梗阻性无精子症患者应用附睾、睾丸精子助孕的结局比较
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摘要
目的比较梗阻性无精子症患者应用附睾、睾丸精子助孕的结局差异。方法梗阻性无精子症患者54例,其中经皮附睾穿刺抽吸术取精者29例(PESA),睾丸精子抽提术取精者25例(TESE)。辅助生殖采用卵胞浆内单精子注射技术(ICSI),对其正常受精率、胚胎种植率、人绒毛膜促性腺激素(HCG)阳性率及临床妊娠率进行比较。结果不同取精组的正常受精率无统计学差异(P>0.05),而PESA组的胚胎种植率、HCG阳性率及临床妊娠率均高于TESE组(P<0.05)。结论梗阻性无精子症患者附睾、睾丸穿刺取精简单易行,创伤小,并发症少,获精率高,ICSI妊娠结局满意;附睾取精避免了睾丸损伤,且助孕结局可能优于睾丸取精。
Objective To compare the assisted reproductive therapy outcome using epididymal,testicular sperm for patients with obstructive azoospermia( OA). Methods Fifty- four patients with OA,including twenty- nine cases treated by percutaneous epididymal sperm aspiration( PESA) and twenty- five cases treated by testicular sperm extraction( TESE).Intracytoplasmic sperm injection( ICSI) procedure was performed immediately. Normal fertilization rates,embryo implantation rates,human chorionic gonadotropin( HCG) positive rates and clinical pregnancy rates were evaluated. Results There were no statistical differences in normal fertilization rates between the two groups( P > 0. 05),and the group of PESA was higher than TESE in embryo implantation rates,HCG positive rates and clinical pregnancy rates( P < 0. 05). Conclusion Having favorable ICSI pregnancy outcome( rate),PESA and TESE are the effective methods to obtain sperms for patients with OA. PESA may be more superior to TESE in assisted reproductive therapy outcome.
Objective To compare the assisted reproductive therapy outcome using epididymal,testicular sperm for patients with obstructive azoospermia( OA). Methods Fifty- four patients with OA,including twenty- nine cases treated by percutaneous epididymal sperm aspiration( PESA) and twenty- five cases treated by testicular sperm extraction( TESE).Intracytoplasmic sperm injection( ICSI) procedure was performed immediately. Normal fertilization rates,embryo implantation rates,human chorionic gonadotropin( HCG) positive rates and clinical pregnancy rates were evaluated. Results There were no statistical differences in normal fertilization rates between the two groups( P > 0. 05),and the group of PESA was higher than TESE in embryo implantation rates,HCG positive rates and clinical pregnancy rates( P < 0. 05). Conclusion Having favorable ICSI pregnancy outcome( rate),PESA and TESE are the effective methods to obtain sperms for patients with OA. PESA may be more superior to TESE in assisted reproductive therapy outcome.
引文
[1]欧建平,庄广伦,周灿权,等.无精子症病人100例取精方法及妊娠结局[J].中华男科学,2002,8(4)∶258-260.
[2]TEMPLE-SMITH P D,SOUTHWICK G J,YATES C A,et al.Human pregnancy by in vitro fertilization(IVF)using sperm aspirated from epidedymis[J].J In Vitro Embryo Transf,1985,2(3):119-122.
[3]PLERMO G,JO RIS H,DOVROEY P,et al.Pregnancies after intracytoplamic injection of single spermatozoa into an oocyte[J].Lancet,1992,340(8 810):17-18.
[4]SU LM,PALERMO G D,GOLDSTEIN M,et al.Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia:testicular histology can predict success of sperm retrieval[J].Urol,1999,161(1):112-116.
[5]BELKER A M,SHERINS R J,DENNISON LAGOS L,et al.Percutaneous testicular sperm aspiration:a convenient and effective office procedure to reteive sperm for in vitro fertilization with intracytop lasmic sperm injection[J].The Journal of U rology,1998,160(6):2058-2062.
