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。     

Paternal age as an independent factor does not affect embryo quality and pregnancy outcomes of testicular sperm extraction‐intracytoplasmic sperm injection in azoospermia

This study was performed to evaluate the independent influence of paternal age affecting embryo development and pregnancy using testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI) in obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). Paternal patients were divided into the following groups: ≤30 years, 31–35 years, 36–40 years, 41–45 years and ≥46 years. There were no differences in the rates of fertilisation or embryo quality according to paternal and maternal age. However, clinical pregnancy and implantation rates were significantly lower between those ≥46 years of paternal age compared with other age groups. Fertilisation rate was higher in the OA than the NOA, while embryo quality, pregnancy and delivery results were similar. Clinical pregnancy and implantation rates were significantly lower for patients ≥46 years of paternal age compared with younger age groups. In conclusion, fertilisation using TESE in azoospermia was not affected by the independent influence of paternal age; however, as maternal age increased concomitantly with paternal age, rates of pregnancy and delivery differed between those with paternal age <41 years and ≥46 years. Therefore, paternal age ≥46 years old should be considered when applying TESE‐ICSI in cases of azoospermia, and patients should be advised of the associated low pregnancy rates.     

无精子症病人100例取精方法及妊娠结局

目的 :回顾性分析 2 0 0 1年 1月～ 2 0 0 2年 1月在生殖中心行卵胞质内单精子注射 (ICSI)治疗的 10 0例无精子症男性的治疗结果。　方法 :经皮附睾精子抽吸术 (PESA)或睾丸精子抽提术 (TESE)获得精子 ,女方进行常规超排卵。分析激素水平 ,行睾丸组织学检查 ,评估取精的成功率、受精率、种植率和临床妊娠率。　结果 :76例(76 % )经PESA获得精子 ,2 3例 (2 3% )通过TESE获得精子。PESA和TESE组的受精率、种植率和临床妊娠率分别为 71.3%和 75 .18% ,2 0 .35 %和 2 2 .0 5 % ,4 2 .11%和 4 1.6 0 %。PESA组有 32例临床妊娠 ,其中 15例继续妊娠 ,15例已分娩 ,2例流产。TESE组有 10例临床妊娠 ,其中 6例继续妊娠 ,2例已分娩 ,2例流产。两组的受精率、种植率和临床妊娠率差异无显著性。在TESE组有 1例取精失败而放弃治疗。　结论 :激素水平和睾丸组织学检查不能预测附睾或睾丸取精的成功 ,PESA和TESE获得精子进行单精子注射是治疗男性无精子症的有效方法 ,两组的受精率 ,种植率和临床妊娠率差异无显著性 (P >0 .0 5 )。     

Intracytoplasmic sperm injection in the treatment of male infertility due to obstructive or non-obstructive azoospermia

<正> Objective:To evaluate the effects of intracytoplasmic sperm injection (ICSI) ontreatment of infertility due to obstructive and non-obstructive azoospermia.Methods:A retrospective analysis of fertilization,cleavage,embryo implantationand pregnancy rates was done in 158 ICSI cycles including 112 obstructive azoospermiaand 46 non-obstructive azoospermia.Ovarian hyperstimulation and ICSI procedureswere performed by conventional protocol.The sperm was collected by percutaneous epi-didymal sperm aspiration (PESA) or testicular sperm extraction (TESE).Results:The fertilization rate (73.1% vs.67.0%),cleavage rate (88.6% vs.86.3%),embryo implantation rate (20.7% vs.11.4%),clinical pregnancy rate per trans-fer cycle (35.7% vs.19.6%) were obtained for obstructive and non-obstructiveazoospermia,respectively.Conclusion:The results revealed that in the cases of obstructive azoospermia,ferti-lization rate,embryo implantation rate and clinical pregnancy rate were significantlyhigher than those of non-obstructive azoospermia.But there was no significant differ-ence of the cleavage rate between two groups.     

