3106个不同来源精子ICSI周期临床妊娠结局分析

目的:分析精子的来源对卵胞质内单精子注射(ICSI)治疗结局的影响。方法:回顾性分析因男性不育行ICSI的3 106个新鲜周期,按精子来源分为:射精组(A组)、附睾穿刺取精(PESA)组(B组)、睾丸穿刺取精(TESA)组(C组)、冻融PESA精子组(D组)及冻融TESA精子组(E组),比较各组ICSI后胚胎发育及妊娠结局情况。结果:C组2PN受精率、卵裂率显著低于A组及B组;B组临床妊娠率、胚胎植入率显著高于A组及C组,A组、B组及C组间分娩率、异位妊娠率、流产率及新生儿畸形率无统计学差异(P>0.05);E组2PN受精率显著低于D组,但B组与D组之间、C组与E组间2PN受精率、优质胚胎率、多胎率、流产率及异位妊娠率均无统计学差异(P>0.05)。结论:PESA/TESA-ICSI、冻融PESA/TESA精子技术是治疗梗阻性无精子症安全有效的方法,建议首先选择附睾取精,并可将剩余PESA/TESA精子冻存。     

不同来源精子行ICSI助孕1662个周期治疗结局分析

目的:探讨不同来源精子行卵胞浆内单精子显微注射(ICSI)助孕的妊娠结局。方法:回顾分析我中心2006年1月~2010年6月1662个ICSI治疗周期,按精子来源分为射出精子来源(重度少、弱精子)组1208周期,附睾穿刺取精(PESA)组324周期,睾丸穿刺取精(TESA)组130周期,比较3组胚胎发育情况和妊娠结局等指标。结果:射出精子组及PESA组受精率、卵裂率及2PN率较TESA组高(79.1%,77.9%vs 73.9%;98.7%,98.8%vs 96.6%;74.6%,73.0%vs 69.5%),TESA组1PN率较射出精子组及PESA组高(3.8%vs 2.2%,2.6%),差异均有统计学意义(P<0.05);3组优质胚胎率、胚胎种植率、临床妊娠率、异位妊娠率、流产率、单胎出生率、双胎出生率、畸形率无统计学差异。结论:PESA及TESA来源精子行ICSI助孕可获得与射出精子相似的妊娠结局。     

不同来源精子对卵胞浆内单精子显微注射助孕结局影响研究

目的探讨不同来源精子对卵胞浆内单精子显微注射(ICSI)助孕结局的影响。方法回顾性分析自2015年1月至2017年3月在郑州大学第二附属医院生殖中心行ICSI治疗的584个新鲜取卵移植周期,依据精子来源分为射精组(392个周期)、经皮附睾穿刺取精(PESA)组(86个周期)、睾丸穿刺取精(TESA)组(68个周期)和供精组(38个周期)。分别比较各组相关指标和妊娠结局。结果射精组、PESA组、TESA组的女方年龄、男方年龄、不孕年限、女方体重指数、MⅡ卵数和移植胚胎数间差异均无统计学意义(P0.05)。射精组受精率高于PESA组(P=0.013)和TESA组(P=0.005),卵裂率高于TESA组(P=0.001);3组间优质胚胎率、新鲜移植周期胚胎种植率、临床妊娠率及流产率差异均无统计学意义(P0.05)。TESA组累计妊娠率低于PESA组(P=0.003);射精组与供精组间受精率、卵裂率、优质胚胎率、胚胎种植率、临床妊娠率、流产率及累计妊娠率差异均无统计学意义(P0.05)。结论不同来源的精子可影响ICSI的受精率和卵裂率,但对胚胎发育无显著影响,可获得相似的助孕结局;PESA是治疗梗阻性无精子症的有效方法;对非梗阻性无精症患者,用供精助孕是很好的选择,即使供精解冻后质量欠佳也不影响ICSI助孕结局。     

