单精子卵细胞质内注射治疗梗阻性无精子症

目的:总结单精子卵细胞质内注射治疗梗阻性无精子症的诊疗经验。方法:回顾总结2006年1月～2008年12月间107例梗阻性无精子症病例ICSI助孕资料,比较先天性输精管缺如组与非先天性输精管缺如组之间受精率、卵裂率以及妊娠率的差异。结果:107例梗阻性无精子症病例ICSI助孕中共行单精子卵细胞质内注射949枚卵子,形成受精卵678枚(受精率71.4%),获得胚胎卵裂605枚(卵裂率89.2%),临床妊娠44例,临床妊娠率41.1%。其中先天性输精管缺如49例,行单精子卵细胞质内注射442枚卵子,形成受精卵308枚(受精率69.6%),获得胚胎卵裂279枚(卵裂率90.6%),临床妊娠27例,临床妊娠率55.1%;炎症或手术等原因引起的梗阻性无精子症58例,行单精子卵细胞质内注射507枚卵子,形成受精卵370枚(受精率72.9%),获得胚胎卵裂326枚(卵裂率88.1%),临床妊娠17例,临床妊娠率29.3%。两组比较受精率、卵裂率无统计学差异(P>0.05),临床妊娠率有统计学差异(P<0.01)。结论:采用经皮附睾或睾丸穿刺抽吸精子结合ICSI技术助孕是治疗梗阻性无精子症的安全有效方法。先天性输精管缺如较其它原因所导致的梗阻性无精子症有更高的临床妊娠率。炎症或手术等原因除引起精道梗阻外也可能影响精子的质量,导致胚胎发育潜能下降。     

中、重度少弱精子症患者冻融精子与新鲜射出精子的ICSI临床结局比较

目的研究中、重度少弱精子症患者冻融精子与新鲜射出精子对ICSI结局的影响。方法回顾性分析227对不育夫妇240个ICSI治疗周期,分为3组:新鲜重度少弱精子组(A组,107例,111个周期);新鲜中度少弱精子组(B组,71例,76个周期);冻融中、重度少弱精子组(C组,49例,53个周期)。比较各组的临床结果。结果新鲜重度、中度少弱精子组的可用胚胎率(分别为78.1%、75.0%)、优质胚胎率(分别为46.1%、46.2%)显著高于冻融组(分别为66.7%和37.4%)(P0.05),但3组间受精率、正常受精率、卵裂率、临床妊娠率、种植率均无显著性差异(P0.05)。新鲜中度少弱精子组与新鲜重度少弱精子组在可用胚胎率、优质胚胎率、受精率、正常受精率、卵裂率、临床妊娠率及种植率方面均无统计学差异(P0.05)。结论中、重度少弱精子症患者冻融精子行ICSI影响可用胚胎率和优质胚胎率,但不影响临床妊娠率和胚胎种植率。     

不同种类精液异常对辅助生殖临床结局的影响

目的探讨少弱畸精子症患者结合单精子卵细胞浆内显微注射技术(ICSI)后的临床结局及安全性。方法回顾性分析2014年1月到2015年5月来我中心行辅助生殖治疗的508对夫妇经ICSI助孕后的临床结局。排除染色体核型异常、Y染色体微缺失、睾丸发育异常和FSH水平异常的干扰,根据精子来源和精液不同质量参数分为3组:A组,单纯梗阻性无精子症组,即PESA组;B组,少弱畸精子症组;C组,严重少弱畸精子症组。比较3组获卵数,正常受精率、卵裂率、可用胚胎率、种植率、妊娠率、生化妊娠率、流产率以及周期活产率等情况。结果 3组之间受精率、卵裂率、可用胚胎率、临床妊娠率、生化妊娠率、流产率以及周期活产率没有明显差异(P0.05);但与A组相比,B组和C组其种植率显著降低(40.5%vs 50.0%,41.6%vs 50.0%,P0.01);B组和C组之间则无统计学差异(40.5%vs41.6%,P0.05)。结论少弱畸精子症及严重少弱畸精子症显著影响胚胎的种植率。     

