Majzoub Ahmad, Viana Marina C, Achermann Arnold P P, Ferreira Isadora T, Laursen Rita J, Humaidan Peter, Esteves Sandro C
Department of Urology, Hamad Medical Corporation, Doha 3050, Qatar.
Department of Clinical Urology, Weill Cornell Medicine-Qatar, Doha 3050, Qatar.
J Clin Med. 2024 Aug 21;13(16):4939. doi: 10.3390/jcm13164939.
Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This review summarizes the chances of success with ICSI for NOA patients and examines preoperative factors and laboratory techniques associated with positive outcomes. Furthermore, we reviewed possible consequences for offspring by the use of ICSI with testicular sperm retrieved from NOA patients and the interventions that could potentially mitigate risks. Testicular sperm retrieved from NOA patients may exhibit increased chromosomal abnormalities, and although lower fertilization and pregnancy rates are reported in NOA patients compared to other forms of infertility, the available evidence does not suggest a significant increase in miscarriage rate, congenital malformation, or developmental delay in their offspring compared to the offspring of patients with less severe forms of infertility or the offspring of fertile men. However, due to limited data, NOA patients should receive specialized reproductive care and personalized management. Counseling of NOA patients is essential before initiating any fertility enhancement treatment not only to mitigate health risks associated with NOA but also to enhance the chances of successful outcomes and minimize possible risks to the offspring.
高达15%的不育男性患有非梗阻性无精子症（NOA）。虽然已经确定了NOA的几种病因，但许多患者的确切病因仍然不明。包括卵胞浆内单精子注射（ICSI）和睾丸精子提取在内的辅助生殖技术的进步，为这些患者带来了希望。本综述总结了NOA患者ICSI治疗的成功几率，并研究了与阳性结果相关的术前因素和实验室技术。此外，我们回顾了使用从NOA患者中提取的睾丸精子进行ICSI对后代可能产生的影响，以及可能降低风险的干预措施。从NOA患者中提取的睾丸精子可能表现出染色体异常增加，尽管与其他形式的不育症相比，NOA患者的受精率和妊娠率较低，但现有证据并未表明其后代的流产率、先天性畸形或发育迟缓与轻度不育症患者的后代或可育男性的后代相比有显著增加。然而，由于数据有限，NOA患者应接受专门的生殖护理和个性化管理。在开始任何生育增强治疗之前，对NOA患者进行咨询至关重要，这不仅可以降低与NOA相关的健康风险，还可以提高成功几率，并将对后代的潜在风险降至最低。