微量精子冷冻复苏行卵胞浆内单精子注射的临床结局

目的:探讨经皮睾丸穿刺取精术(TESA)获得的微量精子经冷冻复苏后行卵胞浆内单精子注射(ICSI)治疗非梗阻性无精子症患者的临床效果。方法:回顾性分析2015年10月至2017年8月在我院生殖中心因少、弱、畸形精子症行射出精子常规ICSI及非梗阻性无精子患者TESA获得的微量精子行新鲜或冷冻后ICSI治疗,共238个周期的临床资料,132个周期为常规ICSI精子组,63个周期为冷冻TESA精子组,43个周期为新鲜TESA精子组,比较3组的实验室指标和临床妊娠结局。结果:常规ICSI精子组获卵数(10.58±5.37枚)与冷冻TESA精子组(10.73±4.19枚)和新鲜TESA精子组(10.88±4.67枚)相比差异无统计学意义(P0.05)。3组患者卵子成熟率、正常受精率、优质胚胎率相比差异无统计学意义(P0.05)。冷冻TESA精子组的临床妊娠率、多胎率、流产率(47.62%、26.67%、6.67%)与常规ICSI精子组(48.48%、25.00%、6.25%)及新鲜TESA精子组(51.16%、22.73%、4.55%)相比差异无统计学意义(P0.05)。结论:经皮睾丸穿刺取精术后对有活动精子的睾丸组织进行冷冻复苏行ICSI可以获得较好的治疗效果,也是治疗非梗阻性无精子症不育患者的有效方法。     

采用新鲜和冻融精子进行卵母细胞胞质内单精子注射的临床效果比较

目的 比较采用新鲜和冻融的睾丸及附睾精子进行卵母细胞胞质内单精子注射(ICSI)的临床效果.方法 选择2006年9月-2007年5月因无精症于北京大学第三医院生殖医学中心行ICSI的患者208例,按患者意愿分为冻融组37例和新鲜组171例.冻融组在行ICSI前将冻存的睾丸或附睾精子解冻并复苏.观察冻融组睾丸和附睾精子的临床利用率;比较两组患者的临床结局(包括正常受精率、优质胚胎率、临床妊娠率及胚胎着床率等)和妊娠结局(包括流产率、分娩孕周及新生儿出生体重等).结果 (1)冻融组睾丸精子的临床利用率为92%(23/25),附睾精子为100%(12/12).(2)新鲜组患者的正常受精率、优质胚胎率、临床妊娠率及胚胎着床率分别为62.25%(973/1563)、78.9%(768/973)、44.4%(60/135)和29.3%(84/287),分别与冻融组[分别为64.53%(282/437)、79.1%(223/282)、46.9%(15/32)和33.3%(23/69)]比较,差异均无统计学意义(P＞0.05).(3)新鲜组患者的流产率、单胎妊娠分娩孕周、双胎妊娠分娩孕周、单胎妊娠平均新生儿出生体重及双胎妊娠平均新生儿出生体重分别为11%(6/55)、(39.0±1.4)周、(36.8±1.7)周、(3409±393)g和(2584±266)g,分别与冻融组[分别为7%(1/15)、(38.7±0.6)周、(36.3±1.2)周、(3350±383)g和(2635±171)g]比较,差异均无统计学意义(P＞0.05).结论 采用冻融的睾丸或附睾精子行ICSI安全、有效,值得在临床推广.     

不同精子参数及来源与ICSI结局的相关性研究

目的:探讨不同精子参数及来源与单精子卵胞浆内注射(ICSI)治疗结局的相关性.方法:回顾分析2010年6月至2011年12月在武汉大学人民医院生殖医学中心行ICSI助孕治疗的413个周期,根据精子质量及来源分为4组,非严重少弱的新鲜射出精子组(A1组,244个周期)、严重少弱的新鲜射出精子组(A2组,61个周期)、睾丸精子组(B组,86个周期)、冻融的射出精子组(C组,22个周期).比较4组的ICSI治疗结局.结果:4组患者的受精率、正常受精率、卵裂率、优胚率、临床妊娠率、胚胎种植率和早期流产率均无显著差异(P＞0.05).结论:精子的质量及来源不影响ICSI治疗的受精及早期妊娠结局.     

精子来源与数量对单精子卵胞浆内注射术妊娠结局的影响

目的:分析不同精子来源和数量对单精子卵胞浆内注射术(ICSI)妊娠结局的影响。方法:2000年1月至2003年6月在本中心进行ICSI治疗而妊娠的271例,据精子来源与数量分为精液正常组(39例)、少弱精组(144例)与手术取精组(88例)。比较精液正常组、少弱精组、手术取精组的临床妊娠率、流产率、分娩率、妊娠并发症、分娩孕周、新生儿出生体重、畸形、围生儿死亡率等组间差异。结果:精液正常组、少弱精组与手术取精组患者的临床妊娠率、流产率、分娩率、双胎率、妊娠期高血压疾病发生率、前置胎盘发生率、早产率、分娩孕周、新生儿出生体重、先天性畸形发生率(4.5%、6.3%、4.0%)、围生儿死亡率差异均无显著性(P>0.05)。结论:精液正常组、少弱精组与手术取精组ICSI治疗后临床妊娠率、流产率、妊娠期并发症、新生儿出生体重、先天性畸形发生率、围生儿死亡率相似,不同精子来源与数量不影响ICSI治疗后的妊娠和围生儿结局。     

