PDF(Pubmed)
Abstract：
Most of data available in the literature reported the sperm retrieval rate and limited intracytoplasmic sperm injection (ICSI) results of microdissection testicular sperm extraction (micro-TESE) in non-obstructive azoospermia (NOA) patients with different etiologies. Unfortunately, there is currently a lack of comprehensive data to guide clinicians in conducting comprehensive consultations with NOA patients.
To obtain more comprehensive evidence-based data and clinical outcomes for better consultation of NOA patients who opted to undergo micro-TESE combined with ICSI-IVF.
It was a retrospective study involved 968 NOA patients underwent micro-TESE during January 2015 to December 2019. Embryological, clinical, and live birth outcomes were demonstrated comprehensively and three kinds of stratification analyses were performed based on ICSI-IVF cycles using frozen and fresh sperm, different etiologies of NOA and various amounts of sperm retrieved.
The sperm retrieval rate was 44.6%, and ICSI was performed in 299 couples leading to 150 clinical pregnancies and 140 live-birth deliveries. The clinical pregnancy rate (CPR) was 50.17%, and the cumulative live birth rate (LBR) was 46.82%, and the low birth defects rate was 1.43%. No significant difference was observed about cumulative LBR in frozen sperm group and fresh sperm group (47.5% vs 42.9%, P>0.05). NOA patients with AZFc microdeletions had the lowest rate of a high-score embryo on day 3 (4.4%, P<0.05) and the lowest cumulative LBR (19.4%, P<0.05). NOA patients with lower sperm count (having fewer than 20 sperms retrieved) had significantly lower cumulative LBR than those with higher sperm count (having more than 20 sperms retrieved) (28.1% vs 51.9%, P<0.05).
For those NOA patients who stepped in ICSI-IVF cycles, the cumulative LBR was 46.82%. No significant difference was indicated in the LBR between ICSI-IVF cycles using frozen or fresh testicular sperm. Compared to other etiologies, NOA caused by AZFc microdeletions have the poorest embryological and clinical outcomes. Patients with less testicular sperm retrieved have poorer embryological and clinical outcomes.
To obtain more comprehensive evidence-based data and clinical outcomes for better consultation of NOA patients who opted to undergo micro-TESE combined with ICSI-IVF.
It was a retrospective study involved 968 NOA patients underwent micro-TESE during January 2015 to December 2019. Embryological, clinical, and live birth outcomes were demonstrated comprehensively and three kinds of stratification analyses were performed based on ICSI-IVF cycles using frozen and fresh sperm, different etiologies of NOA and various amounts of sperm retrieved.
The sperm retrieval rate was 44.6%, and ICSI was performed in 299 couples leading to 150 clinical pregnancies and 140 live-birth deliveries. The clinical pregnancy rate (CPR) was 50.17%, and the cumulative live birth rate (LBR) was 46.82%, and the low birth defects rate was 1.43%. No significant difference was observed about cumulative LBR in frozen sperm group and fresh sperm group (47.5% vs 42.9%, P>0.05). NOA patients with AZFc microdeletions had the lowest rate of a high-score embryo on day 3 (4.4%, P<0.05) and the lowest cumulative LBR (19.4%, P<0.05). NOA patients with lower sperm count (having fewer than 20 sperms retrieved) had significantly lower cumulative LBR than those with higher sperm count (having more than 20 sperms retrieved) (28.1% vs 51.9%, P<0.05).
For those NOA patients who stepped in ICSI-IVF cycles, the cumulative LBR was 46.82%. No significant difference was indicated in the LBR between ICSI-IVF cycles using frozen or fresh testicular sperm. Compared to other etiologies, NOA caused by AZFc microdeletions have the poorest embryological and clinical outcomes. Patients with less testicular sperm retrieved have poorer embryological and clinical outcomes.
摘要：
文献中的大多数数据报道了不同病因的非阻塞性无精子症（NOA）患者的显微解剖睾丸精子提取（micro-TESE）的精子提取率和有限的胞浆内精子注射（ICSI）结果。不幸的是,目前缺乏全面的数据来指导临床医生对NOA患者进行全面的咨询.
为了获得更全面的循证数据和临床结果，为选择接受微TESE联合ICSI-IVF的NOA患者提供更好的咨询。
这是一项回顾性研究，涉及2015年1月至2019年12月期间接受微TESE的968例NOA患者。胚胎学，临床,和活产结局进行了综合证明，并基于使用冷冻和新鲜精子的ICSI-IVF周期进行了三种分层分析，不同病因的NOA和不同数量的精子回收。
精子提取率为44.6%,在299对夫妇中进行了ICSI，导致150例临床妊娠和140例活产分娩。临床妊娠率(CPR)为50.17%,累计活产率(LBR)为46.82%,低出生缺陷率为1.43%。冷冻精子组和新鲜精子组的累积LBR差异无统计学意义（47.5％vs42.9％，P>0.05)。AZFc微缺失的NOA患者在第3天的高评分胚胎率最低（4.4%，P<0.05）和最低的累积LBR（19.4%，P<0.05)。精子数量较低（精子数量少于20个）的NOA患者的累积LBR明显低于精子数量较高（精子数量超过20个）的患者（28.1%vs51.9%，P<0.05)。
对于那些进入ICSI-IVF周期的NOA患者，累计LBR为46.82%。使用冷冻或新鲜睾丸精子的ICSI-IVF周期之间的LBR没有显着差异。与其他病因相比，由AZFc微缺失引起的NOA具有最差的胚胎和临床结果。获得睾丸精子较少的患者的胚胎和临床结局较差。
为了获得更全面的循证数据和临床结果，为选择接受微TESE联合ICSI-IVF的NOA患者提供更好的咨询。
这是一项回顾性研究，涉及2015年1月至2019年12月期间接受微TESE的968例NOA患者。胚胎学，临床,和活产结局进行了综合证明，并基于使用冷冻和新鲜精子的ICSI-IVF周期进行了三种分层分析，不同病因的NOA和不同数量的精子回收。
精子提取率为44.6%,在299对夫妇中进行了ICSI，导致150例临床妊娠和140例活产分娩。临床妊娠率(CPR)为50.17%,累计活产率(LBR)为46.82%,低出生缺陷率为1.43%。冷冻精子组和新鲜精子组的累积LBR差异无统计学意义（47.5％vs42.9％，P>0.05)。AZFc微缺失的NOA患者在第3天的高评分胚胎率最低（4.4%，P<0.05）和最低的累积LBR（19.4%，P<0.05)。精子数量较低（精子数量少于20个）的NOA患者的累积LBR明显低于精子数量较高（精子数量超过20个）的患者（28.1%vs51.9%，P<0.05)。
对于那些进入ICSI-IVF周期的NOA患者，累计LBR为46.82%。使用冷冻或新鲜睾丸精子的ICSI-IVF周期之间的LBR没有显着差异。与其他病因相比，由AZFc微缺失引起的NOA具有最差的胚胎和临床结果。获得睾丸精子较少的患者的胚胎和临床结局较差。
