Reproductive decisions by couples undergoing artificial insemination with donor sperm for severe male infertility: implications for medical counselling

Since 1992, ICSI has been introduced as a successful treatment for male infertility, including azoospermia. The present study is aimed at evaluating the practice of insemination with donor sperm (AID) in infertile couples who may benefit from the new developments that ICSI has brought in the last decade. AID was performed in 440 heterosexual couples. Twelve couples were lost for follow-up (3%). In 128 (29.9%) and 229 (53.5%) of the couples the husband was either oligozoospermic (OAT) or azoospermic. In 60 couples (14.0%) the man had a transmissible genetic trait. In 11 couples (2.6%) there were other indications for performing AID. In the OAT group 36 couples never had ICSI treatment (28.1%) because they had already an AID child born before the introduction of ICSI (n = 16), the burden of ICSI treatment was too high (n = 9) or they considered that ICSI success rate was too low (n = 7). Ninety-two couples tried ICSI treatment before opting for AID (71.9%), mainly because ICSI failed (n = 43). In 229 couples the husband had azoospermia (53.5%). In 112 couples (49%) no sperm or too few testicular sperm were found at testicular biopsy (TESE) and 15 couples (6.5%) had more than three failed ICSI-TESE attempts. Eighty-one azoospermic men refused TESE (35.4%) because of an anticipated low success rate (n = 28) or the burden of this approach (n = 23). Although a majority of patients could opt for ICSI, our results show that AID is still an option for many couples for whom these techniques were either not feasible or not successful. A substantial proportion of patients (33%) did not even opt for these advanced fertility treatments.     

精液质量对ICSI卵子受精与胚胎发育的影响

目的 探讨不同精液质量的ICSI(卵泡浆内单精子显微注射)周期中卵子受精与胚胎发育潜能间的差异.方法 采用回顾性资料分析的方法,比较了中心71例ICSI治疗周期.女方正常者根据精液质量分为严重少弱畸精子组(A组,n=31)与非严重少弱畸精子组(B组,n=24),非严重少弱畸精子组合并女方异常为C组(n=16).从形态学方面评估三组中受精率、(two pronuclear,2PN)率、异常受精率、未受精率、卵裂率、可用胚胎率、优质胚胎率、不可用胚胎率等实验室指标间的差异.结果 三组在卵子受精率、2PN率、异常受精率、未受精率、卵裂率、可用胚率、优质胚胎率和不可用胚胎率等方面比较,差异均无统计学意义(P＞0.05).但B组的受精率(72.29±23.1 2)低于C组(85.49±1 8.59),两组差异有统计学意义(P＜0.05);未受精率B组(22.81±22.83)高于C组(14.51±18.59),两组差异有统计学意义(P＜0.05).结论 从形态学上看,ICSI前的精液质量对卵子受精及胚胎发育没有明显影响.     

66例男性不育患者采用自然周期IVF/M结合胞浆内单精子注射技术治疗的研究

目的探讨自然周期成熟卵母细胞结合未成熟卵母细胞体外成熟方法(natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes,自然周期IVF/M)用于治疗男性因素引起不育的临床价值。方法66例适应证患者分成3组:少弱精子组、偶见活精子组和无精子症组[行经皮附睾精子抽吸术(PESA)、睾丸精子抽吸术(TESA)或睾丸切开取精术(TESE)],接受72个自然周期IVF/M,比较三组受精率和临床妊娠率。结果64例患者完成70个治疗周期。少弱精子组、偶见活精子组和无精子症组分别占完成周期数的54.3%、38.6%和7.1%,共获得卵母细胞812个,平均(11.3±5.2)个。卵母细胞成熟率为61.2%,正常受精率为82.2%,卵裂率为90.0%(377/419)。共26例患者获得临床妊娠,每取卵周期的妊娠率为36.4%(26/72),每移植周期的妊娠率为37.1%(26/70)。三组受精率分别为84.5%、78.9%和80.0%,三组间差异无统计学意义(P>0.05),临床妊娠率分别为39.5%,29.6%和60.0%,PESA/PESE和TESE组的临床妊娠率(60%)显著高于精液中偶见活精子组(29.6%,P<0.05)。结论自然周期IVF/ M技术对于治疗由于男性因素引起的不育如少弱精子症以及无精子症是一种简便有效的方法。     

Comparative evaluation of the effects of Withania somnifera with pentoxifylline on the sperm parameters in idiopathic male infertility: A triple‐blind randomised clinical trial

In this triple‐blind randomised clinical trial, we compared the effects of Withania somnifera and pentoxifylline on the sperm parameters in idiopathic male infertility. One hundred infertile male patients were randomly allocated into either W. somnifera or pentoxifylline groups. Patients in the herbal group received six capsules containing 5 g/daily of W. somnifera root, and subjects in the pentoxifylline group received six capsules containing 800 mg/daily of pentoxifylline and placebo for 90 days. Sperm parameters were analysed at the beginning and end of the study. W. somnifera increased mean sperm count (12.5%) and progressive motility (21.42%) and improved sperm morphology (25.56%) compared to the baseline (p = .04, p = .001 and p = .000 respectively). Moreover, pentoxifylline increased mean semen volume (16.46%), progressive motility (25.97%) and improved sperm morphology (13.28%) versus the baseline (p = .02, p = .003 and p = .01 respectively). Intergroup comparison showed no significant differences between the two groups regarding semen volume (p = .11), sperm count (p = .09), morphology (p = .12) and progressive motility (p = .77) after treatment. No major complication was reported in either of the two groups. W. somnifera, a traditional medicine remedy, improves sperms parameters in idiopathic male infertility without causing adverse effects. Therefore, this medication can be considered to be an alternative to pentoxifylline in this regard.