不同源性及不同参数精子对ICSI结局的影响

目的:研究不同源性精子、不同参数精子及冻融精子对ICSI结局的影响。方法:接受ICSI治疗的510对不育夫妇共进行了517个周期,分为6组。射出精液少弱畸精子症组(A组)82例,共进行85个周期;射出精液严重少弱精子症组(B组)170例,共进行174个周期;附睾细针穿刺抽吸精子组(C组)108例,共进行108个周期;睾丸细针穿刺抽吸精子组(D组)71例,共进行71个周期;冻融射出精子组(E组)34例,共进行34个周期;冻融附睾睾丸精子组(F组)45例,共进行45个周期;比较其妊娠结局。结果:6组患者一般情况比较无统计学差异(P>0.05),6组患者的受精率、优胚率、临床妊娠率、早期流产率无统计学差异(P>0.05)。结论:不同源性精子、不同参数精子及冻融精子对ICSI结局无明显影响。     

精子畸形率对卵胞浆内单精子注射(ICSI)临床结局的影响

目的:分析畸形精子行卵胞浆内单精子注射(ICSI)的临床结局。方法:回顾性分析因男性因素行ICSI治疗的239个新鲜取卵周期。根据精子形态学分析结果将研究对象分为:精子形态正常组(A组)、非极重度畸形精子症组(B组)和极重度畸形精子症组(C组),比较3组的受精率、卵裂率、优质胚胎率、胚胎种植率及临床妊娠率、流产率、异位妊娠率和多胎妊娠率。结果:A、B组在受精率、卵裂率、优质胚胎率与C组有统计学差异(分别为80.20%、81.40%和67.60%;94.91%、93.42%和79.91%;63.87%、59.30%和54.29%)(P<0.05);3组的胚胎种植率、临床妊娠率、流产率、异位妊娠率、多胎妊娠率均无统计学差异(分别为26.3%、25.6%和24.2%;42.28%、45.00%和42.86%;7.94%、7.40%和25.00%;4.76%、3.70%和8.33%;31.75%、18.52%和25.00%)(P>0.05);而C组内手术取精(PESA/TESA)亚组的卵裂率低于体外排精亚组,差异有统计学意义(86.72%vs 76.11%,P<0.05)。结论:采用畸形精子行ICSI的不育患者同样可获得理想的临床结局。     

睾丸活检和病理学检查对梗阻性无精子症患者睾丸精子检出率初探

目的:初步评估国内目前睾丸活检手术和睾丸病理对梗阻性无精子症的诊断价值。方法:对曾接受过睾丸活检经本次临床诊断为梗阻性无精子症的84例梗阻性无精子症患者进行梗阻病因分析,对病理报告无精子者重新进行经皮细针附睾或睾丸穿刺(PESA或TEFNA)检查,并对先前的睾丸病理报告进行分析。结果:84例均诊断出明确的梗阻病因,其中先天性梗阻56例(66.67%);炎症性梗阻26例(30.95%);另2例为双侧疝气术史。对33例递交的病理报告为无精子者中的29例重新进行PESA或TEFNA手术,均获取了附睾或睾丸精子。84例中的57例行ICSI62个周期,周期妊娠率为46.8%。结论:本组患者的病因主要为先天性或炎症性梗阻,目前国内睾丸病理学对梗阻性无精子症睾丸内是否存在精子的诊断欠准确。对梗阻性无精子症患者可应用损伤小的PESA或TEFNA进行诊断,有利于患者的后续治疗。     

The development of surgical sperm extraction and new challenges to improve the outcome

