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1.
Diagnostic epididymal and testicular sperm recovery and genetic aspects in azoospermic men. 总被引:1,自引:0,他引:1
G Westlander L Hamberger C Hanson K Lundin L Nilsson B S?derlund C Werner C Bergh 《Human reproduction (Oxford, England)》1999,14(1):118-122
Various procedures for sperm recovery in azoospermic men have been described, from open testicular biopsy to simple needle aspiration from the epididymis and the testis. Fifty-one obstructive and 86 non-obstructive azoospermic men were treated to compare the recovery of spermatozoa obtained by percutaneous aspiration from the epididymis (PESA) and aspiration/extraction from the testis (TESA, TESE) with histopathology. If TESA failed, the work up proceeded with TESE. All patients were karyotyped. Spermatozoa were recovered by PESA or TESA in all obstructive men (51/51 patients). In 22 out of 86 patients with non-obstructive azoospermia, testicular spermatozoa could be successfully recovered by TESA. In five additional patients TESE was successful in recovering spermatozoa where TESA had failed. In 43 patients, neither TESA nor TESE was successful. Sixteen patients chose not to proceed with TESE. Seven out of 86 patients had an abnormal karyotype in the non-obstructive group (8%), none in the obstructive group. In the non-obstructive patient group testicular histopathology showed hypospermatogenesis, incomplete maturation arrest and germ cell aplasia with focal spermatogenesis in cases where spermatozoa were recovered and complete germ cell aplasia, complete maturation arrest and fibrosis in cases where no spermatozoa were found. Spermatozoa were recovered by PESA or TESA from all patients with obstructive azoospermia and from approximately 40% of patients with non-obstructive azoospermia by TESA or TESE. Retrieval of viable spermatozoa in the infertility work-up was highly predictable for sperm recovery in subsequent ICSI cycles. TESA performed under local anaesthesia seems almost as effective as more invasive procedures in recovering testicular spermatozoa, both in obstructive and non-obstructive azoospermic men. 相似文献
2.
D Ben-Yosef L Yogev R Hauser H Yavetz F Azem I Yovel J B Lessing A Amit 《Human reproduction (Oxford, England)》1999,14(7):1794-1801
The potency for fertilization and successful implantation was compared between fresh and cryopreserved testicular spermatozoa obtained from the same patient with non-obstructive azoospermia. Spermatozoa cryopreserved at the outset were also evaluated. Non-obstructive azoospermic men (n = 55) underwent testicular sperm extraction (TESE); mature spermatozoa were found in 33 (60%) of them. Of 57 intracytoplasmic sperm injection (ICSI) cycles in 25 patients, 15 used fresh spermatozoa (14 patients, group 1), 24 used the excess spermatozoa cryopreserved after 'fresh' ICSI (11 couples who did not conceive in the 'fresh' cycle, group 2) and 18 cycles used cryopreserved spermatozoa at the outset (11 other patients, group 3). Fertilization, cleavage, embryo quality, implantation and take home baby rates were not significantly different in groups 1 and 2, and 6/14 couples ultimately had healthy babies (42.8% cumulative take home baby rate per TESE). In group 3, neither the fertilization rate, embryo development, pregnancy nor implantation rates per embryo transfer were significantly different from groups 1 and 2. The cumulative delivery and ongoing pregnancy rate in this group was 36. 4%. Cryopreservation did not impair the availability of motile spermatozoa for ICSI. When immotile spermatozoa were injected, however, fertilization rate decreased dramatically. Since criteria for predicting the presence of spermatozoa in the testicular tissue of patients with non-obstructive azoospermia are inadequate, it is suggested that TESE be performed prior to initiating ovarian stimulation. 相似文献
3.
