Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Disease, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Key Laboratory for Reproductive Medicine of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Front Endocrinol (Lausanne). 2023 Feb 21;14:1123541. doi: 10.3389/fendo.2023.1123541. eCollection 2023.
The application of microdissection testicular sperm extraction (micro-TESE) to retrieve the sperm of patients with non-obstructive azoospermia (NOA) has greatly increased. Patients with NOA often have poor quality sperm. Unfortunately, there are few studies on artificial oocyte activation (AOA) performed on patients who successfully retrieved motile and immotile sperm by micro-TESE after intracytoplasmic sperm injection (ICSI). Therefore, this study sought to obtain more comprehensive evidence-based data and embryo development outcomes to aid consultation of patients with NOA who opted to receive assisted reproductive techniques and to determine whether AOA needs to be performed in different motile sperm after ICSI.
This retrospective study involved 235 patients with NOA who underwent micro-TESE to retrieve adequate sperm for ICSI between January 2018 and December 2020. A total of 331 ICSI cycles were performed in the 235 couples. Embryological, clinical, and neonatal outcomes were demonstrated comprehensively between motile sperm and immotile sperm using AOA and non-AOA treatment.
Motile sperm injection with AOA (group 1) showed significantly higher fertility rate (72.77% 67.59%, =0.005), 2 pronucleus (2PN) fertility rate (64.33% 60.22%, =0.036), and miscarriage rate (17.65% 2.44%, =0.018) compared with motile sperm injection with non-AOA (group 2). Group 1 had comparable available embryo rate (41.29% 40.74%, =0.817), good embryo rate (13.44% 15.44%, =0.265), and without an embryo for transfer rate (10.85% 9.90%, =0.815) compared with group 2. Immotile sperm injection with AOA (group 3) displayed significantly higher fertility rate (78.56% 67.59%, =0.000), 2PN fertility rate (67.36% 60.22%, =0.001), without an embryo for transfer rate (23.76% 9.90%, 0.008), and miscarriage rate (20.00% 2.44%, =0.014), but significantly lower available embryo rate (26.63% 40.74%, =0.000) and good embryo rate (15.44% 6.99%, =0.000) compared with group 2. In groups 1, 2, and 3, the rates of implantation (34.87%, 31.85% and 28.00%, respectively; =0.408), clinical pregnancy (43.87%, 41.00%, and 34.48%, respectively; =0.360) and live birth (36.13%, 40.00%, and 27.59%, respectively; =0.194) were similar.
For those patients with NOA from whom adequate sperm were retrieved for ICSI, AOA could improve fertilization rate, but not embryo quality and live birth outcomes. For patients with NOA and only immotile sperm, AOA can help achieve acceptable fertilization rate and live birth outcomes. AOA is recommended for patients with NOA only when immotile sperm are injected.
应用微量睾丸精子提取术（micro-TESE）来获取非梗阻性无精子症（NOA）患者的精子，大大增加了成功的可能性。NOA 患者的精子质量通常较差。不幸的是，对于那些通过 micro-TESE 成功获取运动和非运动精子后进行胞浆内单精子注射（ICSI）的患者，关于人工卵母细胞激活（AOA）的研究很少。因此，本研究旨在获得更全面的循证数据和胚胎发育结果，以帮助咨询选择辅助生殖技术的 NOA 患者，并确定在 ICSI 后是否需要对不同的运动精子进行 AOA。
这是一项回顾性研究，纳入了 2018 年 1 月至 2020 年 12 月期间因 micro-TESE 而成功获取 ICSI 用充足精子的 235 例 NOA 患者。在 235 对夫妇中进行了 331 个 ICSI 周期。通过 AOA 和非 AOA 处理，全面展示了运动精子和非运动精子之间的胚胎学、临床和新生儿结局。
与非运动精子注射的非 AOA 组（2）相比，运动精子注射的 AOA 组（1）的受孕率（72.77%，67.59%，=0.005）、2 原核（2PN）受孕率（64.33%，60.22%，=0.036）和流产率（17.65%，2.44%，=0.018）明显更高。AOA 组（1）的可利用胚胎率（41.29%，40.74%，=0.817）、优质胚胎率（13.44%，15.44%，=0.265）和无胚胎转移率（10.85%，9.90%，=0.815）与非 AOA 组（2）相似。与非 AOA 组（2）相比，非运动精子注射的 AOA 组（3）的受孕率（78.56%，67.59%，=0.000）、2PN 受孕率（67.36%，60.22%，=0.001）、无胚胎转移率（23.76%，9.90%，=0.008）和流产率（20.00%，2.44%，=0.014）明显更高，但可利用胚胎率（26.63%，40.74%，=0.000）和优质胚胎率（15.44%，6.99%，=0.000）明显更低。在组 1、2 和 3 中，着床率（34.87%、31.85%和 28.00%，=0.408）、临床妊娠率（43.87%、41.00%和 34.48%，=0.360）和活产率（36.13%、40.00%和 27.59%，=0.194）相似。
对于那些从 ICSI 中成功获取足够精子的 NOA 患者，AOA 可以提高受精率，但不能提高胚胎质量和活产率。对于只有非运动精子的 NOA 患者，AOA 有助于实现可接受的受精率和活产率。只有在注射非运动精子时，才建议对 NOA 患者进行 AOA。