[6]赵良运,涂响安,王文卫,等.射精管梗阻性无精子症的诊断与治疗(附46例报告)[J].中国男科学杂志,2006,25(2):275-277.
[7]涂响安,赵良运,邓立文,等.梗阻性无精子症的外科治疗(附56例报告)[J].中华男科学杂志.2010,46(1):134-135.
[8]SMIERLY C,WU GJ,ZORAN S,et al.The paternal inheritance of the centrosome,the cell's microtubule organizing-center,in humans,and the implications for in fertility[J].Nature Med,1995,1(1):47
[9]FISHEL S,G REEN S,HUNTER A,et al.Hum an fertilization with round and elongated spermatids[J].Hum Reprod,1997,12(2):336
[10]郭应禄,胡礼泉.男科学[M].北京:人民卫生出版社,2004:34-46.
[11]SEMIO-FRANCISCO L-,BRAGA DP,FIGUEIRA RDE C,et al.Assisted reproductive technology outcomes in azoospermic men:10 years of experience with surgical sperm retrieval[J].Aging Male,2010,13(1):44-50.
[12]罗开玲,邓志华,丘映,等.精液精子、附睾精子和睾丸精子卵胞浆内单精子注射助孕结局的比较[J].广西医科大学学报,2008.25(2):275-277.
[13]欧蕾,郭艺红,孙莹璞,苏迎春.睾丸、附睾精子冻融后行卵胞浆内单精子注射疗效观察[J].郑州大学学报(医学版).2011,46(1):134-135.
[14]PASQUALOTTO F F,ROSSI-FERRAGUT L M,ROCHA C C,et al.Outcome of in vitro fertilization and intracytoplamic injection of epididymal and testicular sperm obtained from patients with obstructiv and nonobstructive azoospermia[J].Urol,2002,167(4):1753-1756.
[15]刘雅峰,欧建平,王琼,等.附睾精子和睾丸精子妊娠结局比较[J].中国优生与遗传杂志,2006,14(11):100-101
[16]DOZORTSEV D,NEME R,DIAMOND M P,et al.Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia[J].Fertil Steril,2006,86(3):606-11
[17]DE CSSIA SAVIO FIGUEIRA R,MADASCHI C,NICHI M,et al.A comparison of post-thaw results between embryos arising from intracytoplasmic sperm injection using surgically retrieved or ejaculated spermatozoa[J].Fertil Steril,2009,91(3):727-32.
[18]SUKCHAROEN N,SITHIPRAVEJ T,PROMVIENGCHAI S,et al Comparison of the fertilization rate after intracytoplasmic sperm injection(ICSI)using ejaculated sperms,epididymal sperms and testicular sperms[J].J Med Assoc Tha,1998,81(8):565-571.
[19]曹英,曹翔,韩金兰,等.经皮睾丸精子抽吸术结合卵浆内单精子注射治疗严重男性因素不育的研究[J].中华妇产科杂志,2001,36(11):666-668.
[20]汪李虎,吴敬之,余云香,等.经皮睾丸精子抽吸术治疗无精子症的研究[J].中国优生与遗传杂志,2004,12(4):120-132.
[21]刘雅峰,欧建平,徐艳文,等.经皮附睾或睾丸抽吸取精结合ICSI治疗无精子症[J].中国优生与遗传杂志,2011,19(11):103-104.
[22]YEUNG C H,COOPER T G,OBERPENNING F,et al.Changes in movement characteristics of human sepermatozoa along the length of the epididymis[J].Biol Reprod,1993,49(2):274.
[2]TEMPLE-SMITH P D,SOUTHWICK G J,YATES C A,et al.Human pregnancy by in vitro fertilization(IVF)using sperm aspirated from epidedymis[J].J In Vitro Embryo Transf,1985,2(3):119-122.
[3]PLERMO G,JO RIS H,DOVROEY P,et al.Pregnancies after intracytoplamic injection of single spermatozoa into an oocyte[J].Lancet,1992,340(8 810):17-18.
[4]SU LM,PALERMO G D,GOLDSTEIN M,et al.Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia:testicular histology can predict success of sperm retrieval[J].Urol,1999,161(1):112-116.
