显微切开睾丸取精术在继发性睾丸损伤所致非梗阻性无精子症患者中的应用
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摘要
目的:探讨显微切开睾丸取精术(micro-TESE)应用于因继发性睾丸损伤导致非梗阻性无精子症(NOA)患者的疗效。方法:回顾性分析2014年9月至2017年12月接受micro-TESE并具继发性睾丸损伤病史的121例NOA患者,分析不同睾丸损伤病因患者micro-TESE取精成功率的差异。并进一步比较micro-TESE获得精子与重度少精子症患者(精子浓度<1×106/ml)射出精子的卵细胞胞质内单精子注射(ICSI)助孕结局,比较两组间女方年龄、受精(2PN)率、第3天(D3)可移植胚胎率、D3优质胚胎率、D14血h CG阳性率、胚胎种植率、临床妊娠率。结果:104例患者(86.0%,104/121)成功通过micro-TESE获得精子。按其继发性睾丸损伤的病史,microTESE取精成功率分别为:睾丸炎98.4%、隐睾下降固定术后75.5%、化疗/放疗损害63.6%。micro-TESE所获得精子和重度少精子症患者射出精子ICSI助孕周期的2PN受精率(59.4%vs 69.3%)、D14血h CG阳性率(44.6%vs 57.9%)、胚胎种植率(31.8%vs 32.6%)、临床妊娠率(41.5%vs 48.7%)均无统计学差异(P>0.05),但两者D3可移植胚胎率(40.5%vs 52.2%)、D3优质胚胎率(32.5%vs 42.1%)均有显著差异(P<0.05)。结论:micro-TESE应用于继发性睾丸损伤所致的NOA患者时取精成功率较高,可作为首选治疗方法,但需要进一步探索改善micro-TESE获得精子后行ICSI助孕结局的有效手段。
Objective: To investigate the value of micro-dissection testicular sperm extraction( micro-TESE) in the treatment of non-obstructive azoospermia( NOA) in patients with the history of secondary testicular injury. Methods: Totally,121 NOA patients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE( the micro-TESE group) and those with the sperm ejaculated from severe oligospermia patients( sperm concentration < 1 × 106/ml,the ejaculate group). Comparisons were also made between the two groups in the female age,two-pronucleus( 2 PN) fertilization rate,transferrable embryos on day 3( D3),D3 high-quality embryos,D14 blood HCG positive rate,embryo implantation rate,and clinical pregnancy rate. Results: Testicular sperm were successfully retrieved by micro-TESE in 86. 0% of the patients( 104/121),of whom 98. 4% had the history of orchitis,75. 5% had been treated surgically for cryptorchidism,and 63. 6% had received chemo-or radiotherapy. No statistically significant differences were observed between the micro-TESE and ejaculate groups in the 2 PN fertilization rate( 59. 4% vs 69. 3%,P > 0. 05),D14 blood HCG positive rate( 44. 6%vs 57. 9%,P > 0. 05),embryo implantation rate( 31. 8 % % vs 32. 6%,P > 0. 05) and clinical pregnancy rate( 41. 5% vs 48.7%,P > 0. 05). However,the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group( 40. 5% vs 52. 2%,P < 0. 05),and so was that of D3 high-quality embryos( 32. 5% vs 42. 1%,P < 0. 05). Conclusion: Micro-TESE can be applied as the first choice for NOA patients with the history of secondary testicular injury,but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro-TESE.
Objective: To investigate the value of micro-dissection testicular sperm extraction( micro-TESE) in the treatment of non-obstructive azoospermia( NOA) in patients with the history of secondary testicular injury. Methods: Totally,121 NOA patients with the history of secondary testicular injury underwent micro-TESE in our hospital from September 2014 to December 2017. We analyzed the correlation of the sperm retrieval rate with the causes of testicular injury and compared the outcomes of the ICSI cycles with the sperm retrieved from the NOA males by micro-TESE( the micro-TESE group) and those with the sperm ejaculated from severe oligospermia patients( sperm concentration < 1 × 106/ml,the ejaculate group). Comparisons were also made between the two groups in the female age,two-pronucleus( 2 PN) fertilization rate,transferrable embryos on day 3( D3),D3 high-quality embryos,D14 blood HCG positive rate,embryo implantation rate,and clinical pregnancy rate. Results: Testicular sperm were successfully retrieved by micro-TESE in 86. 0% of the patients( 104/121),of whom 98. 4% had the history of orchitis,75. 5% had been treated surgically for cryptorchidism,and 63. 6% had received chemo-or radiotherapy. No statistically significant differences were observed between the micro-TESE and ejaculate groups in the 2 PN fertilization rate( 59. 4% vs 69. 3%,P > 0. 05),D14 blood HCG positive rate( 44. 6%vs 57. 9%,P > 0. 05),embryo implantation rate( 31. 8 % % vs 32. 6%,P > 0. 05) and clinical pregnancy rate( 41. 5% vs 48.7%,P > 0. 05). However,the rate D3 transferrable embryos was significantly lower in the micro-TESE than in the ejaculate group( 40. 5% vs 52. 2%,P < 0. 05),and so was that of D3 high-quality embryos( 32. 5% vs 42. 1%,P < 0. 05). Conclusion: Micro-TESE can be applied as the first choice for NOA patients with the history of secondary testicular injury,but more effective strategies are to be explored for the improvement of ICSI outcomes with the sperm retrieved by micro-TESE.
