不同来源精子应用于ICSI治疗的早期临床结局
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摘要
目的:比较不同来源精子应用于卵胞浆内单精子显微注射(ICSI)治疗的胚胎发育及早期临床结局。方法:回顾性分析2014年1月-2016年6月因男性因素在郑州大学第三附属医院生殖中心行ICSI治疗的1 732个新鲜移植周期。根据精子来源分为:A组射精组(n=1 253),B组经皮附睾精子抽吸(PESA)组(n=418),C组经皮睾丸精子取精(TESA)组(n=61)。比较三组正常受精率、正常卵裂率、优质胚胎率、临床妊娠率、异位妊娠率、流产率、活产率及早产率。结果:C组的正常受精率、正常卵裂率均低于A组和B组(P<0.05),B组优质胚胎率高于A组和C组(P<0.05),B组临床妊娠率高于A组(P<0.05),三组异位妊娠率、流产率、活产率及早产率比较,差异均无统计学意义(P>0.05)。结论:PESA和TESA均可以用于梗阻性无精子症患者的助孕,但就早期胚胎质量和临床妊娠率综合考虑,经皮附睾取精行卵胞浆内单精子显微注射术更优。
Objective:To compare the embryonic development and early clinical outcomes of intracytoplasmic sperm injection(ICSI) with sperm from different sources.Method:The date of 1 732 cases received ICSI from January 2014 to June 2016 in Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University was analyzed retrospectively.According to the source of sperm,all cases were divided into group A(ejaculation group,n=1 253),group B[percutaneous epididymal sperm aspiration(PESA),n=418],group C[testicular sperm extraction(TESA),n=61].The embryonic development and pregnancy outcomes among three groups were compared.Result:The rate of normal fertilization and cleavage in group C were significantly lower than those in group A and group B(P<0.05).Group B had more good-quality embryo than those of group A and group C(P<0.05).The clinical pregnancy rate in group B was higher than that in group A(P<0.05).There were no significant differences in ectopic pregnancy rate,abortion rate,live birth rate and premature delivery rate among three groups(P>0.05).Conclusion:PESA and TESA can be used in patients with obstructive azoospermia.However,considering the early embryonic quality and clinical pregnancy rate,PESA-ICSI is better.
Objective:To compare the embryonic development and early clinical outcomes of intracytoplasmic sperm injection(ICSI) with sperm from different sources.Method:The date of 1 732 cases received ICSI from January 2014 to June 2016 in Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University was analyzed retrospectively.According to the source of sperm,all cases were divided into group A(ejaculation group,n=1 253),group B[percutaneous epididymal sperm aspiration(PESA),n=418],group C[testicular sperm extraction(TESA),n=61].The embryonic development and pregnancy outcomes among three groups were compared.Result:The rate of normal fertilization and cleavage in group C were significantly lower than those in group A and group B(P<0.05).Group B had more good-quality embryo than those of group A and group C(P<0.05).The clinical pregnancy rate in group B was higher than that in group A(P<0.05).There were no significant differences in ectopic pregnancy rate,abortion rate,live birth rate and premature delivery rate among three groups(P>0.05).Conclusion:PESA and TESA can be used in patients with obstructive azoospermia.However,considering the early embryonic quality and clinical pregnancy rate,PESA-ICSI is better.
引文
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[8]董瑞娜,郭艺红,孙莹璞,等.3106个不同来源精子ICSI周期临床妊娠结局分析[J].生殖与避孕,2013,33(4):233-238.
[9]于洪君,许蓬,孙晓玲,等.不同来源精子ICSI妊娠结局的初步探讨[J].中国性科学,2015,24(7):71-73.
[10]陈润强,冼英杰,张昭,等.不同来源精子对卵胞内单精子注射术妊娠结局的影响[J/OL].中华临床医师杂志:电子版,2016,10(10):1491-1493.
[11]Huang Y,Liu Y H,Chen Y,et al.Peripheral nerve lesion induces an up-regulation of Spy1 in rat spinal cord[J].Cell Mol Neurobiol,2009,29(3):403-411.
