采用抽吸取精法结合单精子注射治疗无精子症110例临床报告

目的分析采用抽吸取精法（PESA或TESA）获得精子进行单精予注射（ICSI）治疗无精子症的妊娠结局。方法经皮附睾精子抽吸术（PESA）获得附睾精子，经皮睾丸精子抽吸术（TESA）获得睾丸精子，女方进行常规超排卯。两种取精方法获得的精子进行ICSI，比较其受精率、种植率和临床妊娠率。结果110例无精子症患者中有83例（75．5％）经PESA获得精子，26例（23．6％）通过TESA获得精子。PESA和TESA组的受精率、种植率和临床妊娠率分别为72．60％和74．81％，23．89％和21．54％，41．22％和40．35％。两组的受精率、种植率和临床妊娠率比较，差异无显著性（P〉0．05）。在TESA组有1例取精失败而放弃治疗。结论采用抽吸取精方法（PESA或TESA）获得精子进行ICSI是治疗男性无精子症的有效方法。     

精子冷冻对卵胞质内单精子注射治疗结果的影响

目的 了解冷冻保存对射出精子和经皮附睾、睾丸微穿刺抽吸精子进行卵胞质内单精子注射（ICSI）临床结果的影响。方法 将射出精子152个治疗周期和经皮附睾、睾丸微穿刺抽吸精子55个周期分别分为新鲜组和冷冻组，对其ICSI后的结果进行对照。结果 射出精子新鲜组和冷冻组受精率、卵裂率和临床妊娠率（分别为79．70％ vs 76．79％、97．08％ vs 98．35％、39．02％ vs 37．93％）与经皮附睾、睾丸微穿刺抽吸精子新鲜组和冷冻组受精率、卵裂率和临床妊娠率，穿刺周期（分别为77．07％ vs 74．54％、97．47％ vs 94．3l％、35．00％ vs 37．14％）均无显著差异（P〉0．05）。结论 精子的冷冻保存对射出精子和经皮附睾、睾丸微穿刺抽吸精子进行ICSI的临床结果没有影响，我们认为对于经皮附睾、睾丸微穿刺抽吸精子应该进行冷冻保存，以减少对附睾、睾丸的穿刺次数。     

不同方式获取精子对ICSI治疗后妊娠结局分析

目的 分析和比较3种不同获取精子方式行ICSI后的妊娠结局.方法 回顾性分析本中心2009年2月至12月进行ICSI治疗的207 例患者,其中严重少弱精子患者108例、当天受精失败81例和经皮附睾穿刺术(PESA) 18例,比较3组的受精率、卵裂率、优质胚胎率和妊娠率.结果 3组的受精率、卵裂率、优质胚胎率无明显差异,其中受精失败组行补救ICSI妊娠率较高,但与其他两组比较没有统计学意义.结论严重少弱精子症、附睾穿刺和补救ICSI获得的精子,受精率和优质胚胎率,妊娠率相似,不同来源和生理功能的精子不影响ICSI的治疗效果.     

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。     

冻融复苏微量精子行卵细胞胞质内单精子注射术的疗效及临床妊娠结局分析

目的:回顾性分析123例无精子症患者经皮附睾精子抽吸术(PESA)或经皮睾丸精子抽吸术(TESA)后冻融复苏微量精子行卵细胞胞质内单精子注射术(ICSI)的疗效及临床妊娠结局情况。方法:将采用微量冻融PESA、TESA精子行ICSI的病例归为冻融精子组,采用新鲜PESA、TESA精子行ICSI的病例归为对照组。比较冻融精子组与新鲜精子组组间及组内的双原核(2PN)受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率、多胎妊娠率有无统计学差异。结果:PESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为75.67%vs76.49%,64.96%vs66.19%,55.21%vs57.22%,13.21%vs12.61%,3.77%vs5.41%,37.74%vs37.84%(P>0.05),TESA精子冻融组与新鲜组受精率、优质胚胎率、临床妊娠率、流产率、宫外孕率及多胎妊娠率分别为74.41%vs76.43%,64.63%vs66.35%,46.81%vs53.39%,18.18%vs14.55%,4.55%vs1.82%,37.74%vs37.84%,组间及组内均无统计学差异(P>0.05)。PESA精子与TESA精子冻融复苏成功率为70.07%vs62.67%,无统计学差异(P>0.05)。结论:微量PESA及TESA精子冻融技术对无精子症患者来说是一种安全、经济、有效的治疗方法;精子冷冻复苏技术有待于进一步提高;该技术是否会增加子代远期遗传风险仍有待于进一步探讨和研究。     

