不同病因非梗阻性无精子症患者显微切开睾丸取精及ICSI结局比较
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摘要
目的:比较不同病因非梗阻性无精子症(NOA)患者显微切开睾丸取精术(micro-TESE)的成功率及配偶卵细胞胞质内单精子注射(ICSI)结局。方法:回顾分析2016年9月至2017年12月155例行micro-TESE NOA患者的临床资料,根据不同病因将其分为先天性NOA(n=49)、获得性NOA(n=15)和特发性NOA(n=91) 3组,比较3组患者年龄、睾丸体积、生殖激素水平、超声表现、micro-TESE取精成功率。同时,根据女方情况,纳入符合要求的取精成功患者对受精率、可利用胚胎率和临床妊娠率进行分析。结果:先天性NOA患者睾丸体积[(6. 4±5. 0) ml)]显著小于获得性NOA患者[(10. 2±2. 0) ml]和特发性NOA患者[(9.9±3.2) ml](P <0.05);先天性NOA患者LH[(15. 2±10. 1) IU/L]显著高于获得性NOA患者[(9. 1±6. 5) IU/L)]和特发性NOA患者[(7. 8±3. 5) IU/L)](P <0. 05);而特发性NOA患者T[(11. 8±4. 8) nmol/L]显著高于先天性NOA患者[(8. 9±4. 5) nmol/L](P <0. 05)。先天性NOA患者micro-TESE取精成功率为73. 5%(36/49),获得性NOA患者为100%(15/15),特发性NOA患者为24. 2%(22/91),3组间差异显著(P <0. 05)。获得性NOA患者配偶ICSI后受精率为(73. 1±23. 3)%,显著高于先天性NOA患者[(48. 9±21. 7)%]和特发性NOA患者[(52. 6±22. 7)%](P <0. 05)。不同病因NOA患者配偶ICSI后可利用胚胎率和临床妊娠率间无显著差异。结论:获得性NOA患者micro-TESE取精成功率最高,且ICSI后受精率、可利用胚胎率以及临床妊娠率最高,其次是先天性NOA患者;特发性NOA患者取精成功率及ICSI结局较差。
Objective: To compare the sperm retrieval rate( SRR) of microdissection testicular sperm extraction( micro-TESE)and the outcomes of intracytoplasmic sperm injection( ICSI) among different etiological types of non-obstructive azoospermia( NOA).Methods: We retrospectively analyzed the clinical data on 155 cases of NOA undergoing micro-TESE in our hospital from September2016 to December 2017,which were classified into three types according to etiological factors: congenital NOA( n = 49),acquired NOA( n = 15) and idiopathic NOA( n = 91). We compared the age,testis volume,levels of reproductive hormones,ultrasonographic manifestations,and SRR of micro-TESE among the three groups of patients. We also recorded and analyzed the rates of fertilization,available embryos and clinical pregnancy in the spouses of the patients included for successful sperm retrieval in micro-TESE.Results: The testis volume was significantly lower in the congenital than in the acquired and idiopathic NOA groups( [6. 4 ± 5. 0]vs[10. 2 ± 2. 0]and [9. 9 ± 3. 2]ml,P < 0. 05),while the LH level was markedly higher in the former group than in the latter two( [15. 2 ± 10. 1]vs[9. 1 ± 6. 5]and[7. 8 ± 3. 5]m IU/ml,P < 0. 05),and so was the T level in the idiopathic than in the congenital NOA group( [11. 8 ± 4. 8] vs [8. 9 ± 4. 5] nmol/L,P < 0. 05). The SRRs of micro-TESE in the congenital,acquired and idiopathic NOA patients were 73. 5%( 36/49),100%( 15/15),and 24. 2%( 22/91) respectively,with statistically significant differences among the three groups( P < 0. 05). The fertilization rate after ICSI was remarkably higher in the acquired than in the congenital and idiopathic NOA groups( [73. 1 ± 23. 3]% vs [48. 9 ± 21. 7]% and [52. 6 ± 22. 7]%,P < 0. 05). There were no statistically significant differences among the three groups in the rates of embryo utilization and clinical pregnancy. Conclusion: The sperm retrieval rate of micro-TESE and the rates of fertilization,embryo utilization and clinical pregnancy after ICSI were the highest in the acquired NOA but the lowest in the idiopathic NOA patients.
