两种取精方式行ICSI治疗结局的比较

目的:回顾性分析经皮附睾精子抽吸术(PESA)获得的精子和射出的精子行卵浆内单精子注射(ICSI)治疗后的结局。方法:37例因梗阻性无精症或严重少弱畸精症首次要求作ICSI的夫妇,分为附睾穿刺组(9例)和射精组(28例),观察ICSI后两组受精率、优质胚胎率、妊娠率。结果:附睾穿刺组、射精组两组受精率、优质胚胎率、临床妊娠率无显著性差异。结论:经附睾取精和射精获得的精子行ICSI,其治疗结局是相似的。     

Azoospermia: ICSI with synchronous versus non asynchronous testicular sperm retrieval

We review the improvement made in the management of infertile couples with obstructive and non obstructive azoospermia thanks to ICSI. We present the difficulties encountered in predicting the presence or the absence of spermatozoa in non obstructive azoospermia according to clinical and complementary investigations. Testicular biopsy is the only effective test. We recommend the practice of non synchronic testicular biopsy and sperm freezing to avoid unnecessary ovarian hyperstimulation.     

Birth and clinical pregnancy from fresh and frozen oocytes fertilized with cryopreserved testicular spermatozoa

This is the first report showing a second clinical pregnancy of a couple who already have a baby from a previous frozen embryo transfer cycle when the embryos were generated from fresh oocytes that were fertilized by intracytoplasmic sperm injection (ICSI) using frozen testicular spermatozoa (the couple have unsuccessful fresh and frozen embryo transfer cycles). Fifty-two months after the first IVF/ICSI cycle the couple had their second IVF/ICSI cycle, but the collected oocytes (n=8) were frozen because no spermatozoa was obtained from the frozen testicular tissue samples which were cryopreserved prior to the first IVF/ICSI cycle. New testicular tissue samples were obtained and frozen. Finally, 58 months after the first IVF/ICSI cycle all of the 8 frozen oocytes of the couple were thawed and fertilized by ICSI using frozen testicular spermatozoa obtained from the newly cryopreserved testicular tissue. Three embryos were transferred and the couple has an ongoing pregnancy, which is in the 20(th) week of pregnancy. Our case report shows that: 1) developmentally competent embryos can be generated by ICSI of frozen-thawed testicular spermatozoa into both fresh and frozen human oocytes, and 2) clinical pregnancy and a healthy baby can be conceived from both frozen and fresh oocytes fertilized with cryopreserved testicular spermatozoa.     

长方案超排卵获卵数对胞浆内单精子注射治疗结局的影响

目的：比较常规长方案超排卵周期中,获取不同卵母细胞数对胞浆内单精子注射（ICSI）治疗结局的影响。方法：回顾分析广州医科大学附属第三医院生殖医学中心2007年1月—2013年6月因单纯男性因素采用常规长方案超排卵行ICSI治疗的患者资料。根据获卵数目分成4组,获卵数≤4个为G1组（90个周期）,获卵数5~10个为G2组（368个周期）,获卵数11～20个为G3组（449个周期）,获卵数≥21个为G4组（135个周期）。结果：在ICSI治疗中,G1组女方平均年龄高于其他3组（P＜0.01）,但其中＜35岁的患者占57.8%。G1组患者完全受精失败发生率、G4组的卵巢过度刺激综合征（OHSS）发生率以及这2组的移植周期取消率均高于G2组和G3组（P＜0.01）;G1组的临床妊娠率在4组中最低（31.3%,P＜0.05）;4组中G3组的临床妊娠率、胚胎种植率和移植胚胎活产率最高,且后两者差异有统计学意义（P＜0.05）。结论：在ICSI治疗周期中,获卵数≤4个影响ICSI受精结局,完全受精失败发生率升高;获卵数在11～20个时ICSI临床结局最好。     

Spermatogenesis affects the outcome of ICSI for azoospermic patients rather than sperm retrieval method

