Silber S J, Nagy Z, Liu J, Tournaye H, Lissens W, Ferec C, Liebaers I, Devroey P, Van Steirteghem A C
St Luke's Hospital, St Louis, MO 63017, USA.
Hum Reprod. 1995 Aug;10(8):2031-43. doi: 10.1093/oxfordjournals.humrep.a136231.
The results and rationale of using testicular and epididymal spermatozoa with intracytoplasmic sperm injection (ICSI) for severe cases of male infertility are reviewed. A total of 72 consecutive microsurgical epididymal sperm aspiration (MESA) cases were performed for congenital absence of the vas (CAV) and for irreparable obstructive azoospermia. ICSI was used to obtain normal embryos for transfer and fertilization in 90% of the cases. The overall fertilization rate was 46% with a normal cleavage rate of 68%. The pregnancy and delivery rates per transfer were 58 and 37% respectively. The delivery rate per cycle was 33%. In many cases, no epididymal spermatozoa were available and so testicular sperm extraction (TESE) was used for sperm retrieval. The transfer rate was lower with TESE (84 versus 96%) and the spermatozoa could not be frozen and saved for use in future cycles. However, there was little difference in pregnancy rates using epidiymal or testicular spermatozoa. The results were not affected by whether the obstruction was caused by CAV or failed vasoepididymostomy. Both fresh and frozen spermatozoa gave similar results; the only significant factor appeared to be the age of the female. Because of the consistently good results obtained using epididymal sperm with ICSI when compared with conventional IVF, and the similarly good results with testicular tissue spermatozoa, ICSI is mandatory for all future MESA patients. All CAV patients and their partners should be offered genetic screening for cystic fibrosis; hence pre-implantation embryo diagnosis should be available in any full service MESA programme. It is now clear that even with non-obstructive azoospermia, e.g. Sertoli-cell only, or maturation arrest, there are usually some small foci of spermatogenesis which allow TESE with ICSI to be carried out. This means that even in men with azoospermia due to absence of spermatogenesis or to a block in meiosis, there are usually a few spermatozoa available in the testes that are adequate for successful ICSI. Finally, it is likely that some forms of severe male factor infertility are genetically transmitted and although ICSI offspring have been shown to be completely normal, it is possible that the sons of these infertile couples will also require ICSI when they grow up and wish to have a family.
本文回顾了采用睾丸和附睾精子进行卵胞浆内单精子注射（ICSI）治疗严重男性不育症的结果及理论依据。对72例因先天性输精管缺如（CAV）和无法修复的梗阻性无精子症而连续进行显微外科附睾精子抽吸术（MESA）的病例进行了研究。在90%的病例中，采用ICSI获得正常胚胎用于移植和受精。总体受精率为46%，正常分裂率为68%。每次移植的妊娠率和分娩率分别为58%和37%。每个周期的分娩率为33%。在许多病例中，无法获得附睾精子，因此采用睾丸精子提取术（TESE）获取精子。TESE后的移植率较低（84%对96%），且精子无法冷冻保存以备未来周期使用。然而，使用附睾或睾丸精子的妊娠率差异不大。结果不受梗阻是由CAV还是输精管附睾吻合术失败引起的影响。新鲜和冷冻精子的结果相似；唯一显著的因素似乎是女性的年龄。与传统体外受精相比，使用附睾精子进行ICSI始终能取得良好结果，使用睾丸组织精子也有同样好的结果，因此对于所有未来的MESA患者，ICSI是必需的。所有CAV患者及其伴侣都应接受囊性纤维化的基因筛查；因此，在任何全面的MESA项目中都应提供植入前胚胎诊断。现在很清楚，即使是无梗阻性无精子症，如唯支持细胞综合征或成熟停滞，通常也存在一些小的生精灶，这使得可以进行TESE并联合ICSI。这意味着即使是因无精子生成或减数分裂阻滞而患有无精子症的男性，睾丸中通常也有一些精子足以成功进行ICSI。最后，某些形式的严重男性因素不育症可能是遗传传递的，尽管已证明ICSI后代完全正常，但这些不育夫妇的儿子长大后想要组建家庭时，也可能需要ICSI。