Surgical sperm extraction with intracytoplasmic sperm injection has become widespread worldwide and is regarded as the sole option for patients with azoospermia. However, the sperm retrieval rate remains unsatisfactorily low, particularly for men with non-obstructive azoospermia (NOA). Therefore, the technical challenges associated with improving the sperm retrieval rate for men with NOA are being addressed. The most successful method developed to date is microdissection testicular sperm extraction (micro-TESE), which is rapidly becoming recognized as a useful technique due to its relatively high sperm retrieval rate and low complication rate. However, even with micro-TESE, the sperm retrieval rate for men with NOA remains at 30–60 %, with an even lower birth rate. The technical challenges associated with improving the outcomes of surgical sperm extraction are being approached through the use of ultrasound and optimal surgical devices such as narrow band imaging, multiphoton microscopy, and optical coherent tomography. In addition to the difficulties related to searching for sperm, medical treatments that induce spermatogenesis remain controversial. For example, varicocele repair prior to surgical sperm extraction and hormonal therapy before and after TESE have been extensively examined. We herein briefly summarized the development process in surgical sperm extraction up to the present and technical challenges to improve the outcomes of surgical sperm extraction.     

Pregnancy outcome after ICSI with thawed testicular sperm from men with non-obstructive azoospermia compared to ICSI with ejaculated sperm from men with severe oligoasthenoteratozoospermia and IVF with normal ejaculated sperm

The aim of the study was to evaluate the clinical pregnancy outcomes, fetal complications and malformation rate of intracytoplasmic injection of thawed cryopreseverd sperm extracted by testicular aspiration from men with non-obstructive azoospermia (NOA) compared with intracytoplasmic injection of fresh ejaculated sperm from men with severe oligoteratoasthenozoospermia (OTA) and standard in vitro fertilization using ejaculated sperm from normospermic men. The mean oocyte fertilization rate was significantly lowest for ICSI with testicular aspirated sperm (NOA group). However, there was no significant difference among the three groups in pregnancy outcomes, namely rates of spontaneous abortion, biochemical pregnancy, extrauterine pregnancy, singleton multifetal pregnancy, preterm delivery before 36 weeks’ gestation, maternal complications, transfer to the neonatal intensive care unit, intrauterine growth restriction or fetal malformations. These results suggest that despite some earlier findings that intracytoplasmic injection of aspirated sperm from men with NOA is associated with lower fertilization rates and embryo quality, the pregnancy and immediate neonatal outcomes may be unaffected.     

Retrograde vasal sperm aspiration in anejaculatory patients with spinal cord injury

Aim :  This paper describes our experience with retrograde vasal sperm aspiration (ReVSA) in anejaculatory patients with spinal cord injury.
Methods :  We performed 11 vasal sperm aspiration procedures on eight patients presenting with neurogenic anejaculation associated with spinal cord injury at our institute between 2004 and 2007. This procedure was conducted under local anesthesia with a spermatic block. A 24G needle was inserted into the vas in a retrograde fashion. Sperm-washing medium was gently injected into the proximal vas several times and collected. Aspirated sperm was cryopreserved for intracytoplasmic sperm injection.
Results :  Adequate motile sperm was obtained from all patients. All couples underwent intracytoplasmic sperm injection; clinical pregnancies were achieved in eight cases (two ongoing pregnancies and the births of six healthy babies).
Conclusion :  Retrograde vasal sperm aspiration is a reliable method for the consistent recovery of sperm of sufficient quality to afford a high pregnancy rate and in sufficient quantity to permit cryopreservation of excess sperm for future use. (Reprod Med Biol 2008; 7 : 115–118)     

Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration

Purpose

To assess normal fertilization, clinical pregnancy, and live birth rates after the use of microscopic epididymal sperm aspiration (MESA).

Methods

One‐hundred‐and‐sixty azoospermic participants who underwent MESA were evaluated. The MESA was performed by using a micropuncture method with a micropipette. In cases in which motile sperm were not obtained after the MESA, conventional or micro‐testicular sperm extraction (TESE) was completed.

Results

Adequate motile sperm were retrieved in 71 participants by using MESA and in 59 out of 89 participants by using TESE. Of the total number of patients, 123 underwent intracytoplasmic sperm injection. After MESA, the normal fertilization rate was 73.5% and the clinical pregnancy rate per case was 95.7%. Healthy deliveries resulted after MESA in 65 (92.9%) cases and after TESE in 38 (71.7%) cases.

Conclusion

The MESA specimen collection does not have any special requirements, such as mincing tissue disposition. The MESA also can reduce the amount of laboratory work that is needed for cryopreservation. In the authors' experience, MESA is a beneficial procedure and should be given priority over TESE.     

