Rosenlund B, Sjöblom P, Dimitrakopoulos A, Hillensjö T
Department of Obstetrics and Gynecology, Huddinge University Hospital, Sweden.
Acta Obstet Gynecol Scand. 1997 Feb;76(2):135-9. doi: 10.3109/00016349709050069.
The possibility of treating male infertility because of obstructive azoospermia has been poor, but intracytoplasmic sperm injection (ICSI) has given this type of infertility sufferer a new option.
In this study 13 couples with obstructive azoospermia were treated in a total of 19 stimulated IVF cycles. The men were between 27 and 45 (mean 33) years of age. Their partners, 24-39 (mean 31) years of age were treated according to routine IVF procedures, i.e. down regulation with buserelin followed by hyperstimulation with urofollitropin. Fertilization was obtained by ICSI. Two embryos were transferred on day two after the ovum pick up. Sperm were retrieved through microsurgical epididymal aspiration (MESA) in four cycles, percutaneous epididymal sperm aspiration (PESA) in three cycles and through testicular sperm extraction (TESE) in 12 cycles.
The overall fertilization rate was 68%, with a cleavage rate of 82%.The fertilization rate was equal (68%) with epididymal and testicular sperm and the cleavage rate was 87%) and 80%, respectively. Embryos were obtained for embryo transfer (ET) in all cases and five pregnancies (one twin pregnancy) were established (26% per ET), three using epididymal sperm and two using testicular sperm.
Infertility due to obstructive azoospermia can successfully be treated with epididymal sperm and ICSI. When epididymal sperm cannot be found sperm extracted from a testicular biopsy can be used. PESA and TESE are quicker and easier alternatives to MESA and can be performed on an outpatient basis with local anesthesia.
梗阻性无精子症导致的男性不育症以往治疗效果不佳，但卵胞浆内单精子注射（ICSI）为这类不育患者提供了新的选择。
本研究中，13对梗阻性无精子症夫妇共接受了19个促排卵体外受精周期的治疗。男方年龄在27至45岁之间（平均33岁）。其伴侣年龄在24至39岁之间（平均31岁），按照常规体外受精程序进行治疗，即先用布舍瑞林进行降调节，随后用人尿促卵泡素进行超促排卵。通过ICSI实现受精。取卵后第二天移植两枚胚胎。四个周期通过显微外科附睾抽吸术（MESA）获取精子，三个周期通过经皮附睾精子抽吸术（PESA）获取精子，12个周期通过睾丸精子提取术（TESE）获取精子。
总体受精率为68%，卵裂率为82%。附睾精子和睾丸精子的受精率相同（均为68%），卵裂率分别为87%和80%。所有病例均获得了可用于胚胎移植（ET）的胚胎，共确立了5例妊娠（1例双胎妊娠）（每次ET的妊娠率为26%），其中3例使用附睾精子，2例使用睾丸精子。
梗阻性无精子症导致的不育症可通过附睾精子和ICSI成功治疗。若找不到附睾精子，可使用睾丸活检提取的精子。与MESA相比，PESA和TESE更快、更简便，可在门诊局部麻醉下进行。
