非梗阻性无精子症患者采用微量睾丸精子提取术联合卵胞浆内单精子注射的临床结局和活产率：一项单中心队列研究。
Clinical Outcomes and Live Birth Rate Resulted From Microdissection Testicular Sperm Extraction With ICSI-IVF in Non-Obstructive Azoospermia: A Single-Center Cohort Study.
机构信息
Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Center for Reproductive Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 23;13:893679. doi: 10.3389/fendo.2022.893679. eCollection 2022.
BACKGROUND
Most of data available in the literature reported the sperm retrieval rate and limited intracytoplasmic sperm injection (ICSI) results of microdissection testicular sperm extraction (micro-TESE) in non-obstructive azoospermia (NOA) patients with different etiologies. Unfortunately, there is currently a lack of comprehensive data to guide clinicians in conducting comprehensive consultations with NOA patients.
OBJECTIVES
To obtain more comprehensive evidence-based data and clinical outcomes for better consultation of NOA patients who opted to undergo micro-TESE combined with ICSI-IVF.
METHODS
It was a retrospective study involved 968 NOA patients underwent micro-TESE during January 2015 to December 2019. Embryological, clinical, and live birth outcomes were demonstrated comprehensively and three kinds of stratification analyses were performed based on ICSI-IVF cycles using frozen and fresh sperm, different etiologies of NOA and various amounts of sperm retrieved.
RESULTS
The sperm retrieval rate was 44.6%, and ICSI was performed in 299 couples leading to 150 clinical pregnancies and 140 live-birth deliveries. The clinical pregnancy rate (CPR) was 50.17%, and the cumulative live birth rate (LBR) was 46.82%, and the low birth defects rate was 1.43%. No significant difference was observed about cumulative LBR in frozen sperm group and fresh sperm group (47.5% vs 42.9%, 0.05). NOA patients with AZFc microdeletions had the lowest rate of a high-score embryo on day 3 (4.4%, <0.05) and the lowest cumulative LBR (19.4%, <0.05). NOA patients with lower sperm count (having fewer than 20 sperms retrieved) had significantly lower cumulative LBR than those with higher sperm count (having more than 20 sperms retrieved) (28.1% vs 51.9%, <0.05).
CONCLUSIONS
For those NOA patients who stepped in ICSI-IVF cycles, the cumulative LBR was 46.82%. No significant difference was indicated in the LBR between ICSI-IVF cycles using frozen or fresh testicular sperm. Compared to other etiologies, NOA caused by AZFc microdeletions have the poorest embryological and clinical outcomes. Patients with less testicular sperm retrieved have poorer embryological and clinical outcomes.
背景
大多数现有文献数据报道了不同病因非梗阻性无精子症（NOA）患者显微睾丸精子提取（micro-TESE）的精子获取率和有限的卵胞浆内单精子注射（ICSI）结果。不幸的是，目前缺乏全面的数据来指导临床医生对 NOA 患者进行全面咨询。
目的
为了获得更全面的循证数据和临床结果，以便更好地为选择接受 micro-TESE 联合 ICSI-IVF 的 NOA 患者进行咨询。
方法
这是一项回顾性研究，纳入了 2015 年 1 月至 2019 年 12 月期间 968 例接受 micro-TESE 的 NOA 患者。全面展示了胚胎学、临床和活产结局，并基于使用冷冻和新鲜精子、NOA 的不同病因和不同数量的精子提取进行了三种分层分析。
结果
精子获取率为 44.6%，在 299 对夫妇中进行了 ICSI，导致 150 例临床妊娠和 140 例活产。临床妊娠率（CPR）为 50.17%，累积活产率（LBR）为 46.82%，出生缺陷率为 1.43%。在冷冻精子组和新鲜精子组中，累积 LBR 无显著差异（47.5%比 42.9%，0.05）。AZFc 微缺失的 NOA 患者第 3 天高评分胚胎率最低（4.4%，<0.05），累积 LBR 最低（19.4%，<0.05）。精子计数较低（提取精子少于 20 个）的 NOA 患者的累积 LBR 显著低于精子计数较高（提取精子多于 20 个）的患者（28.1%比 51.9%，<0.05）。
结论
对于进入 ICSI-IVF 周期的 NOA 患者，累积 LBR 为 46.82%。使用冷冻或新鲜睾丸精子进行 ICSI-IVF 周期的 LBR 无显著差异。与其他病因相比，由 AZFc 微缺失引起的 NOA 具有最差的胚胎学和临床结局。睾丸精子提取量较少的患者胚胎学和临床结局较差。
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