Fertility with testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermic men 总被引:2,自引:9,他引:2
Kahraman Semra; Ozgur Suat; Alatas Cengiz; Aksoy Senai; Tasdemir Murat; Nuhoglu Alp; Tasdemir Islk; Balaban Basak; Biberoglu Kutay; Schoysman Robert; Nijs Martine; Vanderzwahnen Pierre 《Human reproduction (Oxford, England)》1996,11(4):756-760
In non-obstructive azoospermia spermatozoa can usually onlybe isolated from the testicles, and thus the most promisingtreatment model is testicular sperm extraction (TESE). Hormoneconcentrations, testicular volume determinations and testicularbiopsy results are not uniform enough to select potential candidatesfor successful TESE and intracytoplasmic sperm injection (ICSI)approaches in advance. The aim of this study was to assess theefficacy of using ICSI with testicular spermatozoa in casesof non-obstructive azoospermia and to compare the inclusioncriteria and sperm existence in the testicles in sperm obtainableand non-obtainable groups. All men showed either complete orincomplete (n = 14) maturation arrest in spermatogenesis, severehypospermatogenesis (n = 10) or Sertoli cell-only syndrome (n= 5) in their testicular biopsies. Only 14 out of a total of29 men provided enough spermatozoa for the ICSI procedure, whileno spermatozoa were found in the testicular samples of the remaining15 men. Out of 123 oocytes obtained from 14 females, 101 wereinjected with the husbands' testicular sperm cells. Total fertilizationfailure was observed in three cases. Of 39 oocytes fertilized,38 cleaved. The fertilization and cleavage rates were 38.6 and97.4% respectively. The pregnancy rate was 20.7% per initiatedcycle. In the group from whom spermatozoa were obtainable, thepregnancy rate was 42.9% per initiated cycle and 54.5% per embryotransfer. A total of six pregnancies were achieved, of whichtwo Were twins and four were singletons. One singleton pregnancyresulted in abortion in the first trimester. There was no statisticaldifference concerning the serum follicle stimulating hormoneconcentration, testicular volume and biopsy results in groupsin which spermatozoa were obtainable or not. In conclusion,although the association of TESE with ICSI obtained pregnanciesfor some patients with non-obstructive azoospermia, furtherstudies are needed to determine the inclusion criteria for successfulTESE. 相似文献
4.
Extended sperm preparation: an alternative to testicular sperm extraction in non-obstructive azoospermia 总被引:2,自引:9,他引:2
Ron-El R; Strassburger D; Friedler S; Komarovski D; Bern O; Soffer Y; Raziel A 《Human reproduction (Oxford, England)》1997,12(6):1222-1226
Testicular sperm retrieval for the treatment of non-obstructive azoospermia
requires the execution of an invasive procedure, with all its possible
attending complications and subsequent long-term effects. This study
suggests a new non-invasive approach for collection of spermatozoa in these
patients: the extended sperm preparation (ESP). ESP consists of conducting
a thorough microscopic search through many droplets of ejaculate sediment.
ESP was performed for 49 patients; in 17 patients (35%), spermatozoa were
found and subsequently used in intracytoplasmic sperm injection (ICSI). Of
these preparations, five yielded fewer motile spermatozoa than the number
of corresponding oocytes available, and in one patient only non-motile
spermatozoa were recovered. The remaining 32 ESP-negative patients
underwent testicular sperm extraction (TESE) from testicular biopsy.
Spermatozoa were found in 16 of 32 biopsies (50%) and subsequently used in
ICSI. Fertilization and cleavage rates were comparable in both ESP and TESE
groups, yielding four clinical pregnancies in each group (27 and 29%
respectively). Embryo morphology was defined as excellent in significantly
more cases in the ESP group than the TESE group, and implantation rate
appeared somewhat higher in the ESP group (16%) than the TESE group (13%).
The ESP technique yields results similar to TESE, and can be applied in
cases of non-obstructive azoospermia as a prerequisite modality enabling us
to avoid testicular biopsy in 35% of cases.
相似文献
5.
Friedler S; Raziel A; Strassburger D; Soffer Y; Komarovsky D; Ron-El R 《Human reproduction (Oxford, England)》1997,12(7):1488-1493
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.
相似文献
6.
