Kaiyal Raneen Sawaid, Cannarella Rossella, Kuroda Shinnosuke, Parekh Neel V, Vij Sarah C, Lundy Scott D
Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Urology Department, Cleveland, OH, United States.
Front Urol. 2023 May 9;3:1160122. doi: 10.3389/fruro.2023.1160122. eCollection 2023.
Cryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. Although the number of spermatozoa is usually sufficient for intracytoplasmic sperm injection (ICSI), ICSI fails due to poor sperm quality in some cases. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we will offer patients a surgical sperm retrieval via conventional or microdissection testicular sperm extraction (microTESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microTESE at our center.
We retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE between 2007- 2021 for failed ICSI with ejaculated sperm or sperm quality deemed to be of insufficient quality for ICSI (e.g., nonmotile sperm). We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR) and ICSI outcomes.
28 cryptozoospermic patients were identified. These patients underwent 37 unique microTESE. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had ejaculated sperm with non-suitable quality for ICSI. None had genetic abnormalities. Successful retrieval of motile sperm suitable for ICSI was achieved in in 30 micro TESE procedures (SRR: 81.0%).14 out of 28 patients (50%) who underwent embryo transfer had positive pregnancy result, and 12/28 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). Fibrosis pathology was significantly higher in the negative pregnancy group. There were no postoperative complications noted.
The use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications.
世界卫生组织（WHO）将隐匿性无精子症定义为仅在经过长时间显微镜检查或离心后才在射精中发现孤立的精子细胞。尽管精子数量通常足以进行卵胞浆内单精子注射（ICSI），但在某些情况下，由于精子质量差，ICSI仍会失败。对于在这种特殊情况下睾丸精子是否具有任何优势，仍存在争议。在我们的三级转诊中心，对于隐匿性无精子症且ICSI失败的男性，或者射精标本无活力或不足以进行ICSI的男性，我们将为其提供通过传统或显微解剖睾丸精子提取术（microTESE）进行的手术取精。在本研究中，我们试图描述我们的经验，并评估在我们中心接受microTESE的隐匿性无精子症患者成功的预测因素。
我们回顾性分析了2007年至2021年间所有因ICSI失败（射精精子或精子质量被认为不足以进行ICSI，如无活力精子）而接受microTESE的隐匿性无精子症患者的电子病历。我们评估了人口统计学、术前实验室结果、病理结果、精子获取率（SRR）和ICSI结果。
确定了28例隐匿性无精子症患者。这些患者接受了37次独特的microTESE。其中22名男性之前的射精精子ICSI治疗失败，而其他6名患者的射精精子质量不适合进行ICSI。没有人有基因异常。在30次microTESE手术中成功获取了适合ICSI的活动精子（SRR：81.0%）。28名接受胚胎移植的患者中有14名（50%）妊娠结果为阳性，28名患者中有12名（42.8%）成功活产。最常见的病理模式是生精低下，在65.3%（17/26）的患者中发现。阴性妊娠组的纤维化病理明显更高。未观察到术后并发症。
对于之前使用射精精子ICSI失败的隐匿性无精子症男性，使用睾丸精子有较高的妊娠和活产率。虽然仍存在争议，但我们的结果表明，手术取精对于这些男性是一个可行的选择，并发症风险最小。