附睾或睾丸精子对梗阻性无精子症ICSI治疗结局影响的系统评价

目的:系统评价梗阻性无精子症患者选择附睾精子或睾丸精子行ICSI治疗对其临床结局的影响。方法:通过计算机检索Pub Med、Medline、EMBASE、Cochrane图书馆和CNKI、VIP、CBM、万方数据库建库至2015年12月有关梗阻性无精子症患者采用附睾精子或睾丸精子行ICSI治疗的文献,由2位研究者按照纳入与排除标准进行文献筛选、资料提取和质量评价,并采用Rev Man5.3软件进行meta分析。结果:共纳入14项试验研究,包括梗阻性无精子症患者1 278例,共计1 552个周期。Meta分析结果显示:梗阻性无精子症患者行ICSI治疗,附睾精子比睾丸精子具有更好的受精率[RR=1.08,95%CI(1.05,1.11),P0.01];附睾精子和睾丸精子的卵裂率[RR=1.04,95%CI(0.99,1.10),P=0.13]、优质胚胎率[RR=1.01,95%CI(0.93,1.09),P=0.85]、种植率[RR=1.14,95%CI(0.75,1.73),P=0.55]、临床妊娠率[RR=1.14,95%CI(0.98,1.31),P=0.08]以及流产率[RR=0.86,95%CI(0.53,1.39),P=0.54]差异均无统计学意义。结论:梗阻性无精子症患者行ICSI治疗,附睾精子显示出更高的受精率,而在卵裂率、优质胚胎率、种植率、临床妊娠率以及流产率方面,两者临床结局差异不大。     

不同来源精子对卵胞浆内单精子注射治疗结局的影响

目的分析不同来源精子对卵胞浆内单精子注射术(ICSI)治疗后的胚胎发育及治疗结局的影响。方法回顾性分析来我院行ICSI助孕治疗的144对不育夫妇(共154个周期),其中96个周期(A组,89对夫妇)的精子来源为严重少、弱精子症患者的射出精子,32个周期(B组,30对夫妇)为附睾精子,26个周期(C组,25对夫妇)为睾丸精子。比较三组经ICSI治疗后的2PN率、2PN卵裂率、优质胚胎率、种植率、妊娠率。结果 B组的2PN率、2PN卵裂率、优质胚胎率、妊娠率和种植率与A组相比,均无统计学差异(P0.05);C组2PN率、优质胚胎率低于A组、B组(P0.01),而妊娠率、种植率3组间无统计学差异(P0.05)。结论尽管睾丸精子行ICSI可能影响受精及早期胚胎发育,但与严重少弱精患者的射出精子及附睾来源的精子行ICSI的妊娠结局没有显著差异。     

Y染色体微缺失患者与无精子或严重少弱精子症患者ICSI治疗结局比较

目的:比较Y染色体微缺失患者和没有Y染色体微缺失的无精子或严重少弱精子症患者的卵细胞胞质内单精子注射(ICSI)治疗结局。方法:回顾性分析了本医院2008年1月至2009年12月确诊Y染色体微缺失行ICSI治疗的48例56个周期,与治疗时间严格匹配的无Y染色体微缺失的其他无精子或严重少弱精子症的90例患者94个ICSI周期。比较两组患者女方年龄、不孕年限、男方年龄、精液参数、获卵数、ICSI卵子数、受精率、卵裂率、优质胚胎率、平均移植胚胎数、移植日内膜厚度、胚胎种植率、生化妊娠率、临床妊娠率、流产率、活产率、活产男女比例差异。结果:Y染色体微缺失组与无精子或严重少弱精子症的对照组在女方年龄、不孕年限、男方年龄、获卵数、ICSI卵子数、平均移植胚胎数等基本情况差别无统计学意义(P>0.05);Y染色体微缺失组与无精子或严重少弱精子症的对照组相比受精率(69.0%vs73.2%)、卵裂率(96.0%vs95.3%)、优质胚胎率(53.3%vs48.7%)、胚胎种植率(24.0%vs30.3%)、生化妊娠率(41.1%vs44.7%)、临床妊娠率(37.5%vs35.1%)、早期流产率(4.8%vs6.1%)、活产率(35.7%vs29.2%)差别无统计学意义。结论:Y染色体微缺失不影响ICSI治疗结局;男性后代将会面临生育问题,是否选择胚胎植入前遗传学诊断(PGD)应在充分遗传咨询的情况下遵从患者夫妇意愿。     