Oates RD; Mulhall J; Burgess C; Cunningham D; Carson R 《Human reproduction (Oxford, England)》1997,12(4):734-739
Testicular tissue extraction (TESE) to obtain spermatozoa for use with
intracytoplasmic sperm injection (ICSI) has recently been employed in
patients with non-obstructive azoospermia. Standard protocol is to retrieve
a new sample of testis tissue on the day of oocyte recovery. Unfortunately,
approximately 30% of men will possess no spermatozoa in their tissue,
making ICSI an impossibility. We investigated whether testicular tissue
that was intentionally obtained well before any planned ICSI cycle and
cryopreserved could then serve as an efficacious sperm source in a
subsequent ICSI cycle. This study reports on 10 men with non-obstructive
azoospermia who did have spermatozoa found within their testis tissue at
the time of TESE and who chose to use their frozen samples as the source of
spermatozoa for a later cycle of ICSI. In 19 cycles the overall
fertilization rate was 48%. Embryo transfer occurred in 89% of cycles. Two
couples have achieved pregnancy (one ongoing, one delivered). All patients
except one had multiple vials of frozen tissue remaining following their
first cycle. This approach is offered as an alternative to repeated
testicular tissue sampling, as the availability of spermatozoa is assured
prior to the initiation of ovulation induction. This tissue can be
harvested at the same time as diagnostic biopsy, thereby minimizing the
number of surgical procedures.
相似文献
7.
Amer M Haggar SE Moustafa T Abd El-Naser T Zohdy W 《Human reproduction (Oxford, England)》1999,14(12):3030-3034
Testicular sperm extraction (TESE) may not always be successful in patients with non-obstructive azoospermia, as they only have minute foci of active spermatogenesis from which a tiny number of spermatozoa can be extracted. The aim of this study was to find the percentile incidence of successful TESE in non-obstructive azoospermia patients in relation to various histopathological patterns and the number of performed biopsies, and to determine the optimal time needed for repetition. A total of 216 patients underwent bilateral testicular biopsy taking a single piece from each testis for sperm retrieval and pathological evaluation. In another 100 patients, the same procedure was done but taking multiple samples (maximum four samples/testis). Spermatozoa were successfully retrieved from 37.5 and 49% of patients who supplied single and multiple samples respectively. TESE was significantly higher when multiple samples were taken in all histopathological groups except for Sertoli cell-only syndrome, tubular sclerosis and Klinefelter's pattern. Twenty-seven patients underwent repeated TESE for ICSI between 1 and 24 months from the first procedure; all of them had easy sperm retrieval during the first procedure. Although sperm retrieval was successful in 75 and 94.7% of patients who underwent the second attempt, before and after 3 months respectively, a second TESE was usually more difficult and necessitated multiple sampling. 相似文献
8.
Liu J; Tsai YL; Katz E; Compton G; Garcia JE; Baramki TA 《Human reproduction (Oxford, England)》1997,12(8):1667-1672
The effect of in-vitro culture on the motility and morphology of fresh and
frozen-thawed human testicular spermatozoa obtained from obstructive
azoospermic patients and on the motility of testicular spermatozoa obtained
from non-obstructive azoospermic patients was evaluated. The outcome of
intracytoplasmic sperm injection (ICSI) with fresh and frozen-thawed human
testicular spermatozoa was studied. The results showed that significant
improvement of sperm morphology and motility was observed in culture of
fresh (n = 17) and frozen-thawed (n = 15) testicular sperm samples obtained
from patients with obstructive azoospermia. The motility of cultured
testicular spermatozoa reached a peak at 72 h without the need for special
media. In six of 20 samples obtained from patients with non-obstructive
azoospermia, improvement of sperm motility was observed. When only
non-motile testicular spermatozoa were cultured, they all remained
non-motile (n = 9). In patients with obstructive azoospermia, fertilization
rates of 80 and 81% were obtained using ICSI with fresh and frozen-thawed
testicular spermatozoa respectively. Clinical pregnancies were observed in
four out of nine patients with fresh testicular spermatozoa and two out of
five patients after using frozen-thawed spermatozoa. When fresh testicular
spermatozoa obtained from patients with non-obstructive azoospermia were
used for ICSI, the fertilization rate was 68% and two out of seven patients
achieved clinical pregnancies. In conclusion, the morphology and motility
of fresh and frozen-thawed testicular spermatozoa in patients with
obstructive azoospermia can be significantly improved after in-vitro
culture. The outcome of in-vitro culture of testicular spermatozoa in
patients with non-obstructive azoospermia is unpredictable. In-vitro
culture of non-motile testicular spermatozoa is not successful so far. The
outcome of ICSI with fresh and with frozen-thawed testicular spermatozoa
was similar.
相似文献
9.
