输精管绝育后经皮穿刺吸精子IUI辅助授孕技术临床研究

应用经皮穿刺输精管精子（PVSA）及经皮穿刺附睾吸精子（PESA）宫腔内人工授精（IUI）技术，治疗男性绝育后术后要求复育或复通复育失败者共28例。其中PVSA16例，IUI16个月经周期，6例妊娠，周期妊娠率37．5％；其余12个列由于吻合术输精管与周围组织粘连严重采用PESA，4例从附睾尾吸出精子，IUI后1例妊娠并足月出生一健康男婴；8例从附睾头吸出活精子，IUI10个月经周期，1例妊娠，现已4个月，结论认为，附睾头部精子进入女性生殖道内具有自然受精能力；PESA或PVSA结合IUI治疗男性绝育术后要求复育者安全、经济、有效，其辅助授孕技术为男性绝育术后复育提供了新的途径。     

卵浆内单精子注射治疗男性因素不育

为探讨卵浆内单精子显微注射(ICSI)及经皮穿刺附睾吸取精子(PESA)治疗严重少、弱、畸形精子及精道不通男性不育患者的价值,对7对男性不育夫妇采用ICSI或PESA+ICSI治疗。对女方常规促超排卵、取卵,共获卵子97个,其中成熟卵子81个,行ICSI后存活72个,受精率为62.5％,每周期可移植胚胎2～4个,临床妊娠6例。于1998年2月16日足月出生一正常男婴(PESA+ICSI)。初步研究表明:ICSI或PESA+ICSI技术是治疗男性因素不育的有效方法,尤其PESA+ICSI技术为男性输精管绝育(结扎、粘堵)受术者提供生殖保险。     

经皮穿刺输精管吸取精子行宫腔内人工授精治疗不射精症不育

目的:观察经皮穿刺输精管吸取精子(PVSA)行宫腔内人工授精(IUI)治疗不射精症致不育的临床疗效。方法:对经药物治疗无效的不射精症不育患者23例,采用经PVSA行IUI的方法助孕。结果:23例不射精症不育患者经31个治疗周期,15例妊娠,妊娠率为65.2％(15/23),周期妊娠率为48.4％。PVSA吸出精子活率、动力(a+b级)、精子密度、精子总数及畸形精子分别为(78.6±14.2)％、(60.4±11.2)％、(37.6±13.2)×10_9/L、(35.2±13.2)×10_6及(18.6±7.6)％。结论:PVSA结合IUI治疗难治性不射精症不育,疗效确切,方法简便、创伤小、费用低,可重复操作,便于推广应用。     

两种取精方式行ICSI治疗结局的比较

目的:回顾性分析经皮附睾精子抽吸术(PESA)获得的精子和射出的精子行卵浆内单精子注射(ICSI)治疗后的结局。方法:37例因梗阻性无精症或严重少弱畸精症首次要求作ICSI的夫妇,分为附睾穿刺组(9例)和射精组(28例),观察ICSI后两组受精率、优质胚胎率、妊娠率。结果:附睾穿刺组、射精组两组受精率、优质胚胎率、临床妊娠率无显著性差异。结论:经附睾取精和射精获得的精子行ICSI,其治疗结局是相似的。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的回顾性分析38例阻塞性无精子症(OA)患者利用附睾或睾丸精子行卵胞浆内单精子注射(ICSI)的治疗结局。方法OA患者通过经皮附睾精子抽吸术(PESA)或睾丸切开取精术(TESE)获得精子行ICSI,评估受精率及临床妊娠率,以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期,受精率和临床妊娠率分别为73.3%和53.6%,精液精子组31例33个治疗周期受精率和临床妊娠率分别为75.1%和48.4%,两组间比较,受精率和临床妊娠率差异无统计学意义(P>0.05)。OA组共妊娠22例,已分娩13例,流产6例,继续妊娠3例;精液精子组共妊娠16例,已分娩10例,流产1例,继续妊娠5例。结论采用附睾/睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

梗阻性无精子症患者应用附睾、睾丸精子助孕的结局比较

目的比较梗阻性无精子症患者应用附睾、睾丸精子助孕的结局差异。方法梗阻性无精子症患者54例,其中经皮附睾穿刺抽吸术取精者29例(PESA),睾丸精子抽提术取精者25例(TESE)。辅助生殖采用卵胞浆内单精子注射技术(ICSI),对其正常受精率、胚胎种植率、人绒毛膜促性腺激素(HCG)阳性率及临床妊娠率进行比较。结果不同取精组的正常受精率无统计学差异(P>0.05),而PESA组的胚胎种植率、HCG阳性率及临床妊娠率均高于TESE组(P<0.05)。结论梗阻性无精子症患者附睾、睾丸穿刺取精简单易行,创伤小,并发症少,获精率高,ICSI妊娠结局满意;附睾取精避免了睾丸损伤,且助孕结局可能优于睾丸取精。     

附睾或睾丸取精术在男性不育症治疗中的应用

目的:探讨附睾及睾丸取精术在男性梗阻性无精子症(OA)患者的不育治疗中的应用价值。方法:对38例OA患者行经皮附睾精子抽吸术(PESA)或开放式睾丸取精术(TESE),获取精子后行卵泡浆内单精子注射术(ICSI)及胚胎移植术(ET),统计评估受精率及临床妊娠率。结果:38例OA患者均顺利获取精子,共进行治疗41个周期,受精率及临床妊娠率分别为73.3%、56.3%。妊娠22例,已分娩13例,继续妊娠3例,流产6例。结论:附睾及睾丸穿刺取精术在男性梗阻性无精子症的不育治疗中具有重要应用价值。     

经皮附睾穿刺取精术在梗阻性无精子症诊断中的应用

目的 探讨经皮附睾穿刺取精术(PESA)在梗阻性无精子症患者中的诊断价值.方法 采用PESA对94例无精子症患者进行诊断性穿刺,观察穿刺效果.有精子者为PESA穿刺阳性.结果 无精子症患者的PESA穿刺阳性率为77.7％,睾丸体积≥12 mL患者PESA穿刺阳性率高于睾丸体积＜12 mL患者(p＜0.01)；FSH≤1...     