ICSI周期显微镜下睾丸切开取精术治疗非梗阻性无精子症的临床研究

目的探讨ICSI周期显微镜下睾丸切开取精术(microTESE)治疗非梗阻性无精子症(NOA)的临床疗效。方法回顾性分析了2015年1月至2017年6月在西北妇女儿童医院生殖中心就诊、并在第一周期接受ICSI周期microTESE的281例NOA患者和ICSI周期睾丸穿刺取精术的95例梗阻性无精子症(OA)患者的临床资料,比较两组之间获取精子行ICSI的正常受精率、优胚率、临床妊娠率、流产率、活产率,以及两组间新生儿的出生参数。结果 NOA组和OA组在正常受精率(63.50%vs.66.37%)、优胚率(46.24%vs.46.35%)、临床妊娠率(60.29%vs.70.97%)、流产率(5.88%vs.4.84%)及出生婴儿活产率(54.41%vs.66.13%)方面的差异均无统计学意义(P0.05);NOA组和OA组间出生新生儿的孕周[(38.27±1.79)周vs.(38.31±2.22)周]、出生体重[(2.98±0.62)kg vs.(2.87±0.68)kg]及男性性别比例(43.48%vs.66.00%)均无统计学差异(P0.05)。结论 ICSI周期显微镜下睾丸切开取精术治疗非梗阻性无精子症患者婴儿的活产率偏低,但是出生新生婴儿的各种参数正常,值得临床推广。     

冻融复苏微量精子行卵细胞胞质内单精子注射术的疗效及临床妊娠结局分析

目的:回顾性分析123例无精子症患者经皮附睾精子抽吸术(PESA)或经皮睾丸精子抽吸术(TESA)后冻融复苏微量精子行卵细胞胞质内单精子注射术(ICSI)的疗效及临床妊娠结局情况。方法:将采用微量冻融PESA、TESA精子行ICSI的病例归为冻融精子组,采用新鲜PESA、TESA精子行ICSI的病例归为对照组。比较冻融精子组与新鲜精子组组间及组内的双原核(2PN)受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率、多胎妊娠率有无统计学差异。结果:PESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为75.67%vs76.49%,64.96%vs66.19%,55.21%vs57.22%,13.21%vs12.61%,3.77%vs5.41%,37.74%vs37.84%(P>0.05),TESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为74.41%vs76.43%,64.63%vs66.35%,46.81%vs53.39%,18.18%vs14.55%,4.55%vs1.82%,37.74%vs37.84%,组间及组内均无统计学差异(P>0.05)。PESA精子与TESA精子冻融复苏成功率为70.07%vs62.67%,无统计学差异(P>0.05)。结论:微量PESA及TESA精子冻融技术对无精子症患者来说是一种安全、经济、有效的治疗方法;精子冷冻复苏技术有待于进一步提高;该技术是否会增加子代远期遗传风险仍有待于进一步探讨和研究。     

