共查询到20条相似文献,搜索用时 31 毫秒
1.
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
2.
F Ubaldi Z P Nagy L Rienzi J Tesarik R Anniballo G Franco F Menchini-Fabris E Greco 《Human reproduction (Oxford, England)》1999,14(11):2796-2800
Controversial reports have been published about the influence of sperm source and of the underlying testicular pathology on success rates of intracytoplasmic sperm injection (ICSI). In this controlled study, ICSI treatment cycles with testicular spermatozoa from men with obstructive and non-obstructive azoospermia were compared with ICSI ejaculated sperm cycles with semen parameters < or = 5 x 10(6)/ml and < or = 10% progressive motility. The control cases were matched for female age, rank of trial, female basal follicle-stimulating hormone serum concentrations and close proximity to the study group's procedure. The fertilization, cleavage, pregnancy and abortion rates were similar in matched groups irrespective of the type of azoospermia. However, the implantation rate in the non-obstructive azoospermic patient group was significantly lower than that in the matched ejaculated sperm group (13.4% versus 26%, P = 0.05). On the other hand, no impairment of the implantation rate was observed in the obstructive azoospermic patient group. These data show that testicular pathology has a negative impact on reproductive performance of testicular spermatozoa, resulting in a decreased implantation potential without any apparent effect on fertilization and early preimplantation development. 相似文献
3.
Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men 总被引:8,自引:0,他引:8
Palermo GD Schlegel PN Hariprashad JJ Ergün B Mielnik A Zaninovic N Veeck LL Rosenwaks Z 《Human reproduction (Oxford, England)》1999,14(3):741-748
The evident ability of the intracytoplasmic sperm injection (ICSI) procedure to achieve high fertilization and pregnancy rates regardless of semen characteristics has induced its application with spermatozoa surgically retrieved from azoospermic men. Here, ICSI outcome was analysed in 308 cases according to the cause of azoospermia; four additional cycles were with cases of necrozoospermia. All couples were genetically counselled and appropriately screened. Spermatozoa were retrieved by microsurgical epididymal aspiration or from testicular biopsies. Epididymal obstructions were considered congenital (n = 138) or acquired (n = 103), based on the aetiology. Testicular sperm cases were assessed according to the presence (n = 14) or absence (n = 53) of reproductive tract obstruction. The fertilization rate using fresh or cryopreserved epididymal spermatozoa was 72.4% of 911 eggs for acquired obstructions, and 73.1% of 1524 eggs for congenital cases; with clinical pregnancy rates of 48.5% (50/103) and 61.6% (85/138) respectively. Spermatozoa from testicular biopsies fertilized 57.0% of 533 eggs in non-obstructive cases compared to 80.5% of 118 eggs (P = 0.0001) in obstructive azoospermia. The clinical pregnancy rate was 49.1% (26/53) for non-obstructive cases and 57.1% (8/14) for testicular spermatozoa obtained in obstructive azoospermia, including three established with frozen-thawed testicular spermatozoa. In cases of obstructive azoospermia, fertilization and pregnancy rates with epididymal spermatozoa were higher than those achieved using spermatozoa obtained from the testes of men with non-obstructive azoospermia. 相似文献
4.
Ghazzawi IM; Sarraf MG; Taher MR; Khalifa FA 《Human reproduction (Oxford, England)》1998,13(2):348-352
A prospective study was carried out to compare the fertilizing capability
and pregnancy outcome following intracytoplasmic sperm injection (ICSI)
using spermatozoa obtained from ejaculates, or surgically from epididymis
or seminiferous tubules. A total of 77 ICSI cycles (one per patient) was
included. In all, 28 patients had severe oligoasthenoteratozoospermia, 19
patients had obstructive azoospermia and 30 patients had non-obstructive
azoospermia. The main outcome measures were fertilization rate per injected
metaphase II oocyte and the clinical pregnancy rate per embryo transferred
back to the female recipients. In patients with severe
oligoasthenoteratozoospermia, the fertilization and pregnancy rates were 79
and 25 %. In patients with obstructive azoospermia, for whom epididymal
spermatozoa were used, these were 75 and 28%, and in the non-obstructive
group for which testicular spermatozoa were used for injection, they were
69 and 21% respectively. These rates were not significantly different in
the three groups (P = 0.85 and P = 0.14 respectively), suggesting that
spermatozoa from the ejaculates and epididymal or testicular biopsies are
able to fertilize equally by using ICSI. Live birth per embryo transfer was
significantly reduced in patients with non-obstructive azoospermia compared
to the other two groups. The high abortion rate (50%) in the group in which
testicular spermatozoa were used raises doubts about the developmental
competence of such embryos.
