显微外科精索静脉结扎术后严重少精子症男性的自发性妊娠：初步的越南报告。

Spontaneous pregnancies post-microsurgical varicocelectomy in infertile men with severe oligozoospermia: a preliminary vietnamese report.

机构信息

Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam.

Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Vietnam.

出版信息

Clin Ter. 2023 Mar-Apr;174(2):126-131. doi: 10.7417/CT.2023.2508.

DOI:10.7417/CT.2023.2508

PMID:36920128

Abstract

BACKGROUND

This study evaluated whether microsurgical varico-celectomy performed in infertile men with severe oligozoospermia (SO) resulted in improved semen parameters or increased rates of spontaneous pregnancy (SP) and performed a cost-effectiveness analysis comparing intrauterine insemination (IUI), in vitro fertilization (IVF), and varicocelectomy.

METHODS

This study included 25 patients with SO who underwent microsurgical varicocelectomy between September 2019 and May 2022, which resulted in post-surgical SP in all cases. Men with azoospermia, abnormal karyotype, or Y-chromosome microdeletion were excluded from the study. Serum luteinizing, follicle-stimulating, and testosterone hormones were measured preoperatively. Semen was analyzed every 3 months postoperation. The incidence of SP was recorded at each visit. Cost-effectiveness for assisted reproductive technologies was calculated based on reported costs. Several parameters were evaluated as potential predictors of the response to microsurgical varicocelectomy using univariate and multivariate analyses.

RESULTS

After a mean postoperative observation period of 7 months, 25 couples with SP after microsurgical varicocelectomy were recruited. The mean sperm concentration increased from 3 million/mL (interquartile range [IQR]: 2-5 million/mL) to 12 million/mL (IQR: 5-17 million/mL; p<0.05), and mean sperm motility improved from 4% (IQR: 3%-6%) to 7.6% (p<0.05). Total motile sperm count (TMSC) increased to 3.08 million (IQR: 1.02-5.83 million) from a preoperative value of 0.34 million (IQR: 0.16-0.83 million). A cost-effectiveness analysis comparing IVF with varicocelectomy indicates that varicocelectomy may represent a better first-line option for infertile men with very low preoperative TMSC. However, further research remains necessary to confirm this result.

CONCLUSION

Varicocelectomy should be discussed as a treatment option for men with SO and may improve sperm quality and fertility potential, resulting in SP.

摘要

背景

本研究评估了在严重少精子症（SO）的不育男性中进行显微精索静脉结扎术是否会改善精液参数或增加自然妊娠（SP）率，并对宫内授精（IUI）、体外受精（IVF）和精索静脉结扎术进行了成本效益分析。

方法

本研究纳入了 25 例 SO 患者，他们在 2019 年 9 月至 2022 年 5 月期间接受了显微精索静脉结扎术，所有患者术后均出现 SP。本研究排除了无精子症、染色体异常或 Y 染色体微缺失的患者。术前测量血清黄体生成素、卵泡刺激素和睾酮激素。术后每 3 个月分析一次精液。每次就诊时记录 SP 的发生率。根据报告的成本计算辅助生殖技术的成本效益。使用单变量和多变量分析评估了几个参数作为对显微精索静脉结扎术反应的潜在预测因子。

结果

在平均术后观察期 7 个月后，招募了 25 对接受显微精索静脉结扎术后 SP 的夫妇。精子浓度从 300 万/mL（四分位距 [IQR]：2-500 万/mL）增加到 1200 万/mL（IQR：5-1700 万/mL；p<0.05），精子活力从 4%（IQR：3%-6%）提高到 7.6%（p<0.05）。总活动精子计数（TMSC）从术前的 0.34 百万（IQR：0.16-0.83 百万）增加到 3.08 百万（IQR：1.02-5.83 百万）。一项比较 IVF 与精索静脉结扎术的成本效益分析表明，对于术前 TMSC 非常低的不育男性，精索静脉结扎术可能是更好的一线选择。然而，需要进一步的研究来证实这一结果。