PDF(Pubmed)
Abstract：
OBJECTIVE: The use of testicular sperm is confined to patients with azoospermia, but there is evidence to support its use in males with poor semen parameters and/or previous intracytoplasmic sperm injection (ICSI) failures with ejaculated spermatozoa. We compared the aneuploidy rate and quality between embryos derived from ICSI cycles with ejaculated sperm (EJ-ICSI) and those from ICSI cycles using testicular spermatozoa (TT-ICSI) within the same couple.
METHODS: Retrospective study of 27 couples who first underwent an EJ-ICSI cycle that did not result in a livebirth and afterwards a TT-ICSI cycle. Only the two closer cycles of each couple were included. Preimplantation genetic test for aneuploidies (PGT-A) was performed in both ICSI cycles and classic parameters of embryo quality were assessed until blastocyst-stage.
RESULTS: A total of 375 embryos from 54 ICSI cycles were evaluated. Aneuploidy rate was measured by two different parameters. Patients undergoing TT-ICSI presented a similar aneuploidy rate as EJ-ICSI group: 30.7% (23.4-38.0) vs 26.8% (18.1-35.5) per inseminated oocytes (P>0.05), and 76.2% (66.2-86.2) vs 72.1% (59.1-85.2) per the total number of biopsied embryos (P>0.05), respectively. Further, the good-quality blastocyst rate per correctly fertilized oocyte was significantly higher in TT-ICSI group (33.6% (30.4-36.9)) than EJ-ICSI group (24.2% (20.3-28.0)) (P<0.001).
CONCLUSIONS: Switching to testicular sperm for ICSI yielded better-quality blastocysts without affecting the chromosomal load of the embryos in non-azoospermic couples with a previous unsuccessful ICSI using ejaculated sperm. This strategy is a good option for couples seeking a livebirth who do not want to use donor sperm.
METHODS: Retrospective study of 27 couples who first underwent an EJ-ICSI cycle that did not result in a livebirth and afterwards a TT-ICSI cycle. Only the two closer cycles of each couple were included. Preimplantation genetic test for aneuploidies (PGT-A) was performed in both ICSI cycles and classic parameters of embryo quality were assessed until blastocyst-stage.
RESULTS: A total of 375 embryos from 54 ICSI cycles were evaluated. Aneuploidy rate was measured by two different parameters. Patients undergoing TT-ICSI presented a similar aneuploidy rate as EJ-ICSI group: 30.7% (23.4-38.0) vs 26.8% (18.1-35.5) per inseminated oocytes (P>0.05), and 76.2% (66.2-86.2) vs 72.1% (59.1-85.2) per the total number of biopsied embryos (P>0.05), respectively. Further, the good-quality blastocyst rate per correctly fertilized oocyte was significantly higher in TT-ICSI group (33.6% (30.4-36.9)) than EJ-ICSI group (24.2% (20.3-28.0)) (P<0.001).
CONCLUSIONS: Switching to testicular sperm for ICSI yielded better-quality blastocysts without affecting the chromosomal load of the embryos in non-azoospermic couples with a previous unsuccessful ICSI using ejaculated sperm. This strategy is a good option for couples seeking a livebirth who do not want to use donor sperm.
摘要：
目的：睾丸精子的使用仅限于无精子症患者，但有证据支持其用于精液参数差和/或先前有卵胞浆内单精子注射（ICSI）失败的男性。我们比较了同一对夫妇中使用睾丸精子（TT-ICSI）从ICSI周期获得的胚胎与射精精子（EJ-ICSI）和ICSI周期获得的胚胎之间的非整倍体率和质量。
方法：对27对夫妇进行回顾性研究，这些夫妇首先进行了EJ-ICSI周期，但没有导致分娩，然后进行了TT-ICSI周期。仅包括每对夫妇的两个更紧密的周期。在两个ICSI周期中进行非整倍体（PGT-A）的植入前遗传测试，并评估胚胎质量的经典参数，直到胚泡期。
结果:评价了来自54个ICSI周期的总共375个胚胎。通过两个不同的参数测量非整倍体率。接受TT-ICSI的患者表现出与EJ-ICSI组相似的非整倍体率：每个授精卵母细胞为30.7％（23.4-38.0）vs26.8％（18.1-35.5）（P>0.05），活检胚胎总数的76.2%(66.2-86.2)vs72.1%(59.1-85.2)(P>0.05)，分别。Further,TT-ICSI组每个正确受精卵母细胞的优质囊胚率（33.6％（30.4-36.9））显着高于EJ-ICSI组（24.2％（20.3-28.0））（P<0.001）。
结论：在之前使用射精精子进行ICSI的ICSI不成功的非无精子夫妇中，转换为睾丸精子可产生质量更好的胚泡，而不会影响胚胎的染色体负荷。对于不想使用供体精子的寻求活产的夫妇来说，这种策略是一个很好的选择。
方法：对27对夫妇进行回顾性研究，这些夫妇首先进行了EJ-ICSI周期，但没有导致分娩，然后进行了TT-ICSI周期。仅包括每对夫妇的两个更紧密的周期。在两个ICSI周期中进行非整倍体（PGT-A）的植入前遗传测试，并评估胚胎质量的经典参数，直到胚泡期。
结果:评价了来自54个ICSI周期的总共375个胚胎。通过两个不同的参数测量非整倍体率。接受TT-ICSI的患者表现出与EJ-ICSI组相似的非整倍体率：每个授精卵母细胞为30.7％（23.4-38.0）vs26.8％（18.1-35.5）（P>0.05），活检胚胎总数的76.2%(66.2-86.2)vs72.1%(59.1-85.2)(P>0.05)，分别。Further,TT-ICSI组每个正确受精卵母细胞的优质囊胚率（33.6％（30.4-36.9））显着高于EJ-ICSI组（24.2％（20.3-28.0））（P<0.001）。
结论：在之前使用射精精子进行ICSI的ICSI不成功的非无精子夫妇中，转换为睾丸精子可产生质量更好的胚泡，而不会影响胚胎的染色体负荷。对于不想使用供体精子的寻求活产的夫妇来说，这种策略是一个很好的选择。