Silber Sherman J.; Nagy Zsolt; Liu Jian; Tournaye Herman; Lissens Willy; Ferec C.; Liebaers Ingeborg; Devroey Paul; Van Steirteghem Andre C. 《Human reproduction (Oxford, England)》1995,10(8):2031-2043
The results and rationale of using testicular and epididymalspermatozoa with intracytoplasmic sperm injection (ICSI) forsevere cases of male infertility are reviewed. A total of 72consecutive microsurgical epididymal sperm aspiration (MESA)cases were performed for congenital absence of the vas (CAV)and for irreparable obstructive azoospermia. ICSI was used toobtain normal embryos for transfer and fertilization in 90%of the cases. The overall fertilization rate was 46% with anormal cleavage rate of 68%. The pregnancy and delivery ratesper transfer were 58 and 37% respectively. The delivery rateper cycle was 33%. In many cases, no epididymal spermatozoawere available and so testicular sperm extraction (TESE) wasused for sperm retrieval. The transfer rate was lower with TESE(84 versus 96%) and the spermatozoa could not be frozen andsaved for use in future cycles. However, there was little differencein pregnancy rates using epidiymal or testicular spermatozoa.The results were not affected by whether the obstruction wascaused by CAV or failed vasoepididymostomy. Both fresh and frozenspermatozoa gave similar results; the only significant factorappeared to be the age of the female. Because of the consistentlygood results obtained using epididymal sperm with ICSI whencompared with conventional IVF, and the similarly good resultswith testicular tissue spermatozoa, ICSI is mandatory for allfuture MESA patients. All CAV patients and their partners shouldbe offered genetic screening for cystic fibrosis; hence pre-implantationembryo diagnosis should be available in any full service MESAprogramme. It is now clear that even with non-obstructive azoospermia,e.g. Sertoli-cell only, or maturation arrest, there are usuallysome small foci of spermatogenesis which allow TESE with ICSIto be carried out. This means that even in men with azoospermiadue to absence of spermatogenesis or to a block in meiosis,there are usually a few spermatozoa available in the testesthat are adequate for successful ICSI. Finally, it is likelythat some forms of severe male factor infertility are geneticallytransmitted and although ICSI offspring have been shown to becompletely normal, it is possible that the sons of these infertilecouples will also require ICSI when they grow up and wish tohave a family. 相似文献
10.
Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. 总被引:9,自引:0,他引:9
P N Schlegel 《Human reproduction (Oxford, England)》1999,14(1):131-135
Testicular sperm extraction (TESE) is often an effective method for sperm retrieval from men with non-obstructive azoospermia. However, TESE has been a blind procedure that does not identify the focal sperm-producing areas of the testicle until after tissue has been excised from the patient. Experience with a new technique of microdissection of testicular tubules is presented here that identifies sperm-containing regions before their removal. Identification of spermatogenically active regions of the testicle is possible by direct examination of the individual seminiferous tubules. The underlying concept for this technique is simple: seminiferous tubules containing many developing germ cells, rather than Sertoli cells alone, are likely to be larger and more opaque than tubules without sperm production. In a sequential series of TESE cases for men with non-obstructive azoospermia, the ability to find spermatozoa increased from 45% (10/22) to 63% (17/27) after introduction of the microdissection technique. Microdissected samples yielded an average of 160,000 spermatozoa per sample in only 9.4 mg of tissue, whereas only 64,000 spermatozoa were found in standard biopsy samples that averaged 720 mg in weight (P < 0.05 for all comparisons). For men where microdissection was attempted, successful identification of enlarged tubules was possible in 56% (15/27) of cases. However, spermatozoa were retrieved with microdissection TESE for six men in whom sperm retrieval was unsuccessful with standard TESE approaches (35% of all men with spermatozoa retrieved). These findings suggest that microdissection TESE can improve sperm retrieval for men with non-obstructive azoospermia over that achieved with previously described biopsy techniques. 相似文献
11.
