精液、附睾及睾丸来源精子行卵母细胞质内单精子注射的临床结局
摘要
目的分析本中心2003年1月至2011年12月利用精液精子、附睾及睾丸精子行卵胞浆内单精子注射(ICSI)的妊娠及分娩结局。方法男性不育行ICSI的1195个新鲜周期,按精子来源分为:射出精液(ES)组852周期、经皮附睾精子抽吸术取精组(PESA)247周期、睾丸精子获取术取精组(TESE)96周期。比较三组的受精率、种植率、临床妊娠率、流产率以及分娩率之间的差别。结果 ES组、PESA组和TESE组的受精率(80.1%,82.3%,84.5%)、种植率(45.5%,48.9%,48.9%)、临床妊娠率(66.6%,68.1%,66.7%)、分娩率(57.3%,59.0%,50.6%)均无显著差别(P>0.05)。TESE组自然流产率显著高于PESA组(15.5%,6.4%,P<0.05),ES组与PESA组自然流产率无显著差别(9.4%,6.4%,P>0.05)。结论精液精子、附睾及睾丸精子行ICSI的临床妊娠率和分娩率无明显差异。无精子症患者应首先选择附睾取精行ICSI,如果附睾取精无活动精子或者取出液中含有大量脓细胞,建议行睾丸取精。
引文
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[3]French DB,Sabanegh ES Jr,Goldfarb J,et al.Does severe teratozoospermia affect blastocyst formation,live birth rate,and other clinical outcome parameters in ICSI cycles?Fertil Steril,2010,93:1097-1103.
[4]Kamal A,Fahmy I,Mansour R,et al.Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction?A comparative analysis.Fertil Steril,2010,94:2135-2140.
[5]Buffat C,Patrat C,Merlet F,et al.ICSI outcomes in obstructive azoospermia:influence of the origin of surgically retrieved spermatozoa and the cause of obstruction.Hum Reprod,2006,21:1018-1024.
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[8]Sandalinas M,Sadowy S,Alikani M,et al.Developmental ability of chromosomally abnormal human embryos to develop to the blastocyst stage.Hum Reprod,2001,16:1954-1958.
[9]Moskovtsev SI,Jarvi K,Mullen JB,et al.Testicular spermatozoa have statistically significantly lower DNA damage compared with ejaculated spermatozoa in patients with unsuccessful oral antioxidant treatment.Fertil Steril,2010,93:1142-1146.
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[11]Woldringh GH,Besselink DE,Tillema AH,et al.Karyotyping,congenital anomalies and follow-up of children after intracytoplasmic sperm injection with non-ejaculated sperm:a systematic review.Hum Reprod Update,2010,16:12-19.
[12]Dul EC,van Echten-Arends J,Groen H,et al.Chromosomal abnormalities in azoospermic and non-azoospermic infertile men:numbers needed to be screened to prevent adverse pregnancy outcomes.Hum Reprod,2012,27:2850-2856.
[13]Zhang YS,Dai RL,Wang RX,et al.Analysis of y chromosome microdeletion in 1738 infertile men from northeastern China.Urology,2013,82:584-588.
[2]苗聪秀,朱文兵,李娜.不同来源精子及其活力与无精子症患者ICSI受精结局的关系.中国现代医学杂志,2013,23:78-82.
[3]French DB,Sabanegh ES Jr,Goldfarb J,et al.Does severe teratozoospermia affect blastocyst formation,live birth rate,and other clinical outcome parameters in ICSI cycles?Fertil Steril,2010,93:1097-1103.
[4]Kamal A,Fahmy I,Mansour R,et al.Does the outcome of ICSI in cases of obstructive azoospermia depend on the origin of the retrieved spermatozoa or the cause of obstruction?A comparative analysis.Fertil Steril,2010,94:2135-2140.
[5]Buffat C,Patrat C,Merlet F,et al.ICSI outcomes in obstructive azoospermia:influence of the origin of surgically retrieved spermatozoa and the cause of obstruction.Hum Reprod,2006,21:1018-1024.
[6]Dozortsev D,Neme R,Diamond MP,et al.Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia.Fertil Steril,2006,86:606-611.
[7]Silber S,Escudero T,Lenahan K,et al.Chromosomal abnormalities in embryos drived from testicular sperm extraction.Fertil Steril,2003,79:30-38.
[8]Sandalinas M,Sadowy S,Alikani M,et al.Developmental ability of chromosomally abnormal human embryos to develop to the blastocyst stage.Hum Reprod,2001,16:1954-1958.
[9]Moskovtsev SI,Jarvi K,Mullen JB,et al.Testicular spermatozoa have statistically significantly lower DNA damage compared with ejaculated spermatozoa in patients with unsuccessful oral antioxidant treatment.Fertil Steril,2010,93:1142-1146.
[10]Suganuma R,Yanagimachi R,Meistrich ML.Decline in fertility of mouse sperm with abnormal chromatin during epididymal passage as revealed by ICSI.Hum Reprod,2005,20:3101-3108.
[11]Woldringh GH,Besselink DE,Tillema AH,et al.Karyotyping,congenital anomalies and follow-up of children after intracytoplasmic sperm injection with non-ejaculated sperm:a systematic review.Hum Reprod Update,2010,16:12-19.
[12]Dul EC,van Echten-Arends J,Groen H,et al.Chromosomal abnormalities in azoospermic and non-azoospermic infertile men:numbers needed to be screened to prevent adverse pregnancy outcomes.Hum Reprod,2012,27:2850-2856.
[13]Zhang YS,Dai RL,Wang RX,et al.Analysis of y chromosome microdeletion in 1738 infertile men from northeastern China.Urology,2013,82:584-588.