无精子症患者中，通过从睾丸或附睾中获取精子的手术技术，可以实现妊娠，这可能会影响 DNA 完整性和表观遗传学。胎儿和胎盘的 DNA 同样来自于父母双方，但对于胎盘发育重要的基因则从父本等位基因表达。因此，精子的来源可能会影响胎儿和胎盘的发育。
研究通过睾丸精子提取术（TESE）或微创附睾精子抽吸术（MESA）行卵胞浆内单精子注射（ICSI）后妊娠的胚胎和胎盘发育的早期妊娠轨迹是否与通过 ICSI 联合射出精液或自然受孕后妊娠的轨迹不同。
共选择了 147 例单胎 ICSI 妊娠，包括 TESE（n=23）、MESA（n=25）和射出精液（n=99）后妊娠，以及 380 例自然妊娠和 140 例无 ICSI 的体外受精（IVF）治疗后妊娠，所有妊娠均来自前瞻性鹿特丹围孕期队列。在 7、9 和 11 孕周时，使用 3D 超声和虚拟现实技术测量胎儿头臀长（CRL）、胚胎体积（EV）、卡内基分期和胎盘体积（PV）。
线性混合模型分析显示，通过 ICSI 联合睾丸、附睾和射出精液后妊娠的 CRL、EV 和卡内基分期的轨迹无差异。与射出精液 ICSI 后妊娠相比，TESE-ICSI 后妊娠的 PV 呈显著正相关（调整后β：0.28（95%CI：0.05-0.50））。经转换为原始值后显示，TESE-ICSI 后妊娠的胎盘 PV 在 11 孕周时比射出精液 ICSI 后妊娠大 14.6%（95%CI：1.4%-25.5%）。
本研究表明，与射出精液 ICSI 后妊娠相比，TESE-ICSI 后妊娠的胎盘在妊娠早期的生长轨迹增加。研究结果从已知的精子 DNA 完整性、表观遗传学和胎盘基因表达的差异方面进行了讨论。