不同来源精子行ICSI妊娠结局分析

目的：比较经皮附睾或睾丸穿刺抽吸术和手淫取精两种方法获得的精子行卵胞浆内单精子注射（ICSI）治疗妊娠结局。方法：回顾性分析进行ICSI治疗的30例36个周期的临床资料,对其中11例15个周期梗阻性无精子症患者行经皮附睾穿刺抽吸术（PESA）或睾丸穿刺抽吸术（TESA）为A组;19例21个周期严重少、弱、畸精子或受精障碍患者采用手淫获得精子为B组,比较两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率。结果：两组的受精率、卵裂率、优质胚胎率、种植率和临床妊娠率分别为81.6%vs79.0%、87.9%vs96.9%、57.8%vs39.0%、15.2vs19.2%和26.7%vs33.3%,经统计学分析,两组间以上指标均无显著性（P〉0.05）。结论：两组取得相似的临床结局,经皮附睾穿刺获得的精子不影响ICSI的成功率。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的 回顾性分析38例阻塞性无精子症（OA）患者利用附睾或睾丸精子行卵胞浆内单精子注射（ICSI）的治疗结局。方法OA患者通过经皮附睾精子抽吸术（PESA）或睾丸切开取精术（TESE）获得精子行ICSI，评估受精率及临床妊娠率，以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期，受精率和临床妊娠率分别为73．3％和53．6％，精液精子组31例33个治疗周期受精率和临床妊娠率分别为75．1％和48．4％，两组间比较，受精率和临床妊娠率差异无统计学意义（P〉0．05）。OA组共妊娠22例，已分娩13例，流产6例，继续妊娠3例；精液精子组共妊娠16例，已分娩10例，流产1例，继续妊娠5例。结论采用附睾／睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

Restoration of fertility in vasectomized men using percutaneous vasal or epididymal sperm aspiration

OBJECTIVE: To restore fertility of vasectomized men using percutaneous epididymal sperm aspiration (PESA) and percutaneous vasal sperm aspiration (PVSA) via intrauterine insemination (IUI). PATIENTS: Twenty-eight vasectomized men who required restoration of their fertility with PESA, PVSA and IUI. RESULTS: Of 28 vasectomy reversal subjects, 16 cycles of IUI using vasal sperm by percutaneous aspiration were performed in 16 subjects and 6 pregnancies were achieved. IUIs with epididymal sperm by percutaneous aspiration were carried out in 12 subjects with epididymal obstruction due to vasovasostomy for vasectomy reversal, and 2 pregnancies were achieved using caudal and epididymal sperm by percutaneous aspiration, respectively. CONCLUSION: The PESA-IUI and PVSA-IUI techniques are attractive, economical and effective for vasectomy reversal. The pregnancy by IUI using PESA and PVSA reveals that the caput epididymal sperm possess fertilization capacity in female reproductive tract and provides a new approach for the restorative fertility of vasectomized men.     

Prenatal diagnostics in TESA/PESA pregnancies in Denmark 1995-2007: a shift from invasive procedures to nuchal translucency examination

Evidently, children born after intracytoplasmic sperm injection (ICSI) are at an increased risk of having sex chromosomal abnormalities. Here we evaluate the change in methods used for prenatal diagnostics in patients having ICSI with epididymal or testicular sperm from the introduction of the procedure in 1995 until December 2007. Four hundred and fifty pregnancies resulted in the birth of 553 children. Of the Danish subpopulation 115 (34.2%) received nuchal translucency examination (NT) and 43 (12.8%) received invasive prenatal diagnostics (IPD). IPD was carried out in 11 out of 23 couples (48%) during the period 1995–1998. Since 2002, less than 10% chose to receive IPD. Twenty-one (57%) of 37 Danish women 37–44 years of age underwent IPD compared to only 22 (7.4%) of the 299 women less than 37 years of age (p?<?0.001). Conversely, since 1999 the use of NT has gradually increased to a frequency of 88.9% in 2007. The partners of vasectomized men had significantly more often NT performed compared to those of non-vasectomized men. IPD were not otherwise associated with the etiology of azoospermia. This study documents a shift in prenatal diagnostics from IPD to NT for testicular sperm aspiration/percutaneous epididymal sperm aspiration (TESA/PESA) couples.     

Prenatal diagnostics in TESA/PESA pregnancies in Denmark 1995-2007: a shift from invasive procedures to nuchal translucency examination

Evidently, children born after intracytoplasmic sperm injection (ICSI) are at an increased risk of having sex chromosomal abnormalities. Here we evaluate the change in methods used for prenatal diagnostics in patients having ICSI with epididymal or testicular sperm from the introduction of the procedure in 1995 until December 2007. Four hundred and fifty pregnancies resulted in the birth of 553 children. Of the Danish subpopulation 115 (34.2%) received nuchal translucency examination (NT) and 43 (12.8%) received invasive prenatal diagnostics (IPD). IPD was carried out in 11 out of 23 couples (48%) during the period 1995-1998. Since 2002, less than 10% chose to receive IPD. Twenty-one (57%) of 37 Danish women 37-44 years of age underwent IPD compared to only 22 (7.4%) of the 299 women less than 37 years of age (p?相似文献