睾丸精子行ICSI改善严重畸形精子症患者治疗结局5例报告

目的:探讨利用睾丸精子行卵细胞胞质内单精子注射(ICSI)治疗严重畸形精子症患者(精液或附睾液精子畸形率≥99%)的可行性,改善辅助生殖技术治疗结局。方法:回顾性分析5例严重畸形症精子患者(附睾液精子,n=4;精液精子,n=1)利用不同来源精子行ICSI治疗的临床资料,并比较睾丸精子组与非睾丸精子组(附睾液精子和精液精子)之间受精率、卵裂率、优质胚胎率、妊娠率以及种植率的差异。结果:5例严重畸形精子症患者取精液精子或附睾液精子行ICSI治疗后无1例妊娠,而改用睾丸精子行ICSI治疗后4例成功妊娠。睾丸精子组与非睾丸精子组之间受精率、卵裂率及优质胚胎率均无显著差异(P>0.05),而睾丸精子组妊娠率和种植率均显著高于非睾丸精子组(P<0.01)。结论:对应用附睾精子或精液精子行ICSI治疗失败的严重畸形精子症患者改用睾丸精子治疗可有效改善其治疗结局。     

梗阻性无精子症患者睾丸抽吸精子行ICSI后的胚胎结局

目的总结非手术精子抽吸(NSA)联合ICSI对梗阻性无精子症患者的治疗意义,并探讨精子来源等对ICSI后胚胎结局的影响。方法回顾性分析642个ICSI周期,比较了睾丸抽吸精子和精液精子行ICSI后的受精率、优质胚胎率、临床妊娠率、种植率及胚胎停育率等。结果NSA睾丸精子组和精液精子组相比较,其2PN受精率、优质胚胎率、临床妊娠率、种植率及胚胎停育率之间均没有显著性差异(71．4％vs 73．2％, 73．1％vs 70．1％,34．2％vs 32．6％,22．3％vs 19．8％,21．3％vs 25．0％,P>0．05)。结论非手术抽吸睾丸精子联合ICSI是治疗梗阻性无精子症的一种有效方法。     

精子畸形率对体外受精-胚胎移植治疗结局的影响

目的回顾性分析我中心接受常规体外受精（IVF）及卵胞浆内单精子注射（ICSI）治疗中,男方精子畸形率对受精率、胚胎质量及临床结局的影响。方法选取本中心2008年9月至2010年5月接受IVF的344对及ICSI的178对夫妇,分为常规IVF组和ICSI组,组内按照男方精子畸形率分为正常形态组（IVF266／ICSI76）和畸精子症组（IVF78／ICSI102）。受精后分别统计IVF及ICSI两组内畸精子症组和正常形态组正常受精率、优质胚胎率、种植率、临床妊娠率及流产率的差别。结果在IVF中,畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为64．32％／60．09％、33．78％／37．02％、42．03％／54．62％及12．5％／4．23％。两组间受精率无显著性差别,畸精子症组的临床妊娠率显著性低于正常形态组,而早期流产率显著高于正常形态组（P〈0．05）;ICSI组中,畸精子症组和正常形态组的正常受精率、种植率、临床妊娠率及流产率分别为68．01％／64．59％、32．26％／33．78％、43．75％／52．63％及4．76％／5％。畸精子症患者的临床妊娠率较正常组显著性降低（P〈0．05）。将两种受精方式的畸精子症组间比较,IVF的患者早孕流产率显著高于ICSI者（P〈0.05）。结论常规IVF中畸精子症不影响正常受精。对于畸精症子患者,其临床妊娠率均较精子形态正常组低,但是采用ICSI治疗可以显著降低早孕流产率。‘     

