附睾及睾丸精子结合ICSI治疗无精子症的研究

目的回顾性分析比较附睾精子和睾丸精子结合卵胞浆内单精子注射（intracytoplasmic sperm injection,IC-SI）治疗无精子症的助孕结局。方法 167例无精子症患者经皮附睾精子抽吸术（PESA）取得附睾精子,69例无精子症患者经皮睾丸精子抽吸术（TESA）获得睾丸精子。女方进行常规超排卵。采用卵胞浆内单精子注射技术获得妊娠,比较两者的受精率、种植率和临床妊娠率。结果全部患者共41个治疗周期,附睾精子组和睾丸精子组的受精率分别为75.5%和73.9%,两组间比较,差异无统计学意义（P〉0.05）。两组的种植率为40.7%、24.6%,临床妊娠率为53.9%、39.1%,两组间比较,差异有统计学意义（P〈0.05）。结论 PESA和TESA结合ICSI是男性无精子症患者的有效治疗方法 ,附睾是精子获能、成熟的重要部位,附睾精子优于睾丸精子,应首先选取附睾精子。

Treatment of Azoospermia Patients by Epididymal or Testiclular Sperm with ICSI

Objective To review the pregnancy outcome of epididymal or testicular sperm with ICSI on azoospermia patients.Methods Sperm was retrieved by percutaneous epididymal sperm aspiration（PESA）or testitucular sperm aspiration（TESA）.All patients were accepted intracytoplasmic sperm injection（ICSI）for treatment of azoospermia.The rates of fertilization,implantation and pregnancy were analyzed and evaluated.Results Sperm were retrieved by PESA in Forty-one treatment cycles were performed in the 236 azoospermia patients.The rate of fertilization,implantation and clinical pregnancy rate were 75.5%,40.7% and 53.9% respectivetively in PESA group,and 73.9%,24.6% and 39.1% respectively,in TESA group.The rate of fertilization in two groups were different（P〈0.05）,The rate of implantation and clinical pregnancy were similar（P〉0.05）.Conclusion ICSI with PESA or TESA is an effective method for treatment of obstructive azoospermic patients.Epididymis is the important position of capacitation and spermiotelcosis.Epididymal sperm shoud be choosen first for ICSI.