Friedler S, Raziel A, Strassburger D, Soffer Y, Komarovsky D, Ron-El R
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, Israel.
Hum Reprod. 1997 Jul;12(7):1488-93. doi: 10.1093/humrep/12.7.1488.
The efficiency of testicular sperm retrieval by testicular fine needle aspiration (TEFNA) was compared with open biopsy and testicular sperm extraction (TESE), in 37 rigorously selected patients with non-obstructive azoospermia. All patients underwent TEFNA and TESE consecutively. Thus, each patient served as his own control. The case was regarded as successful if at least one testicular spermatozoon was found allowing intracytoplasmic sperm injection (ICSI) of at least one oocyte. The mean age of the male patients was 32.7 years (range 24-47). Whereas by TEFNA spermatozoa enabling performance of ICSI were found in only four patients out of 37 (11%), open biopsy and TESE yielded spermatozoa in 16 cases (43%). The negative predictive value of high serum follicle stimulating hormone (FSH) concentrations (> or =10 IU/l) (predicting failure to find spermatozoa for ICSI) was low (38.4%). The positive predictive value (predicting the chance to find spermatozoa for ICSI) of normal-sized testicle was not different from that of small-sized (<15 ml) testicle (50%). Complications included one case of testicular bleeding following fine needle aspiration, treated locally, and two cases of extratunical haematomata following TESE requiring no intervention. In patients with non-obstructive azoospermia, TEFNA has a significantly lower yield compared to TESE. Performance of ICSI with testicular sperm in these cases resulted in satisfactory fertilization and high embryo transfer rates. The implantation and pregnancy rates per embryo transfer were 13 and 29% respectively. Neither serum FSH values nor testicular size were predictive of the chances to find spermatozoa for ICSI. Some complications may occur even following TEFNA.
在37例经过严格筛选的非梗阻性无精子症患者中，对经睾丸细针抽吸术（TEFNA）获取睾丸精子的效率与开放性活检及睾丸精子提取术（TESE）进行了比较。所有患者均先后接受了TEFNA和TESE。因此，每位患者都作为自身对照。如果发现至少一条睾丸精子，从而能够对至少一个卵母细胞进行卵胞浆内单精子注射（ICSI），则该病例视为成功。男性患者的平均年龄为32.7岁（范围24 - 47岁）。通过TEFNA，仅在37例患者中的4例（11%）发现了可用于ICSI的精子，而开放性活检及TESE在16例（43%）中获取到了精子。高血清促卵泡激素（FSH）浓度（≥10 IU/l）（预测无法找到用于ICSI的精子）的阴性预测值较低（38.4%）。正常大小睾丸（预测找到用于ICSI精子的可能性）的阳性预测值与小睾丸（<15 ml）的阳性预测值无差异（50%）。并发症包括细针抽吸术后1例睾丸出血，经局部治疗；TESE术后2例睾丸外血肿，无需干预。在非梗阻性无精子症患者中，与TESE相比，TEFNA的成功率显著更低。在这些病例中使用睾丸精子进行ICSI，受精情况良好，胚胎移植率较高。每次胚胎移植的着床率和妊娠率分别为13%和29%。血清FSH值和睾丸大小均无法预测找到用于ICSI精子的可能性。即使是TEFNA术后也可能出现一些并发症。