Intracytoplasmic sperm injection by testicular sperm in patients with aspermia or azoospermia after cancer treatment

The aim of this retrospective study was to evaluate the efficiency of testicular biopsy and intracytoplasmic sperm injection (ICSI) in patients with aspermia or non-obstructive azoospermia (NOA) after cancer treatment. From 1996 to 2003, 30 men with a history of cancer, affected by aspermia or NOA and without sperm cryopreserved before cytotoxic treatment underwent testicular sperm extraction (TESE). In these men, clinical, hormonal and histological characteristics were compared; 13 underwent 39 TESE-ICSI cycles using frozen-thawed testicular spermatozoa (TESE-ICSI group). In the same period, 31 ICSI cycles were performed in 20 men with aspermia or NOA using ejaculated sperm frozen before cancer treatment (ejaculated sperm-ICSI group). Fertilization, blastocyst development, pregnancy and miscarriage rates were compared between the groups. Testicular volume, serum follicle-stimulating hormone level and Johnsen score indicated complete although reduced spermatogenesis in men with aspermia and abnormal spermatogenesis in men with NOA. After TESE, sperm retrieval was positive in 92% of men with aspermia and 58% of men with NOA. In TESE-ICSI patients with NOA a significantly lower proportion of embryos developed to the blastocyst stage than in patients with aspermia and in those after ICSI with frozen-thawed ejaculated sperm (23% vs. 43% and 47%, p = 0.03 and p < 0.01 respectively). In all groups the miscarriage rates were high; in patients with aspermia and NOA, characterized by increased age, the miscarriage rate tended to be higher in spite of similar female age and female indications of infertility. In patients affected by aspermia or NOA after cancer treatment and without sperm cryopreserved before treatment, TESE-ICSI using testicular sperm provide a chance to father a child.     

附睾及睾丸精子行ICSI治疗无精子症妊娠结局

目的 :回顾性分析 5 0例无精子症患者利用附睾或睾丸精子行卵细胞胞质内单精子注射 (ICSI)的治疗结局。　方法 :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,评估取精的成功率 ,ICSI后的受精率、种植率及临床妊娠率 ,以精液精子ICSI组作为对照。　结果 :PESA、TESE与精液精子组分别注射MⅡ期成熟卵子 2 86、36 0、15 6 9个 ,受精率 3组差异无显著性 (74 .8% ,75 .2 %vs 77.5 % ,P >0 .0 5 )。种植率、妊娠率TESE与精液精子组差异无显著性 (2 9.87%vs 2 9.5 4 % ;4 8.15 %vs 5 2 .6 0 % ,P >0 .0 5 ) ,PESA组显著高于TESE组及精液精子组 (5 0 .85 %vs 2 9.87% ,2 9.5 4 % ;6 8%vs 4 8.15 % ,5 2 .6 0 % ,P <0 .0 5 )。PESA组共妊娠 17例 ,已分娩 6例 ,继续妊娠 9例 ,流产 2例 ;TESE组共妊娠 13例 ,已分娩 7例 ,继续妊娠 4例 ,流产 2例。　结论 :采用附睾或睾丸精子行ICSI是治疗男性无精子症的有效方法。     

Reproductive outcome of men with azoospermia due to cryptorchidism using assisted techniques

The aetiology of cryptorchidism is still undiscernible in the majority of cases. It has long been argued that cryptorchidism reflects a primary testicular maldevelopment, where the contralateral scrotal testis also suffers from aspermatogenesis and low spermatogonia count. The aim of the study was to determine the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy after testicular sperm extraction (TESE) and intracytoplasmatic sperm injection (ICSI). In a retrospective analysis, we compared the sperm retrieval, fertilization, pregnancy and live birth rates after ICSI of consecutive ex-cryptorchid azoospermic patients ( n  = 15) undergoing TESE between Jan 2000 and Dec 2007 vs. non-cryptorchid azoospermic men ( n  = 142). Sperm retrieval rate of ex-cryptorchid men by TESE (66%) was comparable with non-cryptorchid men (47%) ( p  = 0.15) despite significantly higher FSH levels (30.7 ± 25.4 vs. 17.9 ± 14.8 respectively) ( p  = 0.018) and a more prevalent histopathology diagnosis of aspermatogenesis (75% vs. 40%, p  = 0.046). Fertilization (43.3%), pregnancy (30%) and live birth (20%) rates after TESE–IVF–ICSI in the ex-cryptorchid group were not different from the non-cryptorchid group (48.7, 43 and 29%, p  = 0.26, p  = 0.21, p  = 0.29 respectively). We conclude that the reproductive outcome of ex-cryptorchid men with azoospermia post-orchidopexy employing TESE–IVF–ICSI is comparable with non-cryptorchid azoospermic men.     