Objective: To compare the sperm retrieval rate( SRR) of microdissection testicular sperm extraction( micro-TESE)and the outcomes of intracytoplasmic sperm injection( ICSI) among different etiological types of non-obstructive azoospermia( NOA).Methods: We retrospectively analyzed the clinical data on 155 cases of NOA undergoing micro-TESE in our hospital from September2016 to December 2017,which were classified into three types according to etiological factors: congenital NOA( n = 49),acquired NOA( n = 15) and idiopathic NOA( n = 91). We compared the age,testis volume,levels of reproductive hormones,ultrasonographic manifestations,and SRR of micro-TESE among the three groups of patients. We also recorded and analyzed the rates of fertilization,available embryos and clinical pregnancy in the spouses of the patients included for successful sperm retrieval in micro-TESE.Results: The testis volume was significantly lower in the congenital than in the acquired and idiopathic NOA groups( [6. 4 ± 5. 0]vs[10. 2 ± 2. 0]and [9. 9 ± 3. 2]ml,P < 0. 05),while the LH level was markedly higher in the former group than in the latter two( [15. 2 ± 10. 1]vs[9. 1 ± 6. 5]and[7. 8 ± 3. 5]m IU/ml,P < 0. 05),and so was the T level in the idiopathic than in the congenital NOA group( [11. 8 ± 4. 8] vs [8. 9 ± 4. 5] nmol/L,P < 0. 05). The SRRs of micro-TESE in the congenital,acquired and idiopathic NOA patients were 73. 5%( 36/49),100%( 15/15),and 24. 2%( 22/91) respectively,with statistically significant differences among the three groups( P < 0. 05). The fertilization rate after ICSI was remarkably higher in the acquired than in the congenital and idiopathic NOA groups( [73. 1 ± 23. 3]% vs [48. 9 ± 21. 7]% and [52. 6 ± 22. 7]%,P < 0. 05). There were no statistically significant differences among the three groups in the rates of embryo utilization and clinical pregnancy. Conclusion: The sperm retrieval rate of micro-TESE and the rates of fertilization,embryo utilization and clinical pregnancy after ICSI were the highest in the acquired NOA but the lowest in the idiopathic NOA patients.
引文
[1] Esteves SC,Lee W,Benjamin DJ,et al. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol,2013,189(1):232-237.
[2]杨竣,刘继红.显微切割睾丸活检在非梗阻性无精子症中的应用.中华男科学杂志,2012,18(6):551-555.
[3] Wosnitzer M,Goldstein M,Hardy MP. Review of azoospermia.Spermatogenesis,2014,4:e28218.
[4] Dabaja AA,Schlegel PN. Microdissection testicular sperm extraction:An update. Asian J Androl,2013,15(1):35-39.
[5] Mittal PK,Little B,Harri PA,et al. Role of imaging in the evaluation of male infertility. Radiographics,2017,37(3):837-854.
[6] Schlegel PN,Li PS. Microdissection TESE:Sperm retrieval in non-obstructive azoospermia. Hum Reprod Update, 1998, 4(4):439.
[7] Schlegel PN. Testicular sperm extraction:Microdissection improves sperm yield with minimal tissue excision. Hum Reprod,1999,14(1):131-135.
[8] Matsumiya K,Namiki M,Takahara S,et al. Clinical study of azoospermia. Int J Androl,1994,17(3):140-142.
[9]孔雷,白文俊,王晓峰,等. 73例无精子症患者临床分析.中国男科学杂志,2006,20(4):40-43.
[10]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.
[11] Plotton I,Brosse A,Cuzin B,et al. Klinefelter syndrome and TESE-ICSI. Ann Endocrinol(Paris),2014,75(2):118-125.
[12] Emre Bakircioglu M,Erden HF,Kaplancan T,et al. Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome. Urology,2006,68(5):1082-1086.
[13] Koga M,Tsujimura A,Takeyama M,et al. Clinical comparison of successful and failed microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome. Urology,2007,70(2):341-345.
[14] Tsujimura A,Matsumiya K,Miyagawa Y,et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol,2004,172(5 Pt 1):1944-1947.
[15] Cissen M,Meijerink AM,D'Hauwers KW,et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod,2016,31(9):1934-1941.
[16]杨竣,孙雪娇,任心林,等.非嵌合型克氏综合征显微睾丸取精术后临床妊娠1例报告及文献复习.现代泌尿生殖肿瘤杂志,2017,9(1):33-37.
[17] Klami R,Mankonen H,Perheentupa A. Microdissection testicular sperm extraction in Finland—results of the first 100 patients.Acta Obstet Gynecol Scand,2018,97(1):53-58.
[18] Nardo LG,Sinatra F,Bartoloni G,et al. Ultrastructural features and ICSI treatment of severe teratozoospermia:Report of two human cases of globozoospermia. Eur J Obstet Gynecol Reprod Biol,2002,104(1):40-42.
[19] Loutradi KE,Tarlatzis BC,Goulis DG,et al. The effects of sperm quality on embryo development after intracytoplasmic sperm injection. J Assist Reprod Genet,2006,23(2):69-74.
[20] Mansour R. Preimplantation genetic diagnosis for Y-linked diseases:Why not? Reprod Biomed Online,2004,8(2):144-145.
[21] Wiland E,Wojda A,Kamieniczna M,et al. Idiopathic infertility in married couples in the light of cytogenetic analysis and sperm penetration assay. Folia Histochem Cytobiol,2001,39(1):35-41.
[22] Morris ID,Ilott S,Dixon L,et al. The spectrum of DNA damage in human sperm assessed by single cell gel electrophoresis(Comet assay)and its relationship to fertilization and embryo development. Hum Reprod,2002,17(4):990-998.