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。     

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 )。     

Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia

PURPOSE: We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection. MATERIALS AND METHODS: From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa. RESULTS: The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p <0.05). The normal and abnormal fertilization rates were 58.7% and 21.4% for percutaneous epididymal sperm aspiration (PESA), 62.3% and 10.4% for PESA plus testicular sperm aspiration (TESA), and 57.3% and 14.5% for TESA, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 34.6%, 54.5% and 11.1% for PESA, 37.5%, 37.5% and 33.3% for PESA plus TESA, and 26.1%, 31% and 41% for TESA, respectively (PESA versus PESA plus TESA p >0.05, and PESA and PESA plus TESA versus TESA p <0.05). Epididymal or testicular motile sperm resulted in a lower abortion rate than epididymal or testicular immotile sperm (p = 0.03). CONCLUSIONS: No differences were noted in the fertilization and embryo transfer rates irrespective of etiology (obstructive versus nonobstructive) and type of spermatozoa (epididymal versus testicular). Testicular sperm retrieval results in lower fertilization and pregnancy rates as well as higher abortion rates than epididymal sperm retrieval.     

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。     

Intracytoplasmic sperm injection with motile and immotile frozen-thawed testicular spermatozoa (the Hungarian experience)

The authors summarize their experience in 75 in vitro fertilization cycles, where frozen-thawed testicular spermatozoa were used for intracytoplasmic sperm injection. In 32 cases, motile spermatozoa could be observed in the frozen-thawed sample. In 34 cases, motility could be induced by pentoxifylline and in nine cases immotile spermatozoa, selected with hypoosmotic swelling test, were used for fertilization. The fertilization rates obtained with motile and immotile spermatozoa (66.1% versus 52.3%) were not significantly different. Our data demonstrate that freezing of testicular spermatozoa opened new possibilities for the treatment of azoospermic men. The clinical pregnancy rate per embryo transfer (ET) (21.87%) was comparable with previous results use of fresh testicular spermatozoa (27.7%). The quality and number of transferred embryos had the most significant impact on the pregnancy rate. The fertilization rate and frequency distribution of good-quality embryos were lower in the case of immotile spermatozoa, and pregnancies were only achieved when motile spermatozoa had been used.     

ICSI中不同来源精子对临床结局的影响

目的:分析不同来源精子在卵细胞胞质内单精子注射(ICSI)后的临床结局。方法:将682个ICSI治疗周期分为:射出精子组(598例)、经皮附睾精子抽吸术(PESA)得到精子组(58例)、睾丸精子获取术(TSE)得到精子组(26例),比较三组的受精率、临床妊娠率、种植率、流产率、异位妊娠率以及分娩率之间的差别。结果:TSE组受精率明显低于射出精子组和PESA组(81.06%vs87.95%,87.82%,P<0.05);射出精子组、PESA组和TSE组的妊娠率(39.46%,48.28%,34.62%)、种植率(19.80%,23.80%,18.34%)、流产率(13.13%,17.86%,11.11%)、异位妊娠率(5.51%,7.14%,11.11%)、分娩率(32.11%,36.21%,26.92%),均没有显著差异(P>0.05)。结论:虽然TSE来源精子对ICSI受精率有所影响,但射出精子和手术(TSE和PESA)来源精子对妊娠结局没有影响。     

The motility of epididymal or testicular spermatozoa does not directly affect IVF/ICSI pregnancy outcomes

Our objective was to determine whether the presence of motility in surgically obtained sperm samples improves fertilization and pregnancy rates for patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). This was a retrospective study in a hospital-based infertility center. Sixty-seven couples with a diagnosis of azoospermia or severe oligozoospermia who had undergone a sperm retrieval procedure in conjunction with 100 IVF/ICSI cycles from 1995 to 2004 were evaluated. The impact of sperm motility on fertilization and clinical pregnancy rates was determined. The motile and nonmotile sperm groups differed in the number of mature oocytes retrieved (10.7 +/- 5.8 vs 13.4 +/- 6.0), but fertilization (56.7% vs 59.1%) and embryo cryopreservation rates (35.9% vs 39.3%) were statistically similar. Clinical pregnancy rates did not differ between the motile (38.5%) and nonmotile (31.2%) groups, nor did they differ between obstructive and nonobstructive patients (35.3% vs 26.7%). There was also no statistical difference in pregnancy rates between testicular and epididymal aspiration (35.3% vs 26.7%), although epididymal sperm were significantly more likely to be motile than testicular sperm (100% vs 39.3%, P < .0001). Epididymal aspiration is more likely to produce motile sperm than testicular sperm retrieval. The use of motile sperm from epididymal or testicular samples, however, does not appear to enhance fertilization or clinical pregnancy rates.     

