Japari Andrian, Altay Baris, Christine Wyns, Cayan Selahittin, Saleh Ramadan, Shah Rupin, Agarwal Ashok
Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia.
Global Andrology Forum, Moreland Hills, OH, USA.
Arab J Urol. 2024 Jun 12;23(3):237-243. doi: 10.1080/20905998.2024.2367333. eCollection 2025.
Cryptozoospermia is a condition where spermatozoa can only be detected with extensive sperm-pellet analysis after routine semen analysis failed to detect any spermatozoa. Intracytoplasmic sperm injection (ICSI) can help these cryptozoospermic patients overcome their infertility issues. ICSI can be done with ejaculated or testicular sperm obtained by surgical sperm retrieval (SSR) techniques, each with its advantages and disadvantages. In managing cryptozoospermic patients, there is a need to first investigate the possibility of improving sperm numbers and quality based on etiologies. SSR is a part of the management, but presents also potential risks. The benefit of SSR is that sperm obtained by SSR in cryptozoospermic patients tend to give better outcomes when used for ICSI. However, besides the physical burden, SSR also has potential drawbacks, such as psychological trauma associated with surgery in some patients, the need for extra funding for the surgery, and immaturity of the sperm. According to recent studies, ICSI using testicular sperm from cryptorchid patients provides better pregnancy and live birth rates, as well as a lower miscarriage rate. Some studies contradict these findings, hindering the possibility of providing a robust answer on this matter. This review aims to present ICSI outcomes with ejaculated or testicular sperm, taken from cryptozoospermic patients, and discuss the results of comparative studies highlighting the possible reasons behind these discrepancies, and eventually offer an expert opinion for clinicians.
隐匿性无精子症是一种在常规精液分析未能检测到任何精子后，只能通过广泛的精子沉淀分析才能检测到精子的病症。卵胞浆内单精子注射（ICSI）可以帮助这些隐匿性无精子症患者克服不孕问题。ICSI可以使用通过手术取精（SSR）技术获得的射出精子或睾丸精子来进行，每种方法都有其优缺点。在管理隐匿性无精子症患者时，需要首先根据病因研究提高精子数量和质量的可能性。SSR是管理的一部分，但也存在潜在风险。SSR的好处是，隐匿性无精子症患者通过SSR获得的精子用于ICSI时往往能取得更好的结果。然而，除了身体负担外，SSR还存在潜在的缺点，比如一些患者与手术相关的心理创伤、手术所需的额外资金以及精子不成熟等问题。根据最近的研究，使用隐睾患者的睾丸精子进行ICSI可提供更好的妊娠率和活产率，以及更低的流产率。一些研究与这些发现相矛盾，这使得在此问题上难以给出确凿的答案。本综述旨在介绍隐匿性无精子症患者射出精子或睾丸精子的ICSI结果，并讨论比较研究的结果，突出这些差异背后的可能原因，并最终为临床医生提供专家意见。
