微创取精术联合卵胞浆内单精子注射术治疗不射精症不育的研究

目的探讨微创取精术获取的精子联合卵胞浆内单精子注射术（ICSI）治疗不射精症患者的临床效果。方法将36例不射精症患者按获取精子的方式不同分为2组。附睾精子组31例,采用经皮附睾精子抽吸术（PESA）;睾丸精子组5例,经PESA术未获得精子而进行睾丸精子获取术（TESE）。2组患者均行ICSI治疗。观察2组受精、卵裂、优质胚胎及临床妊娠等情况。结果 36个例患者共获得MⅡ期卵子403个,其中附睾精子组342个（84.8%）,总受精率为76.3%（261/342）,卵裂率为95.0%（248/261）,优质胚胎率为47.9%（119/248）,获得临床妊娠率为41.9%（13/31）;睾丸精子组获得MⅡ期卵子61个（15.1%）,总受精率为68.8%（42/61）,卵裂率为92.9%（39/42）,优质胚胎率为48.7%（19/39）,获得临床妊娠率为40.0%（2/5）。2组患者的受精率、卵裂率、优质胚胎率及临床妊娠率比较差异均无统计学意义（均P〉0.05）。结论通过微创取精术联合ICSI治疗不射精患者的生育问题是安全有效的。不射精患者的附睾精子和睾丸精子具有相同的受精和获得优质胚胎的能力。

Microtraumatic Sperm Retrieval and Intracytoplasmic Sperm Injection for Anejaculatory Infertility

Objective To investigate the clinical efficacy of intracytoplasmic sperm injection（ICSI） combined with microtraumatic sperm retrieval in male infertility caused by anejaculation.Methods Percutaneous epididymal sperm aspiration（PESA）was performed in 31 patients with anejaculation（epididymal sperm group）,and testicular sperm extraction（TESE） was carried out in 5 anejaculation patients who underwent failed PESA（testicular sperm group）.All patients received treatment with ICSI.The fertilization,embryo cleavage,good quality embryo and clinical pregnancy were observed.Results A total of 403 metaphase Ⅱ（MⅡ）stage oocytes were obtained in 36 cycles.Epididymal sperm group had 342 oocytes（84.8%）,with a total fertilization rate of 76.3%（261/342）,an embryo cleavage rate of 95.0%（248/261）,a good quality embryo rate of 47.9%（119/248） and a clinical pregnancy rate of 41.9%（13/31）.Testicular sperm group had 61 oocytes（15.1%）,with a total fertilization rate of 68.8%（42/61）,an embryo cleavage rate of 92.9%（39/42）,a good quality embryo rate of 48.7%（19/39） and a clinical pregnancy rate of 40.0%（2/5）.There were no significant differences in these indexes between the two groups（all P0.05）.Conclusion Microtraumatic sperm retrieval combined with ICSI is safe and effective for male infertility caused by anejaculation.Epididymal sperms and testicular sperms share equal ability to fertilize oocytes and produce good quality embryos in patients with anejaculation.