不同生精功能障碍无精子症患者行ICSI后胚胎发育潜能的研究

目的:分析不同生精功能障碍的无精子症患者行ICSI后其胚胎发育潜能。方法:149例患者分为生精功能正常组,轻度、中度和重度生精功能障碍组,采用经皮附睾精子抽吸术(PESA)或经皮睾丸精子抽吸术(TESA)抽取不同生精功能障碍患者的精子行ICSI,记录和分析胚胎的正常受精率、卵裂率、优良胚胎形成率以及妊娠率。结果:PESA与TESA组比较,正常受精率(%)为74.9±19.6 vs 66.3±22.7(P>0.05),卵裂率(%)为96.7±8.6 vs 92.8±19.8(P>0.05),优良胚胎率(%)为43.5±26.2 vs 35.0±29.4(P>0.05)以及妊娠率(%)为44.0 vs 52.0(P>0.05),均无统计学差异。生精功能障碍从正常组到重度组的正常受精率(%)变化依次为77.8±18.4、68.4±18.5、73.5±19.8、51.4±27.9,其中轻度生精功能障碍与正常生精组有差异(P<0.05),重度生精功能障碍组与其他各组有统计学差异(P<0.05);胚胎卵裂率(%)变化依次为96.7±9.2、96.5±15.0、93.9±12.1、93.7±11.1,各组无统计学差异;优良胚胎率(%)变化依次为47.1±25.8、40.3±27.6、36.2±23.1、15.0±24.6,重度生精障碍组与其他各组有统计学差异(P<0.05);妊娠率(%)依次为54.8%、50.0%、13.6%、10.0%,有统计学差异(P<0.05)。结论:采用PESA或TESA行ICSI在正常受精率,卵裂率,优良胚胎率以及妊娠率上较均无明显差异。随着患者生精障碍程度的加重,受精率、优良胚胎率以及妊娠率均显著下降,而卵裂率却无明显区别。

Embryo development potential after intracytoplasmic injection of sperm from azoospermia patients with different spermatogenic functions

Objective: To analyze the embryo development potential after intracytoplasmic injection of sperm from azoospermia patients with different spermatogenic functions.Methods: We performed ICSI with sperm retrieved from azoospermia patients with different spermatogenic functions using percutaneous epididymal sperm aspiration(PESA) and testicular sperm aspiration(TESA).Then we recorded and analyzed the rates of normal fertilization,cleavages,excellent embryos and pregnancies.Results: No statistically significant differences were found between the PESA and TESA groups in the rates of normal fertilization([74.9±19.6] vs [66.3±22.7] %,P>0.05),cleavages([96.7±8.6] vs [92.8±19.8]%,P>0.05),excellent embryos([43.5±26.2] vs [35.0±29.4] %,P>0.05) and pregnancies(44.0 vs 52.0%,P>0.05).The normal fertilization rates in the patients with normal spermatogenesis,mild spermatogenic dysfunction(SD),moderate SD and severe SD were(77.8±18.4),(68.4±18.5),(73.5±19.8) and(51.4±27.9)%,respectively,with significant difference between the normal spermatogenesis and mild SD groups(P<0.05) as well as between the severe SD and the other groups(P<0.05);the cleavage rates were(96.7±9.2),(96.5±15.0),(93.9±12.1) and(93.7±11.1)%,respectively,with no significant difference among the four groups;the excellent embryo rates were(47.1±25.8),(40.3±27.6),(36.2±23.1) and(15.0±24.6)%,respectively,with significant difference between the severe SD and the other groups;the pregnancy rates were 54.8,50.0,13.6 and 10.0%,respectively,with significant differences among the four groups(P<0.001).Conclusion: ICSI by PESA or TESA is an effective approach to azoospermia.There are no significant differences between PESA and TESA in the rates of normal fertilization,cleavages,excellent embryos and pregnancies.The severity of spermatogenic dysfunction affects fertilization and initial development of embryos,which were shown in the rates of normal fertilization,excellent embryos and pregnancies but not that of cleavages.