Romano Massimo, Cirillo Federico, Ravaioli Noemi, Morenghi Emanuela, Negri Luciano, Ozgur Bulbul, Albani Elena, Levi-Setti Paolo Emanuele
Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Andrology. 2025 Jan;13(1):159-168. doi: 10.1111/andr.13568. Epub 2023 Dec 18.
Comparison of intracytoplasmic sperm injection cycles with testicular sperm extraction in obstructive azoospermia and non-obstructive azoospermia are limited, and few studies have addressed obstetric and neonatal outcomes.
This study analyzed couples who underwent testicular sperm extraction-intracytoplasmic sperm injection cycles for obstructive azoospermia and non-obstructive azoospermia to determine whether impaired spermatogenesis in non-obstructive azoospermia patients would lead to worse reproductive outcomes and higher rates of pregnancy complications and fetal anomalies. This study is a retrospective, single-center analysis of all testicular sperm cycles performed between January 1, 2001 and December 31, 2020.
A total of 392 couples were considered in the study, leading to 1066 induction cycles, 620 (58.2%) from patients with obstructive azoospermia and 446 (41.8%) from non-obstructive azoospermia. The cumulative delivery rate did not significantly differ between the two groups (34% vs. 31%; p = 0.326). The miscarriage rate was similar between obstructive azoospermia and non-obstructive azoospermia patients. Fertilization rate instead showed a statistically significant difference (obstructive azoospermia: 66.1 ± 25.7 vs. non-obstructive azoospermia: 56.1 ± 27.0; p < 0.001). The overall maternal complication rate in the non-obstructive azoospermia group was higher (10.7% vs. 18.4%; p = 0.035), but there was no statistical significance for each pathology. There was no statistical difference in gestational age between the two groups for both single and twin pregnancies. Seven cases of congenital defects occurred in the obstructive azoospermia group, while two cases occurred in the non-obstructive azoospermia group.
Despite impaired spermatogenesis in non-obstructive azoospermia patients, there were no substantial differences in reproductive outcomes compared to patients with obstructive azoospermia, even in terms of obstetric safety and neonatal well-being.
关于梗阻性无精子症和非梗阻性无精子症患者行睾丸精子提取的胞浆内单精子注射周期的比较研究有限，且很少有研究涉及产科和新生儿结局。
本研究分析了因梗阻性无精子症和非梗阻性无精子症而行睾丸精子提取-胞浆内单精子注射周期的夫妇，以确定非梗阻性无精子症患者精子发生受损是否会导致更差的生殖结局、更高的妊娠并发症发生率和胎儿畸形率。本研究是对2001年1月1日至2020年12月31日期间进行的所有睾丸精子周期的回顾性单中心分析。
本研究共纳入392对夫妇，共进行了1066个诱导周期，其中梗阻性无精子症患者620个周期（58.2%），非梗阻性无精子症患者446个周期（41.8%）。两组的累积分娩率无显著差异（34%对31%；p = 0.326）。梗阻性无精子症和非梗阻性无精子症患者的流产率相似。相反，受精率显示出统计学显著差异（梗阻性无精子症：66.1±25.7对非梗阻性无精子症：56.1±27.0；p < 0.001）。非梗阻性无精子症组的总体母体并发症发生率更高（10.7%对18.4%；p = 0.035），但每种病理情况均无统计学意义。单胎和双胎妊娠两组的孕周无统计学差异。梗阻性无精子症组发生7例先天性缺陷，非梗阻性无精子症组发生2例。
尽管非梗阻性无精子症患者精子发生受损，但与梗阻性无精子症患者相比，即使在产科安全性和新生儿健康方面，生殖结局也没有实质性差异。