Cumulative experience of percutaneous epididymal sperm aspiration (PESA) with intracytoplasmic sperm injection

Objective: Our objective was to evaluate the recovery rate of spermatozoa from the epididymis using a percutaneous aspiration technique and to assess the fertilisation rate after intracytoplasmic sperm injection. Materials and Methods: Fifty-four patients with azoospermia had a total of 59 cycles at IVF with intracytoplasmic sperm injection (ICSI). The cause of the azoospermia was failed vasectomy reversal in 23 cases, congenital absence of the vas in 22 cases, partial testicular failure in 5 cases, and retrograde ejaculation in 2 cases, while the remaining 2 patients had erectile disorders. Results: A total of 741 oocytes was collected and 521 metaphase II oocytes were subsequently microinjected. Normal fertilisation occurred in 274 oocytes (52.6%), and of these, 234 cleaved (85.4%). In 54 cycles, embryo transfer of more than one embryo occurred (91.5%) and a total of 155 embryos was replaced. The pregnancy rate was 30.5% per cycle and 33.3% per embryo transfer. The implantation rate was 14.2%; failure of fertilisation occurred in two cycles, while in three other cycles the embryos did not cleave. Conclusions: Percutaneous epididymal sperm aspiration can be used successfully to retrieve sperm in men with azoospermia due to obstructive, or nonobstructive, disorders. The technique is simple, cost-effective, and associated with fewer complications than an open microsurgical operation.     

Update on surgical sperm recovery – The European view

Surgical sperm recovery has become a well-established procedure to obtain spermatozoa for intra-cytoplasmic sperm injection (ICSI). Although a tendency exists to treat all azoospermic patients by ICSI using surgically retrieved sperm, vasovasostomy remains the gold standard for post-vasectomy azoospermia. In men with obstructive azoospermia in whom vasovasostomy is not indicated, sperm can be easily obtained by either aspiration from epididymis or testis, or a testicular biopsy. In about half of men with non-obstructive azoospermia, sperm may be obtained by testicular biopsy but unfortunately no accurate tests are currently available to predict successful recovery. In these patients, not only recovery rates are limited but also the chance to establish an ongoing pregnancy is decreased compared to men with normal spermatogenesis. When no spermatozoa are recovered after testicular sperm extraction (TESE), the use of donor sperm or adoption is indicated. Given the extremely low pregnancy rates, ICSI using round spermatids is not an option and remains unlawful in some countries.     

Different intervals between vasectomy and sperm retrieval interfere in the reproductive capacity from vasectomized men

Purpose : To evaluate the relationship between the postvasectomy period and sperm reproductive capacity after ICSI. Methods : Seventy-seven ICSI cycles with percutaneous epididymal sperm aspiration (PESA) were reviewed. Patients were divided into 4 groups according to the interval after vasectomy: 0 – 5 years (G1); 6 – 8 years (G2); 9 – 14 years (G3), and >15 years (G4). Results : Clinical and ongoing pregnancy rates did not correlate significantly with the time period of vasectomy until 14 years. Although the higher implantation rate observed in G1, no significant differences were noted among Groups 1–3. The miscarriage rates increased from G1 to G4, reaching a statistical significance among G1, G2, and G3 compared with G4. When groups were also divided according to the maternal age, the same results were obtained. Conclusions : The interval between the vasectomy and the sperm retrieval procedure has no effect on the outcome until the interval of 14 years.     

ANDROLOGY: Sperm Retrieval, Fertilization, and Pregnancy Outcome in Repeated Testicular Sperm Aspiration

Purpose: To report the outcome of sperm retrieval and results after ICSI in up to six repeated testicular sperm aspiration procedures.Methods: Twenty-two men with obstructive and thirty-four men with nonobstructive azoospermia underwent 50 and 91 needle aspirations, respectively. Sufficiency of spermatozoa for ICSI and cryopreservation, fertilization rate, and pregnancy outcome was analyzed retrospectively.Results: No major differences were found in sperm recovery or pregnancy outcome in the repeated cycles. Testicular aspirate containing motile spermatozoa with maintained fertilizing capacity was obtained in up to six repeated procedures in the nonobstructive group. No postoperative complications were reported for any of the participants.Conclusions: Testicular sperm aspiration is a simple and effective method of sperm retrieval, which can be performed from the same testis up to several times with good recovery of motile spermatozoa for ICSI and maintaining high fertilization and pregnancy rates, in men with both obstructive and nonobstructive azoospermia.