Microsurgical vasovasostomy versus microsurgical epididymal sperm aspiration/testicular extraction of sperm combined with intracytoplasmic sperm injection. A cost-benefit analysis

PURPOSE: Vasovasostomy (VVS) represents the standard therapy of choice for the treatment of obstructive azoospermia following vasectomy. However, recently, intracytoplasmic sperm injection (ICSI) has been suggested by some to represent the solution for all cases of malefactor infertility regardless of its etiology based on its success rates. Therefore, we compared VVS to microsurgical epididymal sperm aspiration (MESA)/testicular extraction of sperm (TESE) and ICSI in terms of pregnancy, complications, and costs. PATIENTS AND METHODS: Between 1/93 and 6/98, 157 VVS were performed microsurgically using the double-layer technique. Between 9/94 and 9/97, 69 and 42 couples underwent MESA/ICSI and TESE/ICSI, respectively, for epididymal obstruction and azoospermia of testicular origin. RESULTS: The mean interval of vasal obstruction was 7.6 (0.5-18) years; patency after VVS was 77%, pregnancy rate was 52%. Local complication rate was 4.7%, no major complications were observed. Costs per life birth after VVS were 5,447 DM or 2,793 Euro. Pregnancy rates after MESA/TESE and ICSI were 22.5 and 19.5%, respectively, with 16 singletons, 3 twins and 3 abortions; local complications occurred in 3.9% of the men. Multiple births were noticed in 15.8% following ICSI, but in only 0.7% following VVS. 5.7 and 1.4% of the female partners experienced serious complications (mild or severe ovarian hyperstimulation syndrome, respectively). Costs per life birth after a MESA/TESE cycle amounted to 28,804 DM or 14,547 Euro. CONCLUSIONS: Even in the era of ICSI, microsurgical VVS represents the standard approach for obstructive azoospermia following vasectomy. Based on a cost-benefit analysis, VVS is more successful in terms of pregnancy rates (52 vs. 22.5%). VVS does not expose the female partners to complications following treatment of male infertility. In contrast to ICSI, multiple birth rates do not increase after VVS. We conclude that MESA/ICSI should be reversed for patients who are not amenable for microsurgical reconstruction.     

Efficiency of percutaneous testicular sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia

PURPOSE: We determined the feasibility of obtaining mature spermatozoa for intracytoplasmic sperm injection (ICSI) by percutaneous testicular sperm aspiration in men with nonobstructive azoospermia. We also compared the results of ICSI using spermatozoa recovered by open excisional biopsy versus percutaneous testicular sperm aspiration. MATERIALS AND METHODS: A total of 84 men with nonobstructive azoospermia underwent percutaneous testicular sperm aspiration to recover testicular spermatozoa for ICSI on the day of ova retrieval from the wife. Percutaneous testicular sperm aspiration was performed with the patient under general anesthesia in the upper and lower poles of each testis. It was followed by immediate microscopic search of the aspirate to confirm the presence of spermatozoa. In the absence of spermatozoa open excisional biopsy was performed in the same setting. RESULTS: Percutaneous testicular sperm aspiration resulted in the recovery of mature spermatozoa in 45 men (53.6%). Of the remaining 39 men (46.4%) requiring open biopsy adequate spermatozoa were recovered in 28 (71.8%). Although the fertilization rate was significantly higher in the sperm aspiration group, the cleavage and pregnancy rates were similar in the 2 groups. CONCLUSIONS: Percutaneous testicular sperm aspiration was a successful initial approach to collect mature spermatozoa in a high proportion of men with nonobstructive azoospermia. It is safe, minimally invasive and well tolerated by all patients.     

Impact of testicular histopathology as a predictor of sperm retrieval and pregnancy outcome in patients with nonobstructive azoospermia: correlation with clinical and hormonal factors

In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE.     