The study investigated the clinical outcome of intracytoplasmic sperm injection (ICSI) with epididymal and testicular sperm of azoospermic patients exhibiting various disturbances in spermatogenesis, in order to understand the possible factors that might affect ICSI outcome. Of the 134 patients, 92 were diagnosed as being obstructive azoospermic (OA group) with normal spermatogenesis and the remaining 42 patients were diagnosed as being non-obstructive azoospermic (NOA group) with hypospermatogenesis. The 92 OA patients underwent 112 ICSI cycles, which were divided into two subgroups according to their sperm retrieval methods: 1) OA-PESA group (n=51) with sperm obtained by percutaneous sperm aspiration (PESA) cycles and 2) OA-TEFNA group (n=61) with sperm obtained by testicular fine needle sperm aspiration (TEFNA) cycles. The NOA patients diagnosed with hypospermatogenesis according to histopathological analysis and hormone analysis, underwent 42 ICSI cycles with TEFNA. The results showed that the fertilization, cleavage, and clinical pregnancy rates portrayed a significant difference (44.9% vs. 64.1%, P<0.001, 79.8% vs. 89.0%, P<0.001, and 21.4% vs. 40.2%, P=0.047, respectively) between NOA and OA groups. Moreover, the miscarriage rate in the NOA group was visibly higher even though it did not reach a statistical difference (33.3% vs. 15.6%, P=0.433) compared with the miscarriage rate of the OA group. The same statistical differences were observed between the subgroup OA-TEFNA and the NOA group. No statistical difference was observed between OA-PESA and OA-TEFNA groups for the fertilization, cleavage, clinical pregnancy, and miscarriage rates. This study indicates that defective spermatogenesis affects the ICSI clinical outcome of azoospermic patients rather than the sperm retrieval methods.     

IVF/ICSI联合治疗在体外助孕周期中的应用价值

目的:对原发不孕≥5年,男方精液正常或原发不孕≥4年,伴男方精液异常但达不到卵胞浆内单精子显微注射(ICSI)指征的患者,探讨是否存在IVF联合ICSI治疗的必要性与可行性。方法:2006年8月～2009年3月接受体外助孕的夫妇中,选取符合指征者,采用常规超排卵方案,同一周期取得的卵子随机分半,分别进行常规体外受精(IVF)与ICSI治疗。卵裂球≥4个且碎片≤30%的胚胎为可用胚胎。结果:共78个周期采用IVF联合ICSI治疗,其中常规IVF受精失败或低下(LFR)17个周期(21.8%);同期常规IVF治疗204周期,其中LFR8个周期(3.9%),两者LFR周期发生率有显著差异(P<0.005)。研究组共获959枚卵子,其中行常规IVF 470枚,受精率56.8%,行ICSI 408枚,受精率72.3%。两者受精率有显著差异。78个周期临床妊娠率为37.2%。结论:存在对原发不孕≥5年,男方精液正常或原发不孕≥4年,伴男方精液异常但达不到ICSI标准者行IVF联合ICSI治疗的必要性,可明显减少不受精情况的出现。对常规IVF与ICSI均受精的周期,可优先选择移植常规IVF胚胎,以减少子代遗传和先天缺陷的风险。     

FERTILIZATION RATES OF SMALL-HEAD SPERM IN CONVENTIONAL IVF AND ICSI

Five men produced 23 ejaculates in 23 assisted reproductive technology cycles for semen analysis. In 11 of the 14 ICSI cycles and in 5 of the 9 IVF cycles, small-head sperm were found in more than 70% of the cells, having a length of <3.5 µm and a width of <2 µm. In 6 of the 14 ICSI cycles, the embryologist who performed the ICSI was not alerted to the presence of small-head sperm. Subsequent fertilization rate was significantly lower than a) the fertilization rate of the remaining 5 ICSI cycles that acted as a control, in which the embryologist was alerted to the presence of small-head sperm, and b) was lower than the 3 ICSI cycles with normal sperm head ( p <. 05). The 8 cell embryo and blastocyst rates in the former group were also decreased, although not significantly, compared to the latter groups. Likewise, in the 5 IVF cycles with small-head sperm, the fertilization rate was significantly lower than in the 4 IVF with normal sperm head ( p <. 05). Embryologists should be alerted when a high percentage of small-head sperm are detected during routine semen analysis because they may be associated with reduced fertilization and embryo outcome.     

不同体外受精方式对胚胎玻璃化冷冻复苏的影响

目的:观察常规体外受精和卵胞浆内单精子注射两种不同体外受精方式对胚胎玻璃化冷冻复苏的影响。方法:将移植冷冻复苏胚胎的患者(均为玻璃化法)分为两组。IVF组:新鲜周期采取常规体外受精方式而获得的胚胎;ICSI组:新鲜周期采取卵胞浆内单精子注射方式受精而得到的胚胎;比较两组的不孕类型、不孕原因以及冷冻复苏周期的复苏率、着床率、临床妊娠率和流产率等。结果:IVF组和ICSI组的复苏率、着床率、临床妊娠率差异无统计学意义(P>0.05),ICSI组的流产率明显高于IVF组但差异无统计学意义(P>0.05),IVF组和ICSI组原发不孕所占比例、继发不孕所占比例差异有统计学意义(P<0.05),IVF组和ICSI组男方因素不孕所占比例、输卵管因素不孕所占比例差异有统计学意义(P<0.05)。结论:ICSI不影响胚胎玻璃化冷冻周期的复苏率、着床率及临床妊娠率,ICSI后胚胎玻璃化冷冻复苏流产率有升高的趋势,ICSI体外受精方式主要用于原发不孕患者以及男方因素导致的不孕患者。     