相似文献
5.
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
6.
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
7.
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
8.
Silber SJ; Nagy Z; Devroey P; Camus M; Van Steirteghem AC 《Human reproduction (Oxford, England)》1997,12(12):2693-2700
Factors other than spermatozoa could be the major determinant of the
success of assisted reproduction treatment in cases of male infertility.
Our aim was to evaluate the effect of the wife's age and ovarian reserve on
assisted reproduction success rates in the most severe type of male
infertility, i.e. azoospermia. A total of 249 consecutive couples suffering
from male infertility caused by azoospermia underwent microsurgical
epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE)
with intracytoplasmic sperm injection (ICSI). Of these men, 186 had
irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia
due to testicular failure. Neither the pathology, the source, the quantity,
nor the quality of spermatozoa had any effect on fertilization or pregnancy
rates. Maternal age and ovarian reserve (number of eggs) had no effect on
fertilization or embryo cleavage, but did dramatically affect the embryo
implantation, pregnancy and delivery rates. Wives of azoospermic men who
were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36
years had a 34% live delivery rate per cycle, wives aged 37- 39 years had a
13% live delivery rate per cycle, and wives > or = 40 years had only a
4% live delivery rate per cycle. The number of eggs retrieved also affected
pregnancy and delivery rate, but to a lesser extent than age. In virtually
all cases of obstructive azoospermia, and in 62% of cases with
non-obstructive azoospermia caused by germinal failure, sufficient
spermatozoa could be retrieved to perform ICSI, with normal fertilization
and embryo cleavage. However, the pregnancy rate and the live delivery rate
were dependent strictly on the age of the wife, and on her ovarian reserve.
Unfortunately, exaggerated claims of high pregnancy rates can thus easily
be made by manipulating, in a very simple way, selection for female
factors.
相似文献
9.
Pregnancies after intracytoplasmic sperm injection with cryopreserved testicular spermatozoa 总被引:2,自引:14,他引:2
Gil-Salom M.; Romero J.; Menguez Y.; Rubio C.; De los Santos M J.; Remohe J.; Pellicer A. 《Human reproduction (Oxford, England)》1996,11(6):1309-1313
In 25 patients (14 suffering from obstructive azoospermia, sixfrom non-obstructive azoospermia, three from astheno-azoospermiaand two from absence of ejaculation) spermatozoa were extractedfrom testicular biopsies. Intracytoplasmic sperm injection (ICSI)with fresh testicular spermatozoa was performed in 18 cases;spermatozoa in excess were cryopreserved in pills. No pregnancieswere achieved. In the remaining seven patients, testicular spermatozoawere retrieved and cryopreserved during a diagnostic testicularbiopsy. After thawing, sperm motility was assessed in 17 cases(68%), and 18 ICSI with cryopreserved testicular spermatozoawere performed. The mean two-pronuclear (2PN) fertilizationrate was 59%, the mean cleavage rate was 92%, and six clinicalpregnancies were achieved, all of them still ongoing (pregnancyrate 33%). A comparison of the results of ICSI carried out withfresh or cryopreserved testicular spermatozoa showed that themean 2PN fertilization rates per cycle (53 compared with 55%),mean cleavage rates per cycle (99 compared with 96%) and embryoquality were not significantly different In conclusion, cryopreservationof testicular spermatozoa is feasible, even in patients withnon-obstructive azoospermia, and the results of ICSI with frozen-thawedtesticular spermatozoa are similar to those obtained using freshtesticular spermatozoa. Cryopreservation of testicular spermatozoamay avoid repetition of testicular biopsies to retrieve spermatozoafor successive ICSI cycles in patients in whom the only sourceof motile spermatozoa is the testicle. 相似文献
10.
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
11.
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
12.
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
13.
