Shi S L, Shi Q Y, Jin H X, Yao G D, Liu Y, Guo Y H
Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2021 Mar 2;101(8):591-596. doi: 10.3760/cma.j.cn112137-20200704-02034.
To investigate the efficacy and clinical outcomes of intracytoplasmic sperm injection (ICSI) with micro amount frozen-thawed diagnostic sperm obtained by microdissection testicular sperm extraction (microTESE), percutaneous epididymal sperm as-piration (PESA) and testicularsperm extraction (TESA) in the treatment of azoospermia. A retrospective analysis was performed on 736 ICSI cycles of azoospermia patients.In Reprocluctive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019. Including 199 ICSI cycles (microTESE 47cycles, PESA 75cycles and TESA 77 cycles) with micro amount frozen-thawed diagnostic sperm and 537 ICSI cycles (microTESE 23 cycles, PESA 111 cycles and TESA 403 cycles) with fresh micro amount sperm. The general conditions, embryo development conditions and clinical outcomes of patients were compared between and within the two groups. The recovery rate of PESA group was significantly lower than that of TESA group (89.3% vs 98.7%), 0.05. The rate of 2PN in the fresh control group was significantly higher than that in the experiment group (75.5% vs 71.3%) and the rate of 2PN in the fresh microTESE and PESA groups were also significantly higher than those of the frozen-thawed microTESE and PESA groups (74.2% vs 64.6%) and (78.5% vs 72.4%), <0.05. Both the rate of D5 blastocyst formation and high quality blastocyst in the fresh group were significantly lower than that in the experiment group (26.9% vs 32.9%) and (15.1% vs 18.0%), <0.05; both the rate of early cleavage and blastocyst formation in the fresh microTESE group were significantly lower than that in the frozen-thawed microTESE group (55.1% vs 68.3%) (27.3% vs 39.3%), <0.05. Both the rate of 8 cells embryos and blastocyst formation in the fresh TESA group were significantly lower than those of the TESA frozen-thawed group (41.3% vs 46.0%) (26.5% vs 32.4%), <0.05. There was no significant difference in pregnancy rate and planting rate between or within the groups(0.05). The abortion rate in the frozen-thawed group was significantly higher than the fresh group (12.0% vs 4.0%), <0.05, especially the abortion rate in the PESA frozen-thawed group was significantly higher than the fresh group (18.0% vs 1.7%), <0.05. There was no significant difference in gender, weight and body length between the fresh group and the frozen-thawed group (0.05), but there were two malformed babies born in the frozen-thawed group. Frozen-thawed microinjection of diagnostic microspermatozoa is a feasible method for the treatment of asthenospermia.There was on significonty difference in pregnancy rate and planting rate between of with in the groups. However, significantly higher than the fresh PESA group of the influence on offspring needs to be further studied.
探讨采用微量冻融诊断性精子,经显微切割睾丸精子提取术(microTESE)、经皮附睾精子抽吸术(PESA)和睾丸精子提取术(TESA)获取精子后行卵胞浆内单精子注射(ICSI)治疗无精子症的疗效及临床结局。对郑州大学第一附属医院生殖医学中心2018年1月至2019年12月736例无精子症患者的ICSI周期进行回顾性分析。其中包括199例采用微量冻融诊断性精子的ICSI周期(microTESE 47周期、PESA 75周期和TESA 77周期)以及537例采用新鲜微量精子的ICSI周期(microTESE 23周期、PESA 111周期和TESA 403周期)。比较两组间及组内患者的一般情况、胚胎发育情况及临床结局。PESA组的回收率显著低于TESA组(89.3%对98.7%),P<0.05。新鲜对照组的2PN率显著高于实验组(75.5%对71.3%),新鲜microTESE组和PESA组的2PN率也显著高于冻融microTESE组和PESA组(74.2%对64.6%)以及(78.5%对72.4%),P<0.05。新鲜组的D5囊胚形成率和优质囊胚率均显著低于实验组(26.9%对32.9%)以及(15.1%对18.0%),P<0.05;新鲜microTESE组的早期卵裂率和囊胚形成率均显著低于冻融microTESE组(55.1%对68.3%)(2对7.3%对39.3%),P<0.05。新鲜TESA组的8细胞胚胎率和囊胚形成率均显著低于TESA冻融组(41.3%对46.0%)(26.5%对32.4%),P<0.05。组间及组内的妊娠率和种植率差异均无统计学意义(P>0.05)。冻融组的流产率显著高于新鲜组(12.0%对4.0%),P<0.05,尤其是PESA冻融组的流产率显著高于新鲜组(18.0%对1.7%),P<0.05。新鲜组与冻融组在性别、体重和身长方面差异无统计学意义(P>0.05),但冻融组有2例畸形儿出生。微量冻融诊断性精子显微注射是治疗弱精子症的一种可行方法。组间及组内的妊娠率和种植率差异无统计学意义。然而,其对后代的影响显著高于新鲜PESA组,有待进一步研究。