利用附睾或睾丸精子行卵胞浆内单精子注射治疗阻塞性无精子症

目的回顾性分析38例阻塞性无精子症(OA)患者利用附睾或睾丸精子行卵胞浆内单精子注射(ICSI)的治疗结局。方法OA患者通过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,评估受精率及临床妊娠率,以精液精子行ICSI组为对照。结果OA组38例共41个治疗周期,受精率和临床妊娠率分别为73.3%和53.6%,精液精子组31例33个治疗周期受精率和临床妊娠率分别为75.1%和48.4%,两组间比较,受精率和临床妊娠率差异无统计学意义(P>0.05)。OA组共妊娠22例,已分娩13例,流产6例,继续妊娠3例;精液精子组共妊娠16例,已分娩10例,流产1例,继续妊娠5例。结论采用附睾/睾丸精子行ICSI是治疗男性阻塞性无精子症的有效方法。     

The Impact of laparoscopic surgery of peritoneal endometriosis and endometrioma on the outcome of ICSI cycles

Our objective was to assess the role of laparoscopic removal of ovarian endometriomas and ablation of peritoneal endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) - Embryo Transfer cycles by comparing with the results of patients with untreated endometriomas and tubal factor without underlying endometriosis confirmed by laparoscopy. For this purpose, between 2002 and 2015, outcomes of 257 ICSI cycles of 150 patients, including 91 cycles of 48 patients in minimal endometriosis, 57 cycles of 25 patients in endometrioma removal, 65 cycles of 53 patients in non-operated endometrioma, and 44 cycles of 24 patients in tubal factor groups were retrospectively analyzed. Basal ovarian reserve was significantly lower, mean starting and total gonadotropin consumption was significantly higher, and mean serum E2 on the day of hCG injection, number of dominant follicles, number of retrieved total, and MII oocytes were all significantly lower in the endometrioma cystectomy group. Fertilization and embryo cleavage rates were also significantly the lowest in the endometrioma cystectomy group, whereas clinical pregnancy and live birth rates were comparable among all groups. The number of transferred embryos and duration of infertility were the most significant predictors of clinical pregnancy and live birth. Basal antral follicle count was also significant in predicting live birth.     

ULTRASTRUCTURAL ANALYSIS OF TESE AND SEMEN SPERM TAILS FROM PATIENTS EXHIBITING ABSOLUTE IMMOTILITY ON THE DAY OF ICSI

Sperm flagellar pathology was found to be the underlying cause of motility disorders that lead to male infertility. Conventional in vitro fertilization (IVF) procedures will fail when sperm show a total absence of motility. In such difficult cases intracytoplasmic sperm injection (ICSI) is the only available technique to fertilize an oocyte. Fertilization rates are low and may also be reduced when immotile sperm are used for ICSI from ejaculate of other than epididiymal or testicular origin.Presence of totally immotile sperm in the ejaculate on the day of ICSI if spermatogenesis is normal testicular sperm recovery can improve ICSI outcomes. But for patients having severe morphological or functional sperm defects embryos of lower quality tend to be produced when totally immotile sperm are used. In this study the 2 patients exhibiting totally immotile sperm in their ejaculates and TESE samples on the day of ICSI showed the same ultrastructural abnormalities. Peri-axonemal and axonemal abnormalities that were seen in association with sperm nucleus structural defects suggested that the source of sperm has no effect on morphologic characteristics and also reflects abnormality in both spermatogenesis and spermiogenesis. In this study the two patients who presented with oligoteratozoospermia with total immotility, using either ejaculate or TESE sperm fertilization and embryo development, can be obtained with ICSI, but no pregnancies were established after embryo transfers.     