Y染色体微缺失对卵胞浆内单精子注射胚胎发育和妊娠结局的影响

目的探讨Y染色体微缺失对卵胞质内单精子注射(ICSI)胚胎发育和妊娠结局的影响。方法回顾19例Y染色体微缺失患者(研究组)进行的23个治疗周期的胚胎和临床结局资料,与同期无Y染色体微缺失(对照组)的少弱精子症或无精子症的86个治疗周期的相应资料进行比较,分析两组患者在受精率、卵裂率、优质胚胎率、生化妊娠率、临床妊娠率、胚胎种植率、早期流产率的差异。结果研究组和对照组相比,受精率(85.0%vs89.2%)、卵裂率(96.0%vs 95.3%)、优质胚胎率(68.3%vs 66.7%)、生化妊娠率(47.8%vs 50.0%)、临床妊娠率(43.5%vs 41.6%)、胚胎种植率(22.9%vs 20.8%)、早期流产率(10.0%vs 7.5%)差异比较无统计学意义(P0.05)。结论 Y染色体微缺失对胚胎质量和妊娠结局无显著性影响。     

睾丸精子冷冻复苏对ICSI助孕结局的影响

目的探讨睾丸精子冷冻复苏对ICSI助孕结局的影响。方法回顾性分析2010年1月至2014年9月因梗阻性无精子症在本院采用睾丸精子行ICSI助孕的214个周期的临床资料,其中107个周期采用冷冻复苏的睾丸精子(冻精复苏组),另外107个周期采用新鲜睾丸精子(新鲜精子组)。比较两组中女方的一般资料、受精率、卵裂率、可利用胚胎数、优质胚胎率,以及临床妊娠率。结果本研究中,107个周期冻存睾丸精子复苏均获成功;冻精复苏组与新鲜精子组行ICSI助孕后的受精率[(76.91±18.24)%vs.(75.35±20.62)%]、卵裂率[(94.69±5.29)%vs.(95.37±4.48)%]、可利用胚胎数[(4.67±2.52)vs.(4.20±2.75)个]、优质胚胎率[(64.47±26.08)%vs.(60.34±27.39)%]及临床妊娠率(52.24%vs.50.63%)比较均无显著性差异(P0.05)。结论睾丸精子冷冻复苏对ICSI助孕结局并无显著影响。     

Morphological and morphometric attributes of epididymal and testicular spermatozoa following surgical sperm retrieval for obstructive and nonobstructive azoospermia

Whilst the morphological (shape) and morphometric (sperm head size) attributes of ejaculated spermatozoa have been well studied, the morphological and morphometric qualities of testicular and epididymal spermatozoa retrieved from males with obstructive and nonobstructive azoospermia is much less documented. We wished to examine the effect of aetiology of azoospermia and site of retrieval on the attributes of retrieved spermatozoa. This was a prospective observational study of 30 consecutive successful sperm retrievals, six for nonobstructive azoospermia and 24 for obstructive, of which five were retrieved from the epididymis and the remainder from the testis. The proportion of morphologically normal testicular spermatozoa in patients with obstructive and nonobstructive azoospermia was not significantly different (7% versus 7.6%, P = 0.97). Testicular spermatozoa from males with obstructive azoospermia showed an increase in frequency of sperm with small heads [47/180 (26%) versus 97/909 (11%), P = 0.036] as well as small acrosome and increasing vacuole formation over nonobstructive spermatozoa. Similarly, there was a significant increase in tail deformities and decreases in tail lengths in sperm from males with nonobstructive azoospermia. Epididymal spermatozoa showed significantly greater proportion of morphologically normal spermatozoa than testicular (20% versus 13%, P = 0.001) as well as a significant increase in acrosome vacuoles. Furthermore, morphometrically epididymal spermatozoa displayed with smaller head length, width and area than testicular spermatozoa. Testicular spermatozoa from obstructive azoospermia displayed significantly less tail defects (35% versus 57%, P = 0.003) as well as significantly longer tail lengths (30.6 microm versus 10.7 microm). These morphological and morphometric differences between epididymal and testicular and obstructive and nonobstructive spermatozoa may represent part of the natural maturation process. There were no associations between any morphological or morphometric abnormality with any significant parameter in subsequent use in ICSI.     

Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection

PURPOSE: We tested the hypothesis that spinal cord injury and/or anejaculation affects the outcome of intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: From November 1993 to October 1998 we obtained and prospectively reviewed data on 34 ICSI cycles using electroejaculated sperm, 620 male factor infertility ICSI cycles using normal ejaculated sperm and 120 cases of obstructive azoospermia, in which microsurgical epididymal aspiration and testicular sperm extraction-ICSI were done in 93 and 27, respectively. RESULTS: A total of 34 ICSI cycles were performed in 17 couples with male infertility due to anejaculation secondary to spinal cord injury in 10 patients and retroperitoneal lymph node dissection in 5, and idiopathic in 2. In all 17 couples at least 3 previous intrauterine insemination cycles had failed. After electroejaculation 11 men had oligozoospermia and 6 normal sperm density. Median sperm retrieval volume plus or minus standard deviation was 1.9 +/- 1.9 ml., median sperm concentration 70.7 +/- 60.2 x 106 sperm per ml., median motility 10.7% +/- 10.8% and median forward progression 2.3 +/- 0.5 (scale 1 to 4). In the anejaculation group ICSI resulted in a median fertilization of 60% +/- 28%, 15% pregnancies per cycle and 29% pregnancies per couple. In the control group of 620 ICSI cycles from ejaculated specimens obtained from male patients with infertility median fertilization was 58% +/- 26%, and there were 39% pregnancies per cycle and 47% pregnancies per couple. The rate of pregnancies per embryo transfer and per couple was higher in the control than in the electroejaculation-ICSI group (p <0.05). However, there was no statistically significant difference in the fertilization rate. CONCLUSIONS: ICSI or in vitro fertilization is a viable alternative for patients with anejaculation in whom intrauterine insemination failed. While the fertilization rate is similar in these couples, the pregnancy rate is significantly lower than that achieved with ejaculated specimens from patients with severe male factor infertility. ICSI is a viable alternative for a patient with anejaculation in whom intrauterine insemination or in vitro fertilization failed.     

Chromosomal and Y‐chromosome microdeletion analysis in 1,300 infertile males and the fertility outcome of patients with AZFc microdeletions

The present study investigated the frequency of chromosome aberrations and AZF microdeletions in infertile patients with nonobstructive azoospermia (NOA) or severe oligozoospermia. Additionally, the effect of the AZFc microdeletions on the success of microdissection testicular sperm extraction (microTESE) and intracytoplasmic sperm injection (ICSI) methods were evaluated. Peripheral blood samples were received from 1,300 infertile men with NOA and severe oligozoospermia. Karyotyping and FISH analysis were performed according to standard methods. AZF microdeletions were analysed using multiplex polymerase chain reaction or GML Y‐chromosome Microdeletion Detection System consisting of 14 markers. The chromosomal aberrations and the AZF microdeletions frequency among 1,300 infertile men were 10.6% and 4.0% respectively. Either ejaculated spermatozoa or microTESE was performed on only in 19 out of 26 patients with AZFc deletions. Of the 19 patients, four had severe oligozoospermia and 15 had NOA. In eight out of 15 NOA patients, testicular mature spermatozoa were obtained (53.3%) and then ICSI was applied to mature oocytes. After undergoing ICSI treatment, clinical pregnancy and live birth outcome rates were found to be 37.5% and 25% respectively. These results suggest that infertile patients with AZFc microdeletion could achieve successful fertilisation pregnancies with the help of assisted reproductive technology.     

Sperm source does not affect the ICSI outcome of patients with severely compromised spermatogenesis

Patients with spermatogenic dysfunction may display sperm parameters ranging from extremely severe oligozoospermia (sperm count lower than 2 million/ml) to azoospermia. It has been proposed that, since these patients may have increased sperm DNA damage that could affect their ICSI outcome, the use of surgically retrieved testicular spermatozoa should be preferred to improve their chance of fathering their biological offspring. However, studies in this field have yielded conflicting results. The present study provides an updated assessment of this subject by comparing the ICSI outcome of 762 patients with nonobstructive azoospermia and 419 with sperm count lower than 2 million/ml (median sperm count 300,000/ml). Both groups were homogeneous for the number of retrieved and injected MII oocytes. No difference was seen in terms of fertilisation, clinical pregnancy and cumulative live birth rates. Only the number of injected MII oocytes was found to independently predict the live birth rate, even when adjusted for the number of transferred embryos (OR 1.10 (1.0–1.2, p = 0.038)). The results of the present study stand against the use of testicular spermatozoa in patients with extremely severe spermatogenic dysfunction with available spermatozoa in their ejaculate.     