精子形态与体外受精胚胎移植临床妊娠结局的关系

目的:当前精子形态对体外受精(IVF)的影响尚存争议,本研究旨在评估正常形态精子百分率在体外受精-胚胎移植(IVF-ET)中的应用价值。方法:选择生殖遗传中心659对IVF-ET治疗夫妇,按正常形态精子百分率分为4组,A组(2%)112个周期,B组(≥2%~4%)180个周期,C组(≥4%~5%)74个周期,D组(≥5%)293个周期。比较各组间的受精率、正常受精率、卵裂率、优胚率以及新鲜移植周期的生化妊娠率、临床妊娠率、流产率及活产率等指标。结果:4组间的受精率、正常受精率和可移植胚胎率有差异。C组(71.90%)和D组(72.89%)的受精率均显著高于A组(57.97%)和B组(63.29%)(P均0.05),C组与D组间、A组和B组间均无显著差异(P均0.05)。D组的正常受精率(57.16%)显著高于A组(46.52%)和B组(50.89%)(P均0.05),C组正常受精率(54.67%)显著高于A组(P0.05),其余组间无显著差异(P均0.05)。D组的可移植胚胎率(55.62%)显著高于B组(45.75%)(P0.05),其余组间均无显著差异(P均0.05)。D组的无可移植胚胎患者比例(8.87%)显著低于A组(20.54%)和B组(18.89%)(P均0.05),C组(12.16%)与其余组间均无显著差异(P均0.05)。各组间新鲜移植周期的生化妊娠率、临床妊娠率、种植率、流产率和活产率均无显著差异(P均0.05)。结论:正常形态精子百分率对IVF-ET的受精率及胚胎形成有一定影响,用于评估IVF受精结局时,5%临界值略优于4%。     

The efficacy of repeat percutaneous epididymal sperm aspiration procedures

PURPOSE: The development of intracytoplasmic sperm injection spawned new methods of sperm retrieval for men with obstructive azoospermia who did not want to undergo reconstruction of the seminal tract. There is a wide array of different procedures that may be performed in these cases, for instance percutaneous epididymal sperm aspiration (PESA) and microepididymal sperm aspiration. However, concerns regarding the presence of sperm in a second PESA attempt due to possible fibrosis have been suggested by many authors. We evaluate if it is worthwhile to repeat percutaneous epididymal sperm aspiration. MATERIALS AND METHODS: The records of 20 patients (23 attempts) who underwent repeat PESA from January 1996 to September 2000 for assisted reproductive technique purposes were reviewed. In all patients the repeat procedure was performed on the same side as the previous PESA. Data were collected on patient age, presence of motile sperm during PESA, epididymal side, pregnancies and abortion rates. RESULTS: Mean patient age +/- SD was 32.4 +/- 5.6 years. One patient was excluded from our analysis due to lack of information on the chart regarding the side of the procedure. Repeat PESA was performed in the right epididymis in 12 attempts and in the left in 10. Of the remaining 19 patients 14 (73.68%) did not and 5 (26.3%) have sperm in the epididymal fluid. In these 5 patients 8 repeat PESA procedures were performed (3 procedures in 1 and motile sperm was always found (8 of 22 attempts, 36.4%). Three patients achieved pregnancy with the motile sperm retrieved from the repeat PESA (3 of 8 repeat attempts, 37.5%). No abortions were detected. CONCLUSIONS: More than a third of repeat PESA attempts resulted in the presence of motile sperm. Before performing testicular sperm aspiration or extraction in patients who have undergone previous PESA without achieving pregnancy, repeat PESA may be done. Further attempts should be added in the future to confirm these results.