睾丸新鲜精子与冷冻复苏精子临床妊娠结局的比较

目的 比较无精子症患者睾丸穿刺取精(testicular aspiration, TESA)与睾丸显微取精(microdissection testicular speron extraction, m-TESE)新鲜与冷冻复苏精子进行卵胞质内单精子注射(intracytoplasmic sperm injection, ICSI)治疗的结局,以及新鲜、冷冻复苏胚胎移植的妊娠结局。方法 选取2019年6月至2021年3月在华中科技大学同济医学院生殖医学中心接受ICSI助孕的1 116个周期,常规超排卵和经阴道B超引导下取成熟卵子进行ICSI,梗阻性无精子症(obstructive azoospermia, OA)患者行TESA,非梗阻性无精子症(nonobstructive azoospermia, NOA)患者行m-TESE,比较TESA新鲜精子组和冷冻复苏精子组,m-TESE新鲜精子组和冷冻复苏精子组的受精率、卵裂率、优质胚胎率、临床妊娠率、流产率和活产率,以及OA、NOA患者新鲜和复苏胚胎移植的临床妊娠率、流产率和活产率。结果 在受精率方面,TESA新鲜精子组明显高于TESA冷冻...     

原因不明性不孕患者同胞卵母细胞行IVF和ICSI结果比较

目的:探讨原因不明性不孕患者行常规IVF、ICSI对受精、受精后胚胎的影响。方法:回顾性分析2005年6月~2007年12月间非男性因素不孕的夫妇采用同胞卵和同一份精液行常规IVF和ICSI的受精情况、受精后胚胎的发育潜能。结果:50例原因不明性不孕患者中11例常规IVF受精完全失败,IVF完全受精失败率为22%,ICSI组无完全受精失败。IVF、ICSI均受精组ICSI受精率(82%)高于常规IVF(79%),差异无显著性意义(P>0.05)。均受精组和仅ICSI受精组患者的年龄、不孕年限、基础FSH、BMI以及精液标本分析均无显著性差异。比较移植不同受精方式的胚胎着床率、妊娠率差异均无显著性意义。结论:对于原因不明性不孕的夫妇选择施行IVF-ICSI split既可避免受精失败所致的周期取消,保证一定的成功率,又可为下一次施行IVF时决定受精方式提供依据,值得推广。尚需要大样本研究原因不明性不孕患者年龄、不孕年限和受精完全失败的关系,为选择ICSI提供依据。     

自体血清体外成熟培养液卵胞浆优化在首次ICSI治疗中的应用

目的：探讨自体血清体外成熟培养（IVM）液卵胞浆优化对首次行胞浆内单精子注射（ICSI）助孕患者的应用价值。方法：选择2017年1月—2018年7月在安徽医科大学第一附属医院生殖医学中心（我中心）首次行ICSI助孕的不孕症患者共1 074例，根据取卵日有无采用自体血清配制的IVM液培养设为血培组（819例）和非血培组（255例）。血培组取卵后IVM培养2～4 h行ICSI授精，非血培组取卵后在常规受精液中培养2～4 h行ICSI授精。比较2组患者的一般情况、胚胎发育情况和临床结局。结果：2组患者的年龄、不孕时间、体质量指数（BMI）、基础卵泡刺激素（FSH）和基础黄体生成激素（LH）水平比较，差异均无统计学意义（均P＞0.05）。血培组患者的获卵数、受精率、囊胚形成率稍高于非血培组，非血培组的优质囊胚率稍高于血培组，但是差异均无统计学意义（均P＞0.05）。血培组中47例、非血培组中22例行新鲜周期胚胎移植。2组患者新鲜移植周期的年龄、基础FSH水平、hCG日子宫内膜厚度、移植胚胎数、临床妊娠率、周期取消率和胚胎种植率比较，差异均无统计学意义（均P＞0.05），血培组流产率显著降低（6.25% vs. 36.36%）、活产/继续妊娠率显著增加（93.75% vs. 63.64%），差异有统计学意义（均P＜0.05）。结论：对于常规首次行ICSI助孕的患者，采用自体血清短时间培养与常规受精液培养相比可降低流产率，改善妊娠结局。     

附睾精子抽吸术结合卵细胞浆内单精子注射治疗阻塞性无精子症所致男性不育的研究

目的:探讨附睾精子抽吸术(ESA)结合卵细胞内单精子注射(ICSI)技术治疗阻塞性无精子症所致男性不育的治疗效果。方法:选择2002年1月~2003年12月到我院治疗不育症确诊为阻塞性无精子症男性不育患者,采用ESA方法吸取男性附睾液,分离精子用于ICSI;同时按常规体外受精-胚胎移植方法(IVF-ET),采用GnRH-α+FSH/hMG+hCG促排卵方案对女性进行促排成熟卵细胞(M II)用于显微注射授精,受精卵体外培养3 d后移植回子宫内。结果:采用MESA结合ICSI技术治疗32周期阻塞性无精子症所致不育的夫妇,所获成熟卵(M II)162个,受精率66.28%,卵裂率62.21%,临床妊娠率31.20%。结论:采用ESA结合ICSI技术治疗阻塞性无精子症所致男性不育获得良好的效果,该方法为阻塞性无精子症男性不育患者提供了一种快速、方便、无痛、有效的治疗方法。     