[12]Greco E,Scarselli F,Iacobelli M,et al.Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa[J].Hum Reprod,2005,20(1):226-230.
[13]Ketabchi A A.Intracytoplasmic sperm injection outcomes with freshly ejacuated sperms and testicular or epididymal sperm extraction in patients with idiopathic cryptozoospermia[J].Nephrourol Mon,2016,8(6):e41375.
[14]Palermo G D,Neri Q V,Schlegel P N,et al.Intracytoplasmic sperm injection(ICSI)in extreme cases of male infertility[J].PLo S One,2014,9(12):e113671.
[15]Abhyankar N,Kathrins M,Niederberger C.Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia:a meta-analysis[J].Fertil steril,2016,105(6):1469-1475.
[16]倪晓蓓,王珊珊,徐志鹏,等.父方年龄及精子来源对ICSI周期临床结局的影响[J].生殖医学杂志,2017,26(1):29-33.
[2]Palermo G,Joris H,Devroey P,et al.Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte[J].The Lancet,1992,340(8810):17-18.
[3]Esteves S C,Miyaoka R,Agarwal A.Sperm retrieval techniques for assisted reproduction[J].Int Braz J Urol,2011,37(5):570-583.
[4]Buffat C,Patrat C,Merlet F,et al.ICSI outcoes in obstructive azoospermia:influence of the origin of surgically retrieved spermatozoa and the cause of obstruction[J].Hum Reprod,2006,21(4):1018-1024.
[5]Berger D S,Abdelhafez F,Russell H,et al.Severe teratozoospermia and its influence on pronuclear morphology,embryonic cleavage and compaction[J].Reprod Biol Endocrinol,2011,9:37.
[6]Amirjannati N,Heidari-Vala H,Akhondi M A,et al.Comparison of intracytoplasmic sperm injection outcomes between spermatozoa retrieved from testicular-biopsy and from ejaculation in cryptozoospermic men[J].Andrologia,2012,44(s1):704-709.
[7]Hameed,Ozturk O.Testicular versus epididymal spermatozoa in intracytoplasmic sperm injection treatment cycles[J].Ayub Med Coll Abbottabad,2012,22(4):159-163.
[8]董瑞娜,郭艺红,孙莹璞,等.3106个不同来源精子ICSI周期临床妊娠结局分析[J].生殖与避孕,2013,33(4):233-238.
[9]于洪君,许蓬,孙晓玲,等.不同来源精子ICSI妊娠结局的初步探讨[J].中国性科学,2015,24(7):71-73.
[10]陈润强,冼英杰,张昭,等.不同来源精子对卵胞内单精子注射术妊娠结局的影响[J/OL].中华临床医师杂志:电子版,2016,10(10):1491-1493.
[11]Huang Y,Liu Y H,Chen Y,et al.Peripheral nerve lesion induces an up-regulation of Spy1 in rat spinal cord[J].Cell Mol Neurobiol,2009,29(3):403-411.
[12]Greco E,Scarselli F,Iacobelli M,et al.Efficient treatment of infertility due to sperm DNA damage by ICSI with testicular spermatozoa[J].Hum Reprod,2005,20(1):226-230.
[13]Ketabchi A A.Intracytoplasmic sperm injection outcomes with freshly ejacuated sperms and testicular or epididymal sperm extraction in patients with idiopathic cryptozoospermia[J].Nephrourol Mon,2016,8(6):e41375.
[14]Palermo G D,Neri Q V,Schlegel P N,et al.Intracytoplasmic sperm injection(ICSI)in extreme cases of male infertility[J].PLo S One,2014,9(12):e113671.
[15]Abhyankar N,Kathrins M,Niederberger C.Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia:a meta-analysis[J].Fertil steril,2016,105(6):1469-1475.
[16]倪晓蓓,王珊珊,徐志鹏,等.父方年龄及精子来源对ICSI周期临床结局的影响[J].生殖医学杂志,2017,26(1):29-33.