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.     

Comparison of pregnancy and neonatal outcomes of intracytoplasmic sperm injection performed with frozen versus fresh testicular sperm

BackgroundIt remains controversial whether there is a difference in the prognosis of intracytoplasmic sperm injection (ICSI) using frozen or fresh testicular sperm in patients with obstructive azoospermia (OA). Moreover, in the available studies, few have tracked neonatal outcomes. This study aimed to compare the pregnancy and neonatal outcomes of ICSI using cryopreserved sperm versus fresh sperm collected by testicular sperm aspiration (TESA).MethodsA total of 317 OA patients treated with ICSI in a university affiliated hospital from January 2016 to December 2020 were included in this study. The participants were divided into two groups according to the type of sperm used for ICSI: frozen sperm group (n=154) and fresh sperm group (n=163). The pregnancy and neonatal outcomes of the two groups were compared.ResultsThe data produced by this study showed no significant statistical difference in the 2 pronuclei (2PN) fertilization rate, 2PN cleavage rate, high-quality blastocyst rate, and the average number of transferred embryos in the frozen and fresh sperm groups. Similarly, no difference was found in implantation rate, clinical pregnancy rate, multiple pregnancy rate, miscarriage rate, premature delivery rate, live birth rate, and gender ratio at birth (P>0.05). The average newborn birth weight was similar in both groups (2,932.61±728.40 vs. 3,100.32±515.64 g, respectively) (P>0.05). A higher incidence of low birthweight (LBW) newborns was found in the frozen sperm group (20.91% vs. 8.49%) (P<0.05). Multiple logistic regression analysis showed that LBW is related to single or twin pregnancies (P<0.01), but not sperm (frozen or fresh) (P>0.05). We further analyzed the twin and single pregnancies in the two groups separately, and found that the incidences of LBW were both similar (P>0.05). There was no difference in the Apgar scores at 1 min and 5 min after birth between the two groups (P>0.05).ConclusionsThe use of frozen testicular sperm by TESA was efficient for men with OA. There were similar pregnancy and neonatal outcomes following TESA-ICSI using frozen or fresh sperm in this retrospective study. Prospective investigations are needed for further validation.     

Analysis of outcomes of cryopreserved surgically retrieved sperm for IVF/ICSI

We evaluated our experience to date with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) after either cryopreserved sperm or sperm produced on the date of IVF/ICSI was used. We performed a retrospective statistical analysis of data derived from 188 women undergoing IVF/ICSI cycles using surgically retrieved sperm. A total of 318 IVF/ICSI treatment cycles with 3280 ova were performed using testicular sperm extraction (TESE, 304 cycles) or microsurgical epididymal sperm aspiration (MESA, 14 cycles). Sperm obtained at time of IVF/ICSI (fresh) or thawed cryopreserved sperm samples were used in 38 and 280 of the ICSI cycles, respectively. For IVF/ICSI cycles using both TESE and MESA sperm, the fertilization rate was 59.9% for cryopreserved sperm, and 53.6% when fresh sperm was used (chi2 P-alpha < .02, Cramer's 0.04). The fertilization rate for the TESE group alone was 60.0% for cryopreserved sperm and 55.1% for fresh sperm (chi2P-alpha = .075). Cohen effect size was computed at 0.03; yielding for P-beta = .8, 6597 ova would be required to demonstrate similarity between fresh and cryopreserved sperm in the TESE group. To demonstrate superiority of cryopreserved sperm in this group at a P-alpha significance level of .05, 7524 ova would be necessary. The pregnancy rate for the TESE group was 27.3% for cryopreserved sperm and 27% for fresh sperm. Further analysis of the pregnancy data in this group, using the methods described, yielded a chi2 P-alpha and power of 0.971 (effect size calculated at 0.002). While our fertilization rates for cryopreserved sperm are greater in analyses of surgically derived sperm, based on the 7 years required to obtain data on 3280 ova, full numerical resolution of the issue of whether cryopreserved sperm is superior or similar will not be available until approximately 2010. However, we believe these results, along with the similarity shown in pregnancy rates achieved with both types of sperm, clearly indicate that cryopreserved sperm is not inferior to fresh sperm.     

