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。

Efficient Treatment of Severe Teratozoospermia by ICSI with Testicular Spermatozoa:A Report of 5 Cases

Objective： To explore the feasibility of treating severe teratozoospermia （the abnormity rate of ejaculated or epididymal sperm ≥ 99% ） by intracytoplasmic sperm injection （ICSI） with testicular sperm so as to improve the outcome of assisted reproductive technology. Methods ： We retrospectively analyzed the clinical data of 5 patients with severe teratozoospermia （ epididymal ： n = 4 ; ejaculated： n = 1 ） treated by ICSI with sperm from different sources, and compared the rates of fertilization, cleavage, quality embryos, pregnancy and implantation between the testieular and non-testicular sperm groups. Results： Four ongoing clinical pregnancies were achieved by ICSI with testicular sperm, but none with ejaculated （or epididymal） sperm. The rates of pregnancy and implantation were significantly higher in the testicular than in the non-testicular sperm group （ P 〈 0.01 ）, and there were no significant differences in the rates of fertilization, cleavage and quality embryos between the two groups （ P 〉 0.05 ）. Conclusion ： ICSI with testicular sperm could efficiently improve the therapeutic outcome for men with severe teratozoospermia.