引文
[1]Dabaja AA,Schlegel PN.Microdissection testicular sperm extraction:An update.Asian J Androl,2013,15(1):35-39.
[2]Silber SJ,Van Steirteghem AC,Liu J,et al.High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy.Hum Reprod,1995,10(1):148-152.
[3]Schlegel PN,Li PS.Microdissection TESE:Spermatozoa retrieval in non-obstructive azoospermia.Hum Reprod Update,1998,4(4):439.
[4]张靖,刘贵华,赵鲁刚,等.显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告).中华男科学杂志,2017,23(9):804-807.
[5]Silber SJ,Nagy Z,Devroey P,et al.Distribution of spermatogenesis in the testicles of azoospermic men:The presence or absence of spermatids in the testes of men with germinal failure.Hum Reprod,1997,12(11):2422-2428.
[6]Silber SJ.Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia.Hum Reprod,2000,15(11):2278-2284.
[7]唐金鑫,宋乐彬,秦超.睾丸显微取精术在非梗阻性无精子症中的应用.中华男科学杂志,2016,22(8):730-734.
[8]Dardashti K,Williams RH,Goldstein M.Microsurgical testis biopsy:A novel technique for retrieval of testicular tissue.J Urol,2000,163(4):1206-1207.
[9]Tsujimura A,Matsumiya K,Miyagawa Y,et al.Conventional multiple or microdissection testicular sperm extraction:A comparative study.Hum Reprod,2002,17(11):2924-2929.
[10]Deruyver Y,Vanderschueren D,Van der Aa F.Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia.Andrology,2014,2(1):20-24.
[11]毛加明,赵连明,洪锴,等.睾丸显微切开取精术在非嵌合型Klinefelter综合征患者中的临床应用及评价(附143例报告).中华男科学杂志,2017,23(12):1075-1079.
[12]Ishikawa T.Surgical recovery of sperm in non-obstructive azoospermia.Asian J Androl,2012,14(1):109-115.
[13]李石华,Goldstein M.外科取精术:选择哪种方法?.中华男科学杂志,2001,7(2):71-78.
[14]Virtanen HE,Toppari J.Cryptorchidism and fertility.Endocrinol Metab Clin North Am,2015,44(4):751-760.
[15]Hassan MA,Killick SR.Effect of male age on fertility:Evidence for the decline in male fertility with increasing age.Fertil Steril,2003,79(Suppl 3):1520-1527.
[16]Ramasamy R,Trivedi NN,Reifsnyder JE,et al.Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction.Fertil Steril,2014,101(3):653-655.
[17]Bryson CF,Ramasamy R,Sheehan M,et al.Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction.J Urol,2014,191(1):175-178.
[2]Silber SJ,Van Steirteghem AC,Liu J,et al.High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy.Hum Reprod,1995,10(1):148-152.
[3]Schlegel PN,Li PS.Microdissection TESE:Spermatozoa retrieval in non-obstructive azoospermia.Hum Reprod Update,1998,4(4):439.
[4]张靖,刘贵华,赵鲁刚,等.显微取精术治疗非梗阻性无精子症的疗效分析(附196例报告).中华男科学杂志,2017,23(9):804-807.
[5]Silber SJ,Nagy Z,Devroey P,et al.Distribution of spermatogenesis in the testicles of azoospermic men:The presence or absence of spermatids in the testes of men with germinal failure.Hum Reprod,1997,12(11):2422-2428.
[6]Silber SJ.Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia.Hum Reprod,2000,15(11):2278-2284.
[7]唐金鑫,宋乐彬,秦超.睾丸显微取精术在非梗阻性无精子症中的应用.中华男科学杂志,2016,22(8):730-734.
[8]Dardashti K,Williams RH,Goldstein M.Microsurgical testis biopsy:A novel technique for retrieval of testicular tissue.J Urol,2000,163(4):1206-1207.
[9]Tsujimura A,Matsumiya K,Miyagawa Y,et al.Conventional multiple or microdissection testicular sperm extraction:A comparative study.Hum Reprod,2002,17(11):2924-2929.
[10]Deruyver Y,Vanderschueren D,Van der Aa F.Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia.Andrology,2014,2(1):20-24.
[11]毛加明,赵连明,洪锴,等.睾丸显微切开取精术在非嵌合型Klinefelter综合征患者中的临床应用及评价(附143例报告).中华男科学杂志,2017,23(12):1075-1079.
[12]Ishikawa T.Surgical recovery of sperm in non-obstructive azoospermia.Asian J Androl,2012,14(1):109-115.
[13]李石华,Goldstein M.外科取精术:选择哪种方法?.中华男科学杂志,2001,7(2):71-78.
[14]Virtanen HE,Toppari J.Cryptorchidism and fertility.Endocrinol Metab Clin North Am,2015,44(4):751-760.
[15]Hassan MA,Killick SR.Effect of male age on fertility:Evidence for the decline in male fertility with increasing age.Fertil Steril,2003,79(Suppl 3):1520-1527.
[16]Ramasamy R,Trivedi NN,Reifsnyder JE,et al.Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction.Fertil Steril,2014,101(3):653-655.
[17]Bryson CF,Ramasamy R,Sheehan M,et al.Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction.J Urol,2014,191(1):175-178.