[23] Aytoz A,Camus M,Tournaye H,et al. Outcome of pregnancies after intracytoplasmic sperm injection and the effect of sperm origin and quality on this outcome. Fertil Steril,1998,70(3):500-505.
[24] Tsai CC,Huang FJ,Wang LJ,et al. Clinical outcomes and development of children born after intracytoplasmic sperm injection(ICSI)using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm:A comparative study.Fertil Steril,2011,96(3):567-571.
[25] Oron G,Fisch B,Sapir O,et al. Pregnancy outcome after ICSI with thawed testicular sperm from men with non-obstructive azoospermia compared to ICSI with ejaculated sperm from men with severe oligoasthenoteratozoospermia and IVF with normal ejaculated sperm. Gynecol Endocrinol,2014,30(2):103-106.
[2]杨竣,刘继红.显微切割睾丸活检在非梗阻性无精子症中的应用.中华男科学杂志,2012,18(6):551-555.
[3] Wosnitzer M,Goldstein M,Hardy MP. Review of azoospermia.Spermatogenesis,2014,4:e28218.
[4] Dabaja AA,Schlegel PN. Microdissection testicular sperm extraction:An update. Asian J Androl,2013,15(1):35-39.
[5] Mittal PK,Little B,Harri PA,et al. Role of imaging in the evaluation of male infertility. Radiographics,2017,37(3):837-854.
[6] Schlegel PN,Li PS. Microdissection TESE:Sperm retrieval in non-obstructive azoospermia. Hum Reprod Update, 1998, 4(4):439.
[7] Schlegel PN. Testicular sperm extraction:Microdissection improves sperm yield with minimal tissue excision. Hum Reprod,1999,14(1):131-135.
[8] Matsumiya K,Namiki M,Takahara S,et al. Clinical study of azoospermia. Int J Androl,1994,17(3):140-142.
[9]孔雷,白文俊,王晓峰,等. 73例无精子症患者临床分析.中国男科学杂志,2006,20(4):40-43.
[10]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.
[11] Plotton I,Brosse A,Cuzin B,et al. Klinefelter syndrome and TESE-ICSI. Ann Endocrinol(Paris),2014,75(2):118-125.
[12] Emre Bakircioglu M,Erden HF,Kaplancan T,et al. Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome. Urology,2006,68(5):1082-1086.
[13] Koga M,Tsujimura A,Takeyama M,et al. Clinical comparison of successful and failed microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome. Urology,2007,70(2):341-345.
[14] Tsujimura A,Matsumiya K,Miyagawa Y,et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol,2004,172(5 Pt 1):1944-1947.
[15] Cissen M,Meijerink AM,D'Hauwers KW,et al. Prediction model for obtaining spermatozoa with testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod,2016,31(9):1934-1941.
[16]杨竣,孙雪娇,任心林,等.非嵌合型克氏综合征显微睾丸取精术后临床妊娠1例报告及文献复习.现代泌尿生殖肿瘤杂志,2017,9(1):33-37.
[17] Klami R,Mankonen H,Perheentupa A. Microdissection testicular sperm extraction in Finland—results of the first 100 patients.Acta Obstet Gynecol Scand,2018,97(1):53-58.
[18] Nardo LG,Sinatra F,Bartoloni G,et al. Ultrastructural features and ICSI treatment of severe teratozoospermia:Report of two human cases of globozoospermia. Eur J Obstet Gynecol Reprod Biol,2002,104(1):40-42.
[19] Loutradi KE,Tarlatzis BC,Goulis DG,et al. The effects of sperm quality on embryo development after intracytoplasmic sperm injection. J Assist Reprod Genet,2006,23(2):69-74.
[20] Mansour R. Preimplantation genetic diagnosis for Y-linked diseases:Why not? Reprod Biomed Online,2004,8(2):144-145.
[21] Wiland E,Wojda A,Kamieniczna M,et al. Idiopathic infertility in married couples in the light of cytogenetic analysis and sperm penetration assay. Folia Histochem Cytobiol,2001,39(1):35-41.
[22] Morris ID,Ilott S,Dixon L,et al. The spectrum of DNA damage in human sperm assessed by single cell gel electrophoresis(Comet assay)and its relationship to fertilization and embryo development. Hum Reprod,2002,17(4):990-998.
[23] Aytoz A,Camus M,Tournaye H,et al. Outcome of pregnancies after intracytoplasmic sperm injection and the effect of sperm origin and quality on this outcome. Fertil Steril,1998,70(3):500-505.
[24] Tsai CC,Huang FJ,Wang LJ,et al. Clinical outcomes and development of children born after intracytoplasmic sperm injection(ICSI)using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm:A comparative study.Fertil Steril,2011,96(3):567-571.
[25] Oron G,Fisch B,Sapir O,et al. Pregnancy outcome after ICSI with thawed testicular sperm from men with non-obstructive azoospermia compared to ICSI with ejaculated sperm from men with severe oligoasthenoteratozoospermia and IVF with normal ejaculated sperm. Gynecol Endocrinol,2014,30(2):103-106.