特发性继发性无精子症在少精子症男性中的发生。
Idiopathic secondary azoospermia occurrence in men with oligospermia over time.
机构信息
Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
出版信息
J Assist Reprod Genet. 2024 Aug;41(8):2163-2171. doi: 10.1007/s10815-024-03179-6. Epub 2024 Jun 28.
PURPOSE
To investigate the occurrence of idiopathic secondary azoospermia (ISA) in men with oligospermia over time and identify risk factors for ISA in this population.
METHODS
This was a retrospective cohort study conducted in a university-affiliated male infertility clinic. A total of 1056 oligospermic men (concentration < 15 million/ml (M/ml) and no azoospermia) with at least two SA done between 2000 and 2019 were included. The primary outcome was the occurrence of ISA by oligospermia severity.
RESULTS
In the entire cohort, 31 patients (2.9%) eventually became azoospermic with time. The ≤ 1 M/ml extremely severe oligospermia (ESO) group (283 patients) had significantly higher rates of ISA in each time period compared to the 1-5 M/ml severe oligospermia (SO) (310 patients) and 5-15 M/ml mild oligospermia (MO) (463 patients) groups (p < 0.05 for all comparisons), with rates of 21.1% in the ESO, 4.8% in the SO, and 0% in the MO group (p = 0.02) after 3-5 years, reaching 32% after 5 years in the ESO group compared to no cases in the other two groups (p = 0.006). Parameters shown to predict ISA were initial concentration < 1 M/ml (OR 22.12, p < 0.001) and time interval of > 3 and 5 years (OR 4.83 and 6.84, p = 0.009 and < 0.001, respectively), whereas testosterone levels were negatively associated with ISA (OR 0.88, p = 0.03).
CONCLUSIONS
Men with ≤ 1 M/ml, especially those with low testosterone levels, have a dramatically increased chance of becoming azoospermic with time. Therefore, sperm banking should be recommended in these cases. Men with a sperm concentration above 1 M/ml have low chances of becoming azoospermic, even after 3 or more years.
目的
研究特发性继发性无精子症（ISA）在少精子症男性中的发生情况，并确定该人群中发生 ISA 的危险因素。
方法
这是一项在大学附属男性不育诊所进行的回顾性队列研究。共纳入 1056 名少精子症男性（浓度 < 1500 万/ml（M/ml）且无无精子症），他们在 2000 年至 2019 年间至少进行了两次精液分析。主要结局是根据少精子症严重程度发生 ISA 的情况。
结果
在整个队列中，31 名患者（2.9%）最终随着时间的推移成为无精子症。浓度 ≤ 1 M/ml 的极重度少精子症（ESO）组（283 名患者）在每个时间段的 ISA 发生率明显高于 1-5 M/ml 的重度少精子症（SO）组（310 名患者）和 5-15 M/ml 的轻度少精子症（MO）组（SO 和 MO 组，p < 0.05），ESO 组的发生率为 21.1%，SO 组的发生率为 4.8%，MO 组的发生率为 0%（p = 0.02），3-5 年后 ESO 组的发生率为 32%，而其他两组均无病例（p = 0.006）。预测 ISA 的参数为初始浓度 < 1 M/ml（OR 22.12，p < 0.001）和时间间隔 > 3 年和 5 年（OR 4.83 和 6.84，p = 0.009 和 < 0.001），而睾酮水平与 ISA 呈负相关（OR 0.88，p = 0.03）。
结论
浓度 ≤ 1 M/ml 的男性，尤其是睾酮水平较低的男性，随着时间的推移，成为无精子症的几率显著增加。因此，应推荐这些病例进行精子储存。浓度大于 1 M/ml 的男性成为无精子症的几率较低，即使经过 3 年或更长时间。
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