[5]BELKER A M,SHERINS R J,DENNISON LAGOS L,et al.Percutaneous testicular sperm aspiration:a convenient and effective office procedure to reteive sperm for in vitro fertilization with intracytop lasmic sperm injection[J].The Journal of U rology,1998,160(6):2058-2062.
[6]赵良运,涂响安,王文卫,等.射精管梗阻性无精子症的诊断与治疗(附46例报告)[J].中国男科学杂志,2006,25(2):275-277.
[7]涂响安,赵良运,邓立文,等.梗阻性无精子症的外科治疗(附56例报告)[J].中华男科学杂志.2010,46(1):134-135.
[8]SMIERLY C,WU GJ,ZORAN S,et al.The paternal inheritance of the centrosome,the cell's microtubule organizing-center,in humans,and the implications for in fertility[J].Nature Med,1995,1(1):47
[9]FISHEL S,G REEN S,HUNTER A,et al.Hum an fertilization with round and elongated spermatids[J].Hum Reprod,1997,12(2):336
[10]郭应禄,胡礼泉.男科学[M].北京:人民卫生出版社,2004:34-46.
[11]SEMIO-FRANCISCO L-,BRAGA DP,FIGUEIRA RDE C,et al.Assisted reproductive technology outcomes in azoospermic men:10 years of experience with surgical sperm retrieval[J].Aging Male,2010,13(1):44-50.
[12]罗开玲,邓志华,丘映,等.精液精子、附睾精子和睾丸精子卵胞浆内单精子注射助孕结局的比较[J].广西医科大学学报,2008.25(2):275-277.
[13]欧蕾,郭艺红,孙莹璞,苏迎春.睾丸、附睾精子冻融后行卵胞浆内单精子注射疗效观察[J].郑州大学学报(医学版).2011,46(1):134-135.
[14]PASQUALOTTO F F,ROSSI-FERRAGUT L M,ROCHA C C,et al.Outcome of in vitro fertilization and intracytoplamic injection of epididymal and testicular sperm obtained from patients with obstructiv and nonobstructive azoospermia[J].Urol,2002,167(4):1753-1756.
[15]刘雅峰,欧建平,王琼,等.附睾精子和睾丸精子妊娠结局比较[J].中国优生与遗传杂志,2006,14(11):100-101
[16]DOZORTSEV D,NEME R,DIAMOND M P,et al.Embryos generated using testicular spermatozoa have higher developmental potential than those obtained using epididymal spermatozoa in men with obstructive azoospermia[J].Fertil Steril,2006,86(3):606-11
[17]DE CSSIA SAVIO FIGUEIRA R,MADASCHI C,NICHI M,et al.A comparison of post-thaw results between embryos arising from intracytoplasmic sperm injection using surgically retrieved or ejaculated spermatozoa[J].Fertil Steril,2009,91(3):727-32.
[18]SUKCHAROEN N,SITHIPRAVEJ T,PROMVIENGCHAI S,et al Comparison of the fertilization rate after intracytoplasmic sperm injection(ICSI)using ejaculated sperms,epididymal sperms and testicular sperms[J].J Med Assoc Tha,1998,81(8):565-571.
[19]曹英,曹翔,韩金兰,等.经皮睾丸精子抽吸术结合卵浆内单精子注射治疗严重男性因素不育的研究[J].中华妇产科杂志,2001,36(11):666-668.
[20]汪李虎,吴敬之,余云香,等.经皮睾丸精子抽吸术治疗无精子症的研究[J].中国优生与遗传杂志,2004,12(4):120-132.
[21]刘雅峰,欧建平,徐艳文,等.经皮附睾或睾丸抽吸取精结合ICSI治疗无精子症[J].中国优生与遗传杂志,2011,19(11):103-104.
[22]YEUNG C H,COOPER T G,OBERPENNING F,et al.Changes in movement characteristics of human sepermatozoa along the length of the epididymis[J].Biol Reprod,1993,49(2):274.