Criteria predicting the absence of spermatozoa in the Sertoli cell-only syndrome can be used to improve success rates of sperm retrieval 总被引:5,自引:0,他引:5
Anniballo R Ubaldi F Cobellis L Sorrentino M Rienzi L Greco E Tesarik J 《Human reproduction (Oxford, England)》2000,15(11):2269-2277
In patients with non-obstructive azoospermia, testicular sperm extraction (TESE) is a method of choice to recover spermatozoa as a male therapeutic approach in intracytoplasmic sperm injection (ICSI) programmes. However, the efficacy of TESE in this indication is burdened by a frequent failure of sperm recovery, which renders useless both the invasive testicular intervention and ovarian stimulation of the patient's spouse. One of the most frequent pathological pictures characterizing complete absence of spermatozoa is germinal aplasia (Sertoli cell- only syndrome or SCOS). Two different histological patterns of SCOS have been already described during the past five decades. These two patterns can be characterized as the congenital (pure) and the secondary (mixed) forms. Both patterns, with different prognosis to retrieve spermatozoa by therapeutic testicular biopsy, are frequently confused when TESE is performed during ICSI programmes. Useful criteria to predict the absence of spermatozoa can be obtained by a definite recognition of the two typical histological patterns during the diagnostic testicular biopsy. The diagnosis of congenital or acquired SCOS can be refined by endocrine, chemical, immunohistochemical and molecular biology aids. Reduction of both sperm retrieval failure and unnecessary ovarian stimulation can be achieved by combination of these methods. 相似文献
12.
M Amer T Abd Elnasser S El Haggar T Mostafa G Abdel-Malak W Zohdy 《Human reproduction (Oxford, England)》2001,16(7):1427-1432
BACKGROUND: Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) have become standard treatments for patients with non-obstructive azoospermia. A diagnostic testicular biopsy for histopathological examination is not always predictive of TESE outcome. Moreover, it is not without potential complications. The aim of this study was to determine the value of various clinical and laboratory parameters, particularly identification of seminal spermatids using May-Grünwald-Giemsa (MGG) stain in predicting TESE results. METHODS: A total of 100 patients with non-obstructive azoospermia was subjected to clinical examination, serum FSH measurement, identification of seminal spermatids and spermatocytes using MGG staining and TESE with multiple testicular sampling. Spermatozoa were retrieved from 49% of patients. Results of TESE were compared with previous parameters in addition to histopathology. RESULTS: Testicular histopathology was, in general, an inaccurate parameter, and identification of testicular spermatids by histology predicted successful TESE in only 74% of cases. Testicular volume and serum FSH concentration also had poor predictive values. Round spermatids were identified in the ejaculate of 83.7% of TESE-positive cases, and in 22% of TESE-negative cases. CONCLUSIONS: The detection of round spermatids in semen by MGG staining provides the greatest predictive value for successful testicular sperm retrieval, and also has the advantages of simplicity, low cost and availability. 相似文献
13.
Spermatozoa recovered from testicular biopsies can be used through
intracytoplasmic sperm injection (ICSI) to achieve a pregnancy. To assess
the likelihood of successful testicular sperm extraction (TESE) in men
suffering from severe oligo- or azoospermia, bilateral biopsy specimens
were obtained. Following semi-thin sectioning, the morphology of testicular
samples was graded according to a modified Johnsen score. TESE was
performed in parallel to this histological examination. The number of
isolated spermatozoa was assessed in a semiquantitative way. From 103
patients investigated, 64 (62.1%) showed azoospermia in a preceding semen
analysis and 29 (28.2%) patients had sperm concentrations between 0.1 and 1
x 10(6)/ml. In 10 patients who had higher sperm counts, most spermatozoa
were non-motile. Spermatozoa could be detected after TESE in the testicular
tissue of 49 (77%) azoospermic men. When follicle stimulating hormone (FSH)
concentration was normal, most patients had detectable spermatozoa after
TESE. Nearly one-third of patients with mildly elevated FSH had no
spermatozoa. Thirty-nine percent of patients in whom FSH was elevated to
more than twice normal and 50% of patients with grossly elevated FSH had no
detectable spermatozoa. In all, 82.8% of men with sperm concentrations
between 0.1 and 1x10(6)/ml in their ejaculate showed spermatozoa in the
tissue sample after TESE. Our data demonstrate that, contrary to previous
recommendations, infertile men with azoospermia and high FSH values should
be reconsidered for testicular biopsy, provided that tissue samples can be
cryopreserved for later TESE/ICSI treatment.
相似文献
14.
