Lantsberg Daniel, Mizrachi Yossi, Katz Darren J
Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
Aust N Z J Obstet Gynaecol. 2022 Apr;62(2):300-305. doi: 10.1111/ajo.13477. Epub 2022 Feb 2.
To evaluate the results of microdissection testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non-obstructive azoospermia (NOA).
We retrospectively analysed data of 88 consecutive patients with clinical NOA who were treated with micro-TESE by a single surgeon, between August 2014 and September 2020, in Melbourne, Victoria. Upon a successful sperm retrieval, sperm was either used fresh for ICSI, frozen for future use or both. The outcome measures were sperm retrieval rate (SRR), and in vitro fertilisation (IVF)/ICSI results. Furthermore, SRR was calculated for the predominant causes and histopathological patterns.
The overall SRR was 61.2%. It was significantly higher in patients with a history of cryptorchidism and other childhood diseases (100%) than in the other NOA groups (P < 0.05). Patients with Klinefelter syndrome had a 75% SRR. Among the different types of testicular histology, the highest SRR were noted in patients with complete hyalinisation (100%) and hypospermatogenesis (92.9%), and low with Sertoli cell-only syndrome (46.3%). The SRR has significantly increased from 33.3% in 2015-2016 to 73.6% in 2019-2020 (P = 0.009). Of the 52 patients with SSR, 47 underwent IVF/ICSI. Fertilisation rate was 42.4%. Twenty-nine couples achieved at least one good-quality embryo and had embryo transfer. Nineteen achieved pregnancy (40.4%), and in three patients a miscarriage resulted.
This is the first report from Australia showing that micro-TESE is an effective treatment for NOA with high SRR. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.
评估显微切割睾丸取精术（micro-TESE）和卵胞浆内单精子注射（ICSI）治疗非梗阻性无精子症（NOA）的效果。
我们回顾性分析了2014年8月至2020年9月间在维多利亚州墨尔本由同一位外科医生对88例连续性临床NOA患者进行显微切割睾丸取精术治疗的数据。成功获取精子后，精子要么新鲜用于ICSI，要么冷冻以备将来使用，或者两者皆用。观察指标为精子获取率（SRR）以及体外受精（IVF）/ICSI结果。此外，还针对主要病因和组织病理学模式计算了SRR。
总体SRR为61.2%。有隐睾病史和其他儿童疾病的患者（100%）的SRR显著高于其他NOA组（P<0.05）。克兰费尔特综合征患者的SRR为75%。在不同类型的睾丸组织学中，完全透明化（100%）和生精功能低下（92.9%）的患者SRR最高，而唯支持细胞综合征患者的SRR较低（46.3%）。SRR已从2015 - 2016年的33.3%显著增至2019 - 2020年的73.6%（P = 0.009）。在52例有精子获取的患者中，47例接受了IVF/ICSI。受精率为42.4%。29对夫妇获得了至少一个优质胚胎并进行了胚胎移植。19例成功妊娠（40.4%），3例患者发生流产。
这是来自澳大利亚的首份报告，表明显微切割睾丸取精术是一种治疗NOA且SRR高的有效方法。数年成功率的提高表明了手术技巧和实验室工作人员经验的重要性。