经皮附睾精子抽吸术和睾丸精子获取术在无精子症诊断和治疗中的应用

目的 :研究附睾和睾丸精子抽吸术对无精子症患者的诊断和治疗价值。　方法 :应用经皮附睾精子抽吸术(PESA)和睾丸精子获取术 (TESE)两种方法对 385例无精子症患者进行穿刺检查。　结果 :其中 6 4例附睾中存在精子 (1 6 .6 2 %) ;4 5例患者睾丸中存在精子 (1 1 .6 9%) ;对其中 6 4例睾丸或附睾中发现精子的患者采取PESA或TESE取精后行卵细胞胞质内单精子注射 (ICSI)治疗。胚胎移植后妊娠率为 39.0 7%。　结论 :PESA和TESE为部分无精子症患者提供了生育的机会 ,也是针对无精子症的有效的治疗手段。     

冻存睾丸精子用于男性生殖力储备的探讨

目的:通过研究对无精子症患者实施睾丸活检或其他手术时冷冻睾丸精子经复苏后行卵细胞胞质内单精子注射(ICSI)助孕的临床效果,探讨冻存睾丸精子作为男性生殖力储备的有效性。方法:回顾性分析了在本院实施睾丸活检或其他手术时冷冻睾丸精子的患者96例,其中的55例已在本中心复苏冷冻精子行ICSI助孕共60个周期,评估其冷冻精子复苏、卵子受精、卵裂、可移植胚胎、优质胚胎、临床妊娠及其分娩情况。结果:复苏冻存睾丸精子60个周期均获成功,复苏后行ICSI技术助孕,受精率77.6%(513/661),2PN受精率69.4%(459/661),卵裂率99.4%(510/513),可利用胚胎率84.5%(431/510),优质胚胎率40.8%(208/510);所有周期均有可移植胚胎;新鲜胚胎移植52个周期,临床妊娠30例(临床妊娠率57.7%),双胎妊娠11例(其中1例双胎自然减为单胎),单胎妊娠19例,种植率为38.7%(41/106),流产率为3.33%(1/30)。目前,已经出生了20例健康婴儿(12个男婴,8个女婴),未发现先天缺陷儿;另外13例(7例单胎和6例双胎)继续妊娠中。结论:睾丸精子冷冻复苏后行ICSI助孕可以得到较好的临床结局。冻存睾丸精子是无精子症男性生殖力储备的有效方式。     

反复附睾或睾丸取精的无精子症病人妊娠结局

目的 :分析反复附睾或睾丸取精进行卵胞质内单精子注射治疗的妊娠结局。　方法 :收集 2 0 0 1年 1月～2 0 0 2年 12月进行 2周期以上附睾或睾丸取精进行卵胞质内单精子注射治疗的无精子症病人 31例 (共 4 3个周期 ) ,对取精情况及受精、种植和妊娠结局进行总结。　结果 :2 4例病人顺利从附睾取精 ,7例病人从睾丸取精 ,无 1例出现感染、血肿或局部的功能障碍。与第 1周期附睾或睾丸取精 15 4例 (共 15 4个周期 )的受精率、种植率和临床妊娠率比较 ,结果分别是 78.39%与 73.6 4 % ,19.6 8%与 18.38%和 34.88%与 37.91% ,差异无显著性 (P >0 .0 5 )。　结论 :无精子症病人进行反复附睾或睾丸取精 ,是安全和可耐受的 ,其妊娠结局与第 1周期比较无统计学差异。     

Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia in the first cycle: a report of case series and meta-analysis

