非梗阻性无精子症患者睾丸组织病理分型不影响生育结局

发布时间：2018-11-09 18:05

【摘要】：目的:探讨非梗阻性无精子症(NOA)患者行卵细胞胞质内单精子注射(ICSI)的助孕结局及睾丸组织病理分型对NOA患者的助孕结局有无影响。方法:回顾性分析2011年1月至2015年12月在我中心行TESE-ICSI助孕的无精子症病例资料,选取不孕原因为单纯男性或男性合并女方输卵管因素且女方年龄在38岁以下的NOA病例73例,共完成105个取卵周期,79个移植周期。按睾丸组织病理分型将ICSI周期分为3组:精子发生低下组、精子成熟阻滞组和唯支持细胞组,统计总体NOA患者和不同组别的男、女方平均年龄、不孕年限、基础FSH值、Gn使用支数、Gn使用天数、hCG日E2值、hCG日P值、内膜厚度、MII卵数、受精、可移植胚胎、优质胚胎、临床妊娠及流产情况。结果:NOA患者的ICSI受精率为67.03%(553/825)、受精失败发生率9.52%(10/105)、可移植胚胎率85.66%(472/551)、优质胚胎率35.03%(193/551)、平均移植胚胎2.10个,临床妊娠44例(55.70%),活婴出生率为53.16%(42/79),未发生出生缺陷。不同组间的男女方平均年龄、不孕年限、基础FSH值、Gn使用支数、Gn使用天数、hCG日E2值、HCG日P值、子宫内膜厚度、MII卵数均无统计学差异。精子发生低下组、精子成熟阻滞组、唯支持细胞组的受精率分别为68.51%、64.39%、61.45%,可移植胚胎率分别为85.05%、90.48%、83.05%,优质胚胎率分别为33.09%、41.67%、38.98%,组间也均无统计学差异(P0.05);而在临床妊娠率及胚胎种植率方面虽然精子发生低下组(60.00%、37.61%)与唯支持细胞组(62.50%、50.00%)要高于精子成熟阻滞组(37.50%、21.21%),但是没有统计学差异(P0.05)。结论:NOA患者一旦获得睾丸精子,借助于ICSI助孕可以得到较好的临床结局,睾丸组织的病理分型对临床结局无明显影响。
[Abstract]:Objective: to investigate the outcome of (ICSI) in patients with non obstructive azoospermia (NOA) by intracytoplasmic sperm injection (ICSI) and whether the pathological classification of testis has influence on the outcome of NOA. Methods: the data of azoospermia cases of TESE-ICSI assisted pregnancy in our center from January 2011 to December 2015 were retrospectively analyzed. 73 cases of NOA patients aged under 38 years with male or female oviduct factors were selected as the cause of infertility. A total of 105 egg collection cycles and 79 transplant cycles were completed. According to testicular histopathological classification, ICSI cycle was divided into three groups: low spermatogenesis group, spermatogenic block group and Sertoli cell only group. The average age of NOA patients and different groups of males and females were counted. Gn use count, Gn use days, hCG day E2 value, hCG day P value, intimal thickness, MII egg number, fertilization, transferable embryo, high quality embryo, clinical pregnancy and abortion. Results: ICSI fertilization rate was 67.03% (553 / 825), fertilization failure rate was 9.52% (10 / 105), transferable embryo rate was 85.66% (472 / 551), high quality embryo rate was 35.03% (19.3 / 551). The average number of embryos transferred was 2.10. 44 cases (55.70%) were clinically pregnant. The birth rate of live infants was 53.16% (42 / 79), and there was no birth defect. There was no significant difference in average age, infertile age, basic FSH value, number of Gn use, days of Gn use, E2 value of hCG day, P value of HCG day, endometrial thickness and MII egg number between different groups. The fertilization rate was 68.51 in the low spermatogenesis group, the sperm maturation block group and the Sertoli cell group in which the fertilization rate was 64.391.45, and the transferable embryo rate was 85.05 and 83.05, respectively, in the spermatogenesis group, the spermatogenesis block group and the Sertoli cell group. The rate of high quality embryo was 33.09%, 41.67% and 38.98%, respectively, and there was no statistical difference between the two groups (P0.05). However, the clinical pregnancy rate and embryo implantation rate were higher in the low spermatogenesis group (60.00,37.61%) and Sertoli cell only group (62.50%) than in the sperm maturation block group (37.50,21.21%). But there was no statistical difference (P0.05). Conclusion: once testicular spermatozoa is obtained in NOA patients, a better clinical outcome can be obtained with the aid of ICSI. The pathological classification of testis has no significant effect on the clinical outcome.
【作者单位】：北京大学第一医院妇产科;北京大学第一医院泌尿科;
【分类号】：R698.2

【相似文献】