Gil-Salom M, Romero J, Mínguez Y, Molero M D, Remohí J, Pellicer A
Instituto Valenciano de Infertilidad, Department of Pediatrics, Obstetrics and Gynecology, University of Valencia Medical School, Spain.
J Urol. 1998 Dec;160(6 Pt 1):2063-7.
We evaluate the efficacy of testicular sperm extraction and results of intracytoplasmic sperm injection in cases of nonobstructive azoospermia. In addition, we define predictive parameters for successful testicular sperm extraction in these patients.
A total of 154 patients with nonobstructive azoospermia underwent multiple testicular biopsies to obtain testicular spermatozoa and for histopathological diagnosis. Results of testicular sperm extraction were related to suspected etiology of azoospermia, patient age, maximal testicular volume, serum follicle-stimulating hormone and histopathology. When testicular sperm extraction was successful, intracytoplasmic sperm injection was performed.
Spermatozoa were obtained from 63 patients (41%). No potential predictive parameters precluded successful testicular sperm retrieval. Fertilization was achieved in 74 of 76 intracytoplasmic sperm injection cycles. Normal 2 pronuclear fertilization was observed in 55% of the intact oocytes after microinjection. Clinical pregnancies were achieved in 21 cases for a pregnancy rate of 28% per started cycle. There were 4 miscarriages and 11 live births from 9 deliveries. In addition, a set of twins died after birth because of prematurity. Seven pregnancies were ongoing.
Men with nonobstructive azoospermia may have areas of preserved spermatogenesis in the testicles, and these spermatozoa can be retrieved for intracytoplasmic sperm injection. Although some clinical and histopathological parameters are associated with significantly different sperm recovery rates, it is not possible to predict with certainty the outcome of testicular sperm extraction in an individual patient. If testicular sperm extraction is successful, intracytoplasmic sperm injection offers the chance of pregnancy to these otherwise intractably infertile couples.
我们评估了睾丸精子提取术的疗效以及非梗阻性无精子症患者卵胞浆内单精子注射的结果。此外，我们定义了这些患者成功进行睾丸精子提取的预测参数。
总共154例非梗阻性无精子症患者接受了多次睾丸活检，以获取睾丸精子并进行组织病理学诊断。睾丸精子提取的结果与无精子症的疑似病因、患者年龄、最大睾丸体积、血清促卵泡激素和组织病理学相关。当睾丸精子提取成功时，进行卵胞浆内单精子注射。
63例患者（41%）获取到了精子。没有潜在的预测参数排除成功的睾丸精子获取。在76个卵胞浆内单精子注射周期中，74个实现了受精。显微注射后，55%的完整卵母细胞观察到正常的双原核受精。21例实现了临床妊娠，起始周期的妊娠率为28%。9次分娩中有4例流产，11例活产。此外，一组双胞胎出生后因早产死亡。7例妊娠仍在继续。
非梗阻性无精子症男性的睾丸中可能存在精子发生保留区域，这些精子可被获取用于卵胞浆内单精子注射。虽然一些临床和组织病理学参数与精子回收率显著不同相关，但无法确切预测个体患者睾丸精子提取的结果。如果睾丸精子提取成功，卵胞浆内单精子注射为这些原本难以治疗的不育夫妇提供了妊娠机会。