High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy 总被引:11,自引:13,他引:11
Silber S.J.; Van Steirteghem A.C.; Liu J.; Nagy Z.; Tournaye H.; Devroey P. 《Human reproduction (Oxford, England)》1995,10(1):148-152
In cases requiring microsurgical epididymal sperm aspiration(MESA) for congenital absence of the vas deferens (CAVD) orirreparable obstructive azoospermia, often no spermatozoa canbe retrieved from the epididymis, or there may even be no epididymispresent. We wished to see whether testicular biopsy with testicularsperm extraction (TESE) in such cases could yield spermatozoathat would result in successful fertilization and pregnancy(despite the absence of epididymal spermatozoa) using intracytoplasmicsperm injection (ICSI). In the same setting during the same2-week period, 28 patients with CAVD or irreparable obstructionwere treated; 16 consecutive fresh MESAICSI cycles and12 cycles which required testicular biopsy with testicular spermextraction (TESEICSI) were performed. Normal two-pronuclearfertilization rates were similar in both groups: 45% for epididymalspermatozoa and 46% for testicular biopsy-extracted spermatozoa.Cleavage rates were also similar (68% for epididymal and 65%for testicular spermatozoa). The ongoing pregnancy rates inthis series were 50 and 43% respectively. We conclude that epididymalspermatozoa and testicular spermatozoa yield similar fertilization,cleavage and ongoing pregnancy rates using ICSI. When epididymalspermatozoa cannot be retrieved, a testicular biopsy can beperformed and the few barely motile spermatozoa thus obtainedcan be used for ICSI. It appears that all cases of obstructiveazoospermia can now be successfully treated. 相似文献
14.
S Al-Hasani L C Demirel B Sch?pper M Bals-Pratsch N Nikolettos W Küpker M Ugur R Sturm K Diedrich 《Human reproduction (Oxford, England)》1999,14(8):2031-2035
The use of frozen-thawed testicular tissue as a source of spermatozoa for intracytoplasmic sperm injection (ICSI) in non-obstructive azoospermia yields favourable fertilization and pregnancy rates while avoiding both repetitive biopsies and unexpected cycle cancellations. Spermatozoa were obtained from frozen-thawed testicular biopsy specimens from 67 non-obstructive azoospermic men. Following fertilization, supernumerary two pronuclear (2PN) oocytes were frozen. After thawing, 17 cycles of embryo transfer were carried out with a mean number of 2.7 embryos and a mean cumulative embryo score (CES) of 18.3 per transfer. The clinical pregnancy and implantation rates per transfer in these cycles (23.5 and 8.3% respectively) were comparable to those of fresh embryo transfers (35.7 and 12.7% respectively) with a mean number of 2.7 embryos and a mean CES of 28.7 per transfer. Abortion rates, although higher with cryopreserved 2PN oocytes were not significantly different. With this approach, cryopreservation of supernumerary 2PN oocytes can be used to improve the cumulative pregnancy rates in a severely defective spermatogenetic population. To our knowledge, these are the first pregnancies reported which have been obtained by the transfer of cryopreserved pronuclear oocytes obtained from ICSI using cryopreserved testicular spermatozoa. 相似文献
15.
Gil-Salom M.; Minguez Y.; Rubio C.; De los Santos M. J.; Remohi J.; Pellicer A. 《Human reproduction (Oxford, England)》1995,10(12):3166-3170
In patients with obstructive azoospermia in whom standard microsurgicalprocedures fail or are unfeasible, the only source of spermatozoais the testicle. In addition, in some azoospermic patients withsevere spermatogenic failure, a few spermatozoa may be presentin testicular biopsyspecimens despite high serum follicle stimulatinghormone concentrations. In all these cases, intra cytoplasmicsperm injection (ICSI) with testicular biopsy-extracted spermatozoamayoffer the chance of pregnancy. To assess the efficacy of thisprocedure, we compared the results of twoseries of ICSI cyclesperformed during the same time period: 21 cycles using testicularbiopsy-extracted spermatozoa and 83 cycles using ejaculatedspermatozoa. Mean fertilization rates (59% with testicular and68% with ejaculated spermatozoa), mean cleavage rates (93% withtesticular and 90% with ejaculated spermatozoa), embryoquality(77% good quality embryos in the testicular sperm group and77% in the ejaculated sperm group) and clinical pregnancy rates(36.8% in the testicular sperm group and 28% in the ejaculatedsperm group) were not significantly different in both groups.We conclude that high fertilization, cleavage and pregnancyrates can be achieved with intra cytoplasmic testicular sperminjection, reaching levels comparable with those of ICSI usingejaculated spermatozoa. 相似文献
16.