Influence of motility and vitality in intracytoplasmic sperm injection with ejaculated and testicular sperm

The vitality of spermatozoa used for intracytoplasmic sperm injection (ICSI) is a crucial factor for fertilization, establishment and outcome of a pregnancy in assisted reproductive technique cycles. The sperm origin may also be a limiting factor, although little is known about this issue. It is known that the motility of injected spermatozoa and their origin from ejaculate or testicular biopsies are important predictors in terms of fertilization, pregnancy and birth rates. Oocytes of patients in 2593 cycles were retrieved in our in vitro fertilization programme and inseminated via ICSI. We used motile (group 1, n = 2317) or immotile ejaculated spermatozoa (group 2, n = 79), motile sperm retrieved from testicular biopsies (group 3, n = 62) and immotile spermatozoa from testicular biopsies (group 4, n = 135). Female age and number of oocytes retrieved did not differ significantly among the groups. The fertilization rates were as follows: 67.1% in group 1, 49.8% in group 2, 68.3% in group 3 and 47.8% in group 4. The pregnancy rates in cases where three embryos had been transferred amounted to 35.7% in group 1, 17.3% in group 2, 38.3% in group 3 and 20.5% in group 4. The embryo quality showed no differences between groups 1 and 3 (14.5), and between groups 2 (11.8) and 4 (10.8). The abortion rate was similar in groups 1-3, but increased in group 4 (26.6%, 27.3%, 31.6% and 55.5%). Irrespective of their origin, the fertilization potential of injected spermatozoa was found to be influenced by motility. The resulting pregnancy and birth rates, i.e. the potential of the resulting embryos to implant and to achieve viable pregnancies, seem to be additionally dependent on the sperm origin. This was well shown by declining rates when spermatozoa in a relatively early stage of maturity had been used. We see increasing evidence that the degree of sperm maturity has an important impact on the outcome of ICSI. In obstructive azoospermia, spermatozoa retrieved from the epididymis should be used rather than testicular biopsy spermatozoa, or testicular sperm should be preincubated in culture medium before ICSI.     

精子发生相关新基因KLHL-10在无精子症及少弱精子症患者中突变筛查分析

目的:探讨精子发生相关新基因KLHL-10突变与无精子症及少、弱精子症之间的关系。方法:收集临床上不明原因的、非阻塞性无精子症及少、弱精子症患者(分别为11例、196例和118例)共325份外周血标本以及100份正常生育男性的外周血标本,抽提其DNA,采用PCR技术、变性高效液相色谱技术以及测序等手段对全部DNA样本进行KLHL-10基因的突变筛查。结果:在少精子症患者组及正常生育男性组中各发现1例及3例在1号外显子有C88→A的新的杂合突变,系同义突变;在少精子症患者组、弱精子症患者组及正常生育男性组中各检出3例、1例及4例在2号外显子有C424→A的新的杂合突变,也系同义突变;尚未发现有该基因的错义突变或微缺失。结论:KLHL-10基因错义突变或微缺失不是引起本组无精子症及少、弱精子症患者的主要致病原因,该基因在男性不育症的诊断价值有待进一步确定。     