To investigate the outcome of intracytoplasmic sperm injection with fresh and cryopreserved-thawed testicular spermatozoa in the first cycle in patients with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA), a total of 90 cases, 48 OA and 42 NOA were studied. All patients underwent sperm retrieval by testicular sperm extraction (TESE) while their wives received conventional ovarian hyperstimulation. The hormone levels, testicular histology, the rates of sperm retrieval, fertilization, implantation and pregnancy were analysed and evaluated. This study and other four similar studies were subjected to meta-analysis. Sperm retrieval was successful in 100% OA and 61% NOA. Fresh spermatozoa were used in 87.5% and 92.4% of OA and NOA cases respectively; while cryopreserved-thawed spermatozoa were used in 12.5% and 7.6% of OA and NOA, respectively. The fertilization, implantation and clinical pregnancy rates were 65.5%, 15% and 25% respectively in OA group, and 54.2%, 5% and 23.1% respectively in NOA group. Sperm status (fresh or thawed), male partner's age, female age and male serum follicle-stimulating hormone had no significant effect upon fertilization rate, implantation rate, or pregnancy rate per embryo transfer. The results of meta-analysis indicate that there is no statistically significant difference in clinical pregnancy rates between the two groups. There was a significantly higher fertilization rate among OA patients in all analysed studies (95% CI = 14.29-15.71, d.f. 832, T = 1.96). In conclusion, although the fertilization rate was significantly higher in the OA group in our study and from the given meta-analysis, there were some differences as regards pregnancy rates. Although the overall effect was more or less similar pregnancy rates in both subtypes of azoospermia, this may not be true if non-male infertility variables were controlled for in all studies.     

使用放大系统对睾丸精子行形态选择性卵细胞胞质内单精子注射的临床结局分析

目的:探讨使用放大系统对睾丸精子行形态选择性卵细胞胞质内单精子注射术(ICSI)的临床结局。方法:回顾分析本中心2008年1月至2008年10月共66例无精子症患者行常规ICSI,2008年11月至2009年7月共39例无精子症患者用放大系统将睾丸精子放大6 000倍后,行卵细胞胞质内形态选择性单精子注射(IMSI)。结果:行ICSI的患者临床妊娠率为51.52%,种植率为30.67%,早期流产率为11.76%;行IMSI的患者临床妊娠率为56.41%,种植率为35.29%,早期流产率为4.50%。结论:无精子症患者的睾丸精子通过放大系统选择后行ICSI,早期流产率较常规ICSI有下降的趋势。     

外科取精术在无精子症诊断与治疗中的应用

目的研究外科取精术在无精子症诊断与治疗中的应用价值。方法在诊断为无精子症的、患者中,经睾丸体积测定、血清性激素水平、生殖系统超声等检查后,选择符合条件者198例,在局麻下行外科取精术,对获得组织显微镜下检查,统计分析取精结果。获得的精子行卵胞浆内单精子显微注射术（ICSI）及胚胎移植术（ET）,统计评估受精率、卵裂率、临床妊娠率及流产率。结果其中78例附睾中存在精子（39．4％）,23例睾丸中存在精子（11．6％）。睾丸体积正常的取精成功率明显高于睾丸体积偏小者,有显著性差异（P〈0．01）。血清促卵泡刺激素（FSH）水平正常的取精成功率明显高于FSH增高者,差异有显著性意义（P〈0．01）。82例外科取精术获得精子的患者进行ICSI治疗,附睾取精组与睾丸取精组比较,受精率、卵裂率、临床妊娠率及流产率差异均无统计学意义（P均〉0．05）。结论外科取精术操作简单且创伤较小,能准确鉴别诊断梗阻性无精子症（OA）及非梗阻性无精子症（NOA）,对无精子症的诊断有重要价值;为部分无精子症患者提供了生育自己生物学子代的机会,也是针对无精子症的有效治疗手段。     

Microsurgical epididymal sperm aspiration: indications,techniques and outcomes

Microsurgical epididymal sperm aspiration (MESA) refers to retrieval of sperm-containing fluid from optimal areas of the epididymis that are selected and sampled using high-power optical magnification provided by an operating microscope. Retrieved sperm are subsequently used for intracytoplasmic sperm injection (ICSI) to induce fertilization and pregnancy. MESA is considered by many experts to be the gold standard technique for sperm retrieval in men with obstructive azoospermia given its high yield of quality sperm, excellent reported fertilization and pregnancy rates, and low risk of complications. However, MESA must be performed in an operating room, requires microsurgical skills and is only useful for reproduction using ICSI. Herein we present an overview of the evaluation of candidate patients for MESA, the technical performance of the procedure and the outcomes that have been reported.