Outcome of testicular sperm recovery and ICSI in patients with non-obstructive azoospermia with a history of orchidopexy 总被引:1,自引:0,他引:1
Vernaeve V Krikilion A Verheyen G Van Steirteghem A Devroey P Tournaye H 《Human reproduction (Oxford, England)》2004,19(10):2307-2312
BACKGROUND: Little is known about sperm recovery and ICSI using testicular sperm from men with non-obstructive azoospermia who had a previous orchidopexy. We therefore studied the sperm recovery in this subgroup and evaluated clinical parameters predicting successful sperm retrieval and the outcome of ICSI. METHODS: A total of 79 non-obstructive azoospermic men with a history of orchidopexy underwent a sperm recovery procedure. The predictive value of clinical parameters such as age at sperm retrieval, age at orchidopexy, testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index (LH x testosterone) for successful testicular sperm retrieval was evaluated using receiver operating characteristics (ROC) curve analysis. A comparison between 64 ICSI cycles performed in these couples and 92 cycles performed in couples in which the men had an unexplained non-obstructive azoospermia was carried out. RESULTS: Testicular spermatozoa were recovered in 41 patients (52%). The mean age at orchidopexy of the patients with a positive sperm recovery was 10.6 years [95% confidence interval (CI) 7.3-13.8] versus 15.5 years (95% CI 11.3-19.8) for those where no spermatozoa were found. The mean testicular volume of the largest testis of patients with spermatozoa found was 10 ml (95% CI 8.3-11.9) versus 8.5 ml (95% CI 5.8-11.1) in patients with no spermatozoa found. The mean FSH and testosterone value for patients with successful and unsuccessful sperm recovery, respectively, was 24.1 IU/l (95% CI 17.9-30.3) and 4.4 ng/ml (95% CI 3.7-5.1) versus 28.8 IU/l (95% CI 19.4-38.2) and 3.4 ng/ml (95% CI 2.2-4.5). All clinical and biological parameters examined failed to predict the outcome of the testicular sperm extraction. No differences were observed between the orchidopexy and unexplained group for the number of oocytes retrieved, fertilization rate, embryo quality, pregnancy rate and implantation rate. CONCLUSIONS: As in the population of men with non-obstructive azoospermia, the sperm recovery rate for patients with a history of orchidopexy is approximately 50% and there are currently no clinical parameters predicting successful sperm retrieval in this subpopulation of patients. The outcome of the ICSI cycles is comparable with that in the population of men with non-obstructive azoospermia. 相似文献
15.
Fertilization, pregnancy and embryo implantation rates after ICSI in cases of obstructive and non-obstructive azoospermia 总被引:2,自引:0,他引:2
De Croo I Van der Elst J Everaert K De Sutter P Dhont M 《Human reproduction (Oxford, England)》2000,15(6):1383-1388
The aetiology of azoospermia can be grossly divided into obstructive and non-obstructive causes. Although in both cases testicular spermatozoa can be used to treat male fertility, it is not well established whether success rates following intracytoplasmic sperm injection (ICSI) are comparable. Therefore, a retrospective analysis of fertilization, pregnancy and embryo implantation rates was performed following ICSI with testicular spermatozoa in obstructive or non-obstructive azoospermia. In total, 193 ICSI cycles were carried out with freshly retrieved testicular spermatozoa; in 139 cases of obstructive and 54 cases of non-obstructive azoospermia. The fertilization rate after ICSI with testicular spermatozoa in non-obstructive azoospermia was significantly lower than in obstructive azoospermia (67.8% versus 74.5%; P = 0.0167). Within the non-obstructive group, the fertilization rate in the group of maturation arrest (47.0%) was significantly lower than in case of Sertoli cell-only (SCO) syndrome (71.2%) or germ cell hypoplasia (79. 5%). Embryo quality on day 2 after ICSI was similar for all groups. Pregnancy rates per transfer between obstructive (36.8%) and non-obstructive groups (36.7%) were similar. In cases of maturation arrest the pregnancy rate per transfer was lowest (20.0%) although not significantly different from SCO syndrome or hypoplasia groups. Embryo implantation rates were not different between the obstructive (19.6%) and non-obstructive groups (25.8%), and were lowest in cases of germ cell hypoplasia (15.8%). This retrospective analysis shows that although fertilization rate after ICSI with testicular spermatozoa in non-obstructive azoospermia is significantly lower than in obstructive azoospermia, pregnancy and embryo implantation rates are similar. 相似文献
16.
Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia: percutaneous aspiration versus open biopsy 总被引:4,自引:0,他引:4
Mercan R Urman B Alatas C Aksoy S Nuhoglu A Isiklar A Balaban B 《Human reproduction (Oxford, England)》2000,15(7):1548-1551
The aim of this study was to evaluate whether the extraction of testicular spermatozoa with percutaneous versus open biopsy has an effect on the treatment outcome with intracytoplasmic sperm injection (ICSI) in men with non-obstructive azoospermia. Regardless of testicular size, follicle stimulating hormone concentration, and previous biopsy result, percutaneous testicular sperm aspiration (PTSA) using a 21-gauge butterfly needle was attempted first and if this failed testicular sperm extraction (TESE) was performed. In 63 men spermatozoa were found with PTSA whereas in 228 men TESE had to be undertaken. More men in the PTSA group had previously been diagnosed with hypospermatogenesis (82 versus 50%). Compared with the PTSA group, more men in the TESE group had germ cell aplasia (27 versus 10%) or maturation arrest (22 versus 8%). There was no difference between the groups regarding mean age of men and their partners, duration of stimulation, oestradiol concentration on the day of human chorionic gonadotrophin, number of oocytes retrieved, fertilization rate, and embryo quality between the two groups. The number of embryos transferred (4.38 versus 3.90) was significantly higher in the PTSA group (P < 0.05), reflecting the increased number of embryos available for transfer. Implantation rate per embryo was 20.7% in the PTSA and 13.3% in the TESE group (P < 0.05). Clinical pregnancy rates were 46 and 29% in the PTSA and TESE groups respectively (P < 0.05). Clinical abortion rates were similar (21.2 versus 24%). It is concluded that in men with non-obstructive azoospermia, easier sperm retrieval, which is most likely indicative of a more favourable histopathology, is associated with higher implantation rates per embryo. 相似文献
17.
F M K?hn I Schroeder-Printzen W Weidner M Montag H van der Ven W B Schill 《Human reproduction (Oxford, England)》2001,16(11):2343-2346
A new indication for testicular tissue cryopreservation is demonstrated in a patient with metachronous bilateral testicular tumours and azoospermia. At the age of 18 (1982) the patient underwent left orchidectomy and radical retroperitoneal lymphadenectomy for a testicular teratoma (pT1N0M0). Semen samples were not cryopreserved because of absence of motile spermatozoa after thawing. Seventeen years after the primary testicular cancer, a seminoma of the contralateral right testis was diagnosed (pT1N0M0). Since the patient was azoospermic, no semen samples could be cryopreserved. However, spermatozoa were detected in testicular biopsy material of the right testis and were cryopreserved for ICSI. Since all spermatozoa were dead after thawing, testicular sperm extraction (TESE) was performed in the remaining tissue samples at the time of ICSI treatment. Only spermatids could be extracted from frozen-thawed samples due to the inhomogeneous distribution of spermatogenic activity in the testicular tissue. Although one oocyte was fertilized with these spermatids, a clinical pregnancy was not achieved. Despite the disappointing results of ICSI in the couple presented here, this case report demonstrates that cryopreservation of testicular tissue and TESE should be considered in patients with bilateral testicular tumours and azoospermia, if frozen semen samples are not available. 相似文献
18.
Silber SJ; Nagy Z; Devroey P; Tournaye H; Van Steirteghem AC 《Human reproduction (Oxford, England)》1997,12(11):2422-2428
The aim of the study was to determine whether a prior diagnostic testicle
biopsy can predict success or failure of testicular sperm extraction (TESE)
with intracytoplasmic sperm injection (ICSI) in patients with
non-obstructive azoospermia caused by testicular failure, and what is the
minimum threshold of sperm production in the testis which must be surpassed
for spermatozoa to reach the ejaculate. Forty- five patients with
non-obstructive azoospermia caused by testicular failure underwent
diagnostic testicle biopsy prior to a planned future TESE-ICSI procedure.
The diagnostic testicle biopsy was analysed quantitatively, and correlated
with the quantitative findings of spermatogenesis in patients with normal
spermatogenesis, as well as with the results of subsequent attempts at
TESE-ICSI. Men with non- obstructive azoospermia caused by germinal failure
had a mean of 0-6 mature spermatids/seminiferous tubule seen on a
diagnostic testicle biopsy, compared to 17-35 mature spermatids/tubule in
men with normal spermatogenesis and obstructive azoospermia. These findings
were the same for all types of testicular failure whether Sertoli cell
only, maturation arrest, cryptorchidism, or post-chemotherapy azoospermia.
