目的:使用睾丸能动精子进行卵胞浆内单精子注射(ICSI)周期的累积临床妊娠率(CPR)和活产率(LBR)是多少?从睾丸精子抽吸术(TESA)或睾丸精子提取术(TESE)获得?
方法:对使用TESA或TESE的ICSI周期进行7年的回顾性分析。根据回收的精子的运动性将周期分为两组:A组由具有活动精子的夫妇组成;B组具有不运动精子的夫妇。B组分为两组:B1由具有活动精子的夫妇组成,B2在添加己酮可可碱后具有不活动精子。
结果:在新鲜胚胎移植后,研究组之间在每次移植的CPR和LBR方面没有发现差异。B2组的玻璃化温热胚胎移植未实现妊娠。使用不动精子时,受精率降低(64.4%,56%,37.9%,对于A组,B1和B2,分别P<0.001)。A组和B1组的优质胚胎率高于B2组(40.7%和40.1%对19.1%,分别,P=0.015)。累积CPR(53%,41.7%,A组13.6%,B1和B2,分别P=0.005)和LBR(42.4%,30%,A组13.6%,B1和B2,分别为P=0.03),与添加己酮可可碱后的活动精子或不活动精子相比,使用活动精子时,每个卵母细胞的提取率明显更高。
结论:尽管受精,最高质量的胚胎率,当使用不运动精子时,累积CPR和LBR降低,ICSI仍然有效;因此,在开始供体精子授精周期之前,应该考虑并提供给夫妇,或冷冻保存卵母细胞用于将来额外的睾丸精子回收。
OBJECTIVE: What are the cumulative clinical pregnancy rates (CPR) and live births rates (LBR) in intracytoplasmic sperm injection (ICSI) cycles using testicular motile compared with immotile spermatozoa, obtained from testicular sperm aspiration (
TESA) or extraction (TESE)?
METHODS: A retrospective analysis of ICSI cycles using
TESA or TESE over a period of 7 years. Cycles were divided into two groups according to the motility of the retrieved spermatozoa: Group A consisted of couples with motile spermatozoa; Group B of couples with immotile spermatozoa. Group B was subdivided into two groups: B1 consisted of couples with motile spermatozoa and B2 with immotile spermatozoa after the addition of pentoxifylline.
RESULTS: No differences in CPR and LBR per transfer was found between the study groups after fresh embryo transfer. No pregnancies were achieved by vitrified-warmed embryo transfer in group B2. Fertilization rates decreased when using immotile spermatozoa (64.4%, 56%, 37.9%, for groups A, B1 and B2, respectively, P < 0.001). Top-quality embryo rates were higher in groups A and B1 compared with B2 (40.7% and 40.1% versus 19.1%, respectively, P = 0.015). Cumulative CPR (53%, 41.7%, 13.6% for groups A, B1 and B2, respectively, P = 0.005) and LBR (42.4%, 30%, 13.6% for groups A, B1 and B2, respectively P = 0.03) per oocyte retrieval was significantly higher when using motile spermatozoa compared with motile or immotile spermatozoa after adding pentoxifylline.
CONCLUSIONS: Although fertilization, top-quality embryo rates, cumulative CPR and LBR decreased when using immotile spermatozoa, ICSI is still valid; therefore, it should be considered and offered to couples before embarking on a donor sperm insemination cycle, or cryopreserving oocytes for future additional testicular sperm retrieval.