2nd Department of Obstetrics & Gynaecology, National & Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece.
Centre of Reproductive Medicine, Barts Health NHS Trust, London, UK.
Andrology. 2023 Oct;11(7):1326-1336. doi: 10.1111/andr.13415. Epub 2023 Mar 14.
The egg donation model offers an opportunity to isolate the male factor and evaluate its impact on IVF-intracytoplasmic sperm injection and pregnancy outcomes.
To study the effect of non-obstructive azoospermia on intracytoplasmic sperm injection and pregnancy outcomes compared with severe oligozoospermia and mild-to-moderate oligozoospermia in egg recipient cycles.
This is a retrospective longitudinal cohort study, including 1594 patients who underwent intracytoplasmic sperm injection in egg recipient cycles with preimplantation genetic testing for aneuploidies. The cohort was divided into three groups: couples with non-obstructive azoospermia accounting for 479 patients (30%); couples with severe oligozoospermia (sperm number <5 × 10 /mL), accounting for 442 patients (27.8%); couples with mild-to-moderate oligozoospermia, with sperm number >5 × 10 and <15 × 10 /mL, accounting for 673 patients (42.2%).
The fertilisation rate was significantly reduced in the non-obstructive azoospermia group as compared with the severe oligozoospermia and the mild-to-moderate oligozoospermia group: 30.3% versus 63% and 77.3% (p < 0.05). Logistic regression analysis adjusted for confounders highlighted non-obstructive azoospermia as a negative predictor of obtaining a euploid blastocyst both per injected oocyte and per obtained blastocyst. The miscarriage rate in the non-obstructive azoospermia group was 11.8%; higher than the severe oligozoospermia and mild-to-moderate oligozoospermia groups (7% and 2.7%) (p < 0.05). The live birth rate per embryo transfer (ET) was significantly lower in the non-obstructive azoospermia group compared with the severe oligozoospermia and the mild-to-moderate oligozoospermia group (20.4% vs. 30.3% and 35.4%, p < 0.05). The risk of preterm labour was significantly higher in the non-obstructive azoospermia group, compared with the severe oligozoospermia and mild-to-moderate oligozoospermia group (55.1% vs. 46.8% and 16.1%, p < 0.001), and this difference was observed in both singleton and twin pregnancies.
In our retrospective comparative study, non-obstructive azoospermia significantly affects early embryonic potential and live birth rates per cycle and per embryo transfer. It is also associated with higher risk of preterm birth. Future prospective multi-centre studies are needed to highlight the effect of sperm quality on ART and pregnancy outcomes.
捐卵模式为分离男性因素并评估其对体外受精-胞浆内单精子注射和妊娠结局的影响提供了机会。
研究非梗阻性无精子症对卵母细胞受者周期中胞浆内单精子注射和妊娠结局的影响，与严重少精子症和轻度至中度少精子症进行比较。
这是一项回顾性纵向队列研究，包括 1594 名接受植入前遗传学检测非整倍体的卵母细胞胞浆内单精子注射的患者。该队列分为三组：非梗阻性无精子症患者 479 例（30%）；严重少精子症（精子数<5×10 /mL）患者 442 例（27.8%）；轻度至中度少精子症患者，精子数>5×10且<15×10 /mL，共 673 例（42.2%）。
与严重少精子症和轻度至中度少精子症组相比，非梗阻性无精子症组的受精率明显降低：30.3%比 63%和 77.3%（p<0.05）。经混杂因素调整的 logistic 回归分析突出显示，非梗阻性无精子症是每个注射卵母细胞和获得的囊胚获得整倍体囊胚的负面预测因子。非梗阻性无精子症组的流产率为 11.8%；高于严重少精子症和轻度至中度少精子症组（7%和 2.7%）（p<0.05）。与严重少精子症和轻度至中度少精子症组相比，非梗阻性无精子症组每个胚胎移植（ET）的活产率显著降低（20.4%比 30.3%和 35.4%，p<0.05）。非梗阻性无精子症组早产风险明显高于严重少精子症和轻度至中度少精子症组（55.1%比 46.8%和 16.1%，p<0.001），这种差异在单胎和双胎妊娠中均存在。
在我们的回顾性比较研究中，非梗阻性无精子症显著影响早期胚胎潜能和每个周期及每个胚胎移植的活产率。它还与较高的早产风险相关。需要未来的多中心前瞻性研究来强调精子质量对辅助生殖技术和妊娠结局的影响。