睾丸精子行ICSI改善严重畸形精子症患者治疗结局5例报告

目的:探讨利用睾丸精子行卵细胞胞质内单精子注射(ICSI)治疗严重畸形精子症患者(精液或附睾液精子畸形率≥99%)的可行性,改善辅助生殖技术治疗结局。方法:回顾性分析5例严重畸形症精子患者(附睾液精子,n=4;精液精子,n=1)利用不同来源精子行ICSI治疗的临床资料,并比较睾丸精子组与非睾丸精子组(附睾液精子和精液精子)之间受精率、卵裂率、优质胚胎率、妊娠率以及种植率的差异。结果:5例严重畸形精子症患者取精液精子或附睾液精子行ICSI治疗后无1例妊娠,而改用睾丸精子行ICSI治疗后4例成功妊娠。睾丸精子组与非睾丸精子组之间受精率、卵裂率及优质胚胎率均无显著差异(P>0.05),而睾丸精子组妊娠率和种植率均显著高于非睾丸精子组(P<0.01)。结论:对应用附睾精子或精液精子行ICSI治疗失败的严重畸形精子症患者改用睾丸精子治疗可有效改善其治疗结局。     

The motility of epididymal or testicular spermatozoa does not directly affect IVF/ICSI pregnancy outcomes

Our objective was to determine whether the presence of motility in surgically obtained sperm samples improves fertilization and pregnancy rates for patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). This was a retrospective study in a hospital-based infertility center. Sixty-seven couples with a diagnosis of azoospermia or severe oligozoospermia who had undergone a sperm retrieval procedure in conjunction with 100 IVF/ICSI cycles from 1995 to 2004 were evaluated. The impact of sperm motility on fertilization and clinical pregnancy rates was determined. The motile and nonmotile sperm groups differed in the number of mature oocytes retrieved (10.7 +/- 5.8 vs 13.4 +/- 6.0), but fertilization (56.7% vs 59.1%) and embryo cryopreservation rates (35.9% vs 39.3%) were statistically similar. Clinical pregnancy rates did not differ between the motile (38.5%) and nonmotile (31.2%) groups, nor did they differ between obstructive and nonobstructive patients (35.3% vs 26.7%). There was also no statistical difference in pregnancy rates between testicular and epididymal aspiration (35.3% vs 26.7%), although epididymal sperm were significantly more likely to be motile than testicular sperm (100% vs 39.3%, P < .0001). Epididymal aspiration is more likely to produce motile sperm than testicular sperm retrieval. The use of motile sperm from epididymal or testicular samples, however, does not appear to enhance fertilization or clinical pregnancy rates.     

Molecular genetic analysis of microdeletion on AZF/DAZ gene in patients with idiopathic azoospermia and severe oligozoospermia in Fujian

Objective: To identify microdeletions in azoospermia factor(AZF) gene loci in patients with idiopathic azoospermia and severe oligozoospermia in Fujian. Methods: Molecular genetic detection method was used to detect microdeletion at the AZFa, AZFb, AZFc /DAZ,SRY region of Y chromosome in 47 azoospermia and 4 severe oligozoospermia patients. Genomic DNA was extracted from peripheral blood. The sequence tagged site (STS) primers tested in each cases were sY84(AZFa), sY 143(AZFb) sY254(AZFc).SRY region of Y chromosome for control. The PCR products were analyzed on a 2.0% agarose gel. Results: Microdeletions of the Y-chromosomal AZF loci were revealed in 18(35.3%,18/51) of 51 patients with idiopathic azoospermia and severe oligozoospermia. AZFa deletion was found in four (7.8%) patients, AZF b in five (9.8%) patients, AZF c in four (7.8%) patients. AZF a+b in one(1.9%)patient, AZF b+c in two (3.9%) patients, AZF a+b+c in two (3.9%)patients respectively. No deletion of SRY region was found. No deletion of AZF a, AZF b, AZF c/DAZ,SRY regions was found in five fertile male who had at least one or more children. Conclusions: Microdeletions on AZF/DAZ gene loci were major genetics defects leading to azoospermia and severe oligozoospermia in male idiopathic infertility in Fujian. It is necessary to have genetic counseling and carry out microdeletion detection on AZF/DAZ gene loci before performing intracytoplasmic sperm injection (ICSI).