摘要
目的探讨极重度弱精子症患者行卵泡浆内单精子显微注射(ICSI)时,若射出精液中找不到活动精子及卷尾精子,使用经皮睾丸精子抽吸术(TESA)获取的精子对体外受精-胚胎移植(IVF-ET)结局的影响。方法采用回顾性队列研究分析2016年1月1日至2021年4月1日在西北妇女儿童医院生殖中心收治的136对极重度弱精子症和74对完全不动精子患者并于本中心行ICSI助孕患者夫妇的临床资料。根据女性配偶取卵日的男方精子来源将男性患者分为射精进行性活动精子组(Ep组,精子活力<1%,可找到A或B级且形态正常精子,68例)、射精非进行性活动精子组(En组,精子活力=0%,可找到C级或卷尾且形态正常精子,68例)和睾丸精子穿刺组(TESA组,射出精液中无活动及卷尾精子,行TESA,74例)。分别比较三组的一般资料和IVF-ET结局。结果Ep组的可用胚胎率、优质胚胎率、正常受精率、临床妊娠率、活产率均高于En组,而流产率低于En组,但差异均无统计学意义(均P>0.05)。TESA组的优质胚胎率、临床妊娠率、流产率均低于Ep和En组,而活产率、正常受精率高于Ep和En组,但差异均无统计学意义(均P>0.05)。结论极重度弱精子症患者若射出精液中找不到活动精子及卷尾精子后改行TESA-ICSI并不影响卵母细胞受精、胚胎质量。此外,与使用活动精子或卷尾精子相比,其新鲜移植后的临床结局也无显著性差异。
ObjectiveTo investigate the effect percutaneous testicular sperm aspiration(TESA)on the outcomes of in vitro fertilization embryo transfer(IVF-ET)in cases of patients with severe asthenozoospermia undergoing intracytoplasmic sperm injection(ICSI)when no motile sperm or coiled-tail sperm are identified in the ejaculated semen.MethodsA retrospective cohort study was used to analyze the clinical data of 136 couples with severe asthenozoospermia and 74 couples with completely immobile sperm who underwent ICSI in the Assisted Reproductive Center of Northwest Women′s and Children′s Hospital from January 1,2016,to April 1,2021.Male patients were divided into three groups according to the source of the male spermatozoa on the day of oocyte retrieval by the female partner:ejaculatory progressive motile sperm group(Ep group,sperm motility<1%,grade A or B sperm with normal morphology can be found,68 cases),ejaculated non progressive motile sperm group(En group,sperm motility=0%,grade C or spermcoiled-tail sperm with normal morphology can be found,68 cases)and testicular sperm puncture group(TESA group,underwent TESA,with no active or coiled-tail sperm found in the ejaculated semen,74 cases).The general data and ICSI outcomes of the three groups were compared.ResultsThe available embryo rate,high-quality embryo rate,normal fertilization rate,clinical pregnancy rate,and live birth rate in the Ep group were higher than those in the En group.However,the abortion rate was lower in the Ep group compared to the En group,although the difference was not statistically significant(all P>0.05).The high-quality embryo rate,clinical pregnancy rate,and abortion rate in the TESA group were lower than those in the Ep and En groups,while the live birth rate and normal fertilization rate were higher than those in the Ep and En groups.Nevertheless,the differences were not statistically significant(all P>0.05).ConclusionsPatients diagnosed with severe asthenozoospermia,characterized by the absence of motile or coiled-tail sperm in ejaculated semen,who undergo TESA-ICSI do not experience any negative impact on oocyte fertilization or embryo quality.In addition,there is no significant difference in clinical outcomes after fresh transplantation compared to the use of motile or coiled sperm.
作者
刘项
李罗娟
史圣甲
张倩
张洲
孙建华
潘丹
Liu Xiang;Li Luojuan;Shi Shengjia;Zhang Qian;Zhang Zhou;Sun Jianhua;Pan Dan(Assisted Reproductive Center,Northwest Women′s and Children′s Hospital,Xi′an 710003,China;Department of Obstetrics and Gynecology,Chenggu County Hospital,Chenggu 723200,China)
出处
《国际泌尿系统杂志》
2024年第5期895-899,共5页
International Journal of Urology and Nephrology
基金
陕西省卫健委健康研究项目(2021E024)。
关键词
弱精子症
卵泡浆内单精子注射
体外受精
胚胎移植
Asthenozoospermia
Intracytoplasmic Sperm Injection
Fertilization in Vitro
Embryo Transfer
作者简介
通信作者:潘丹,Email:18709270206@139.com。