Twenty-two of 26 men with mature spermatids found in the prior testis
biopsy had successful retrieval of spermatozoa for ICSI, 12 of their
partners became pregnant, and are either ongoing or delivered. The study
suggests that 4-6 mature spermatids/tubule must be present in the testis
biopsy for any spermatozoa to reach the ejaculate. More than half of
azoospermic patients with germinal failure have minute foci of
spermatogenesis which are insufficient to produce spermatozoa in the
ejaculate. Prior diagnostic testicle biopsy analysed quantitatively (for
the presence of mature spermatids) can predict subsequent success or
failure with TESE-ICSI. Incomplete testicular failure may involve a sparse
multi-focal distribution of spermatogenesis throughout the entire testicle,
rather than a regional distribution. Therefore, it is possible that massive
testicular sampling from many different regions of the testes may not be
necessary for successful TESE-ICSI.
相似文献
19.
Mansour RT; Kamal A; Fahmy I; Tawab N; Serour GI; Aboulghar MA 《Human reproduction (Oxford, England)》1997,12(9):1974-1979
We compared the results of intracytoplasmic sperm injection (ICSI) in: (i)
obstructive versus non-obstructive azoospermia, (ii) obstructive
azoospermia using epididymal versus testicular spermatozoa and (iii)
acquired versus congenital obstructive azoospermia due to congenital
absence of the vas deferens (CAVD). A retrospective analysis was done of
241 consecutive ICSI cycles done in 103 patients with non- obstructive
azoospermia and 119 patients with obstructive azoospermia. In the
obstructive group, 135 ICSI cycles were performed. Epididymal spermatozoa
were used in 44 cycles and testicular spermatozoa in 91 cycles. In the
non-obstructive group, 106 cycles were performed. The fertilization and
pregnancy per cycle rates were 59.5 and 27.3% respectively using epididymal
spermatozoa, 54.4 and 31.9% respectively using testicular spermatozoa in
obstructive cases, and 39 and 11.3% respectively in non-obstructive cases.
The fertilization and pregnancy per cycle rates were 56.6 and 37%
respectively in acquired obstructive cases, and 55.2 and 20.4% respectively
in CAVD. In conclusion, ICSI using spermatozoa from patients with acquired
obstructive azoospermia resulted in significantly higher fertilization and
pregnancy rates as compared to CAVD and non-obstructive cases.
相似文献
20.
Fahmy I Kamal A Shamloul R Mansour R Serour G Aboulghar M 《Human reproduction (Oxford, England)》2004,19(7):1558-1561
BACKGROUND: The aim of this study was to assess the use of testicular sperm for ICSI in azoospermic men with hypogonadotrophic hypogonadism unresponsive to gonadotrophin therapy. METHODS: Fifteen patients with hypogonadotrophic hypogonadism who remained azoospermic after hormonal treatment underwent testicular sperm extraction (TESE) and ICSI. These men were recruited from the Egyptian IVF centre over a period of 4 years. All patients were given 75 IU hMG thrice weekly and 5000 IU hCG once or twice weekly for >/=6 months prior to attempting ICSI/TESE. RESULTS: In 11 out of 15 patients (73%), sperm could be retrieved from testicular tissue and were used for ICSI. Two chemical pregnancies resulted but no clinical pregnancies. Nine patients continued gonadotrophin therapy for another 6 months. Sperm appeared in the ejaculate of three of them. The remaining six patients underwent another ICSI cycle, one using cryopreserved sperm and five underwent a second TESE. One chemical pregnancy and three clinical pregnancies were established. One ongoing, one singleton and one twin pregnancies resulted in the delivery of three healthy babies. In total, of 17 ICSI cycles performed using testicular sperm retrieval, the fertilization rate was 41.7% and the cumulative pregnancy rate was 20%. CONCLUSIONS: The use of testicular sperm for ICSI is a treatment option that can be offered to azoospermic males with hypogonadotrophic hypogonadism either not responding or reluctant to continue hormonal treatment. However, prolonged hormonal treatment may improve TESE/ICSI results. 相似文献