控制超排卵中获卵数与体外受精胚胎移植结局的关系

目的：探讨控制超排卵（COH）中获卵数对体外受精-胚胎移植（IVF—ET）结局的影响，及超排卵中最佳获卵数。方法：接受IVF—ET或卵细胞浆内单精子显微注射（ICSI）助孕治疗的不孕症患者221例，其中获卵数〈5者31例（Ⅰ组），获卵数5—10者96例（Ⅱ组），获卵数11—15者49例（Ⅲ组），获卵数〉15者45例（Ⅳ组），回顾性分析4组IVF／ICSI结局。结果：Ⅰ组临床妊娠率（25．8％）明显低于第Ⅱ、Ⅲ、Ⅳ组，差异有极显著统计学意义（P〈0．01），Ⅳ组临床妊娠率（40％）低于Ⅱ组（53．13％）及Ⅲ组（53．04％），但差异无统计学意义（P〉0．05），而重度卵巢过度刺激综合征（OHSS）Ⅳ组发生4例（8．89％），Ⅲ组1例（2．04％），Ⅰ、Ⅱ组无发生。结论：在COH中获卵数5—15个时临床妊娠率最高，获卵数≤10个时可避免重度OHSS发生。     

Testicular Sperm Extraction and ICSI in Patients with Post-Chemotherapy Non-Obstructive Azoospermia

146 MD-TESE procedures were performed in 74 patients presenting with non-obstructive azoospermia (NOA). Five of the 74 patients displayed a history of chemotherapy. Etiology of chemotherapies included testicular cancer, osteosarcoma, Ewing sarcoma, and malignant lymphoma of the stomach. Post-chemotherapy duration was 2.5-18 years. All patients underwent MD-TESE using local anesthesia with spermatic block and sedation. Extracted sperm was cryopreserved for ICSI. Histopathologic examination revealed Sertoli cell-only syndrome in all five patients; however, sperm were retrieved in 3 subjects. Post-chemotherapy MD-TESE and ICSI can be applied successfully in some patients with NOA. However, freezing semen prior to chemotherapy is recommended.     

子宫纵隔不孕症患者行宫腔镜子宫纵隔切除术后IVF/ICSI结局分析

目的：探讨宫腔镜子宫纵隔切除术（transcervical resection of septum,TCRS）对子宫纵隔不孕症患者行体外受精（in vitro fertilization,IVF）/卵细胞质内单精子注射（intracytoplasmic sperm injection,ICSI）结局的影响。方法：回顾性分析并比较2013年1月—2020年7月在南京大学医学院附属鼓楼医院生殖医学中心进行IVF/ICSI的183例子宫纵隔不孕症患者的治疗结局。其中156例行TCRS后IVF/ICSI(TCRS组),而27例患者拒绝TCRS直接行IVF/ICSI（未行TCRS组）。结果：共有247个移植周期,其中新鲜胚胎移植周期100个,临床妊娠率64.0%,活产率49.0%;冻融胚胎移植周期147个,临床妊娠率51.0%,活产率40.1%。新鲜胚胎移植周期和冻融胚胎移植周期中TCRS组与未行TCRS组的胚胎种植率、临床妊娠率、流产率、早产率、活产率及单胎妊娠新生儿出生体质量比较,差异均无统计学意义（均P>0.05）。新鲜胚胎移植周期中,与TCRS组比较,未行TCRS组的双胎妊娠率高（...     

PREGNANCY/IMPLANTATION RATES AS RELATED TO AGE FOLLOWING TRANSFER OF FROZEN EMBRYOS PRODUCED BY ICSI

A study has suggested that one drawback of ICSI is that if these embryos are cryopreserved they have lower implantation rates after thawing and transfer as compared to other frozen embryos derived from conventional oocyte insemination. Other studies have not shown such adverse effects on pregnancy rates following frozen embryo transfer (ET) of embryos formed by ICSI. The study presented here evaluated the largest number of frozen ET cycles of embryos following ICSI, which were compared to couples having frozen ET with embryos formed by conventional insemination. In women age 39 and younger, the clinical, viable, pregnancy rates and implantation rates were very similar. Similar rates were reached for the older group. These data convincingly demonstrate that fertilization by ICSI does not adversely effect the implanting capacity of frozen-thawed embryos.