T Tuuri J Moilanen S Kaukoranta S Makinen S Kotola O Hovatta 《Human reproduction (Oxford, England)》1999,14(5):1274-1278
Using testicular spermatozoa from either open biopsy (29 cycles) or biopty gun needle biopsy (49 cycles), a total of 81 intracytoplasmic sperm injection (ICSI) cycles among 57 couples were carried out from January, 1994 to September, 1997. In six cycles, no spermatozoa were obtained, and in three cycles spermatozoa from both needle and open biopsies were used. The fertilization (37% after open and 41% after needle biopsy) and pregnancy rates (29% per embryo transfer compared with 16% per embryo transfer) were similar after both open and needle biopsies. Five pregnancies were achieved among the 14 couples with non-obstructive azoospermia of the male partner, four of these after needle biopsy. It was possible to use cryopreserved testicular spermatozoa after both needle and open biopsies, and one pregnancy started after using cryopreserved testicular spermatozoa in both groups. Histological needle biopsy was carried out in 62 cases, and they were all diagnostic, giving 15-20 cross-sections of seminiferous tubuli per biopsy. Testicular needle biopsy using a 14 gauge biopsy needle gave a sufficient amount of tissue and spermatozoa for ICSI, cryopreservation and histology, even in non-obstructive azoospermia. This technique is simpler and cheaper than open biopsy and, hence, it can be regarded as the optimal method for the retrieval of testicular spermatozoa. 相似文献
17.
Kahraman S.; Ozgur S.; Alatas C.; Aksoy S.; Balaban B.; Evrenkaya T.; Nuhoglu A.; Tasdemir M.; Biberoglu K.; Schoysman R.; Vanderzwalmen P.; Nijs M. 《Human reproduction (Oxford, England)》1996,11(3):673-676
Thirty-two infertile couples with obstructive and non-obstructiveazoospermia were included in this study. Testicular sperm extraction(TESE) was performed in 16 obstructive azoospermic cases wheremicrosurgical sperm aspiration (MESA) or percutaneous spermaspiration (PESA) were impossible because of totally destroyedepididymis and 16 non-obstructive azoospermia cases with severespermatogenetic defect where the testicles were the only sourceof sperm cells. A total of 288 oocytes was obtained from 32females and 84% were injected. The fertilization rates (FR)with 2 pronuclei (PN) and cleavage rate were 50.8 and 68.2%respectively. A total of 15 pregnancies was achieved (53% perembryo transfer), nine from the obstructive and six from thenon-obstructive group. Four pregnancies resulted in clinicalabortion (26.6%). The ongoing pregnancy rate was 39.2% per embryotransfer (ET) and 343% per started cycle. A high implantationrate was also achieved (26.6% in non-obstructive and 30% inobstructive azoospermia group). Using testicular spermatozoain combination with ICSI in both obstructive and non-obstructiveazoospermic groups, high implantation and pregnancy rates canbe achieved. 相似文献
18.
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
19.
B Balaban B Urman A Sertac C Alatas S Aksoy R Mercan A Nuhoglu 《Human reproduction (Oxford, England)》1999,14(11):2808-2811
The aim of this study was to determine the effect of 24-h in-vitro culture of testicular spermatozoa in recombinant follicle stimulating hormone (recFSH) supplemented medium versus simple medium on sperm motility, and to analyse the outcome of intracytoplasmic sperm injection (ICSI) of such spermatozoa. A total of 143 positive testicular sperm extraction procedures in men with non-obstructive azoospermia was evaluated prospectively. Extracted testicular tissue samples were randomized to be cultured in vitro for 24 h in simple medium or recFSH supplemented media. ICSI was performed with spermatozoa cultured in recFSH (n = 73) or in simple medium (n = 70). Sperm motility following in-vitro culture, embryo quality after ICSI, and implantation and pregnancy rates were assessed. Of the 898 MII oocytes available in the recFSH group, 646 (71.9%) were injected with spermatozoa showing either twitching or progressive motility. However, only 29.1% of the oocytes in the simple medium group (245/841) were injected with motile spermatozoa (P < 0.05). Fertilization rate (68.8 versus 42.1%), implantation rate per embryo (20.1 versus 13.2%), and clinical pregnancy rate (47. 9 versus 30%) were significantly increased in the recFSH group compared with the simple medium group respectively (P < 0.05). In conclusion, in-vitro culture with recFSH appears to increase the motility of testicular spermatozoa, thus increasing the success of ICSI. 相似文献
20.
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