目的:为了确定卵胞浆内单精子注射(ICSI)和手术精子提取(SSR)在使用新鲜和冷冻保存的精子的周期之间的生殖结局是否存在显着差异,在使用附睾和睾丸精子的周期之间。
方法:使用英国人类受精和胚胎学管理局(HFEA)数据进行的回顾性国家队列研究,包括10年期间在英国进行的所有ICSI周期。
方法:2008年至2017年期间的所有非供体ICSI周期,按精子来源和冷冻保存状态进行分类。
方法:SSR-ICSI使用新鲜或冷冻保存的精子,使用射精,睾丸和附睾精子。
结果:活产率,怀孕率,植入率。
结果:我们分析了来自所有214,649个ICSI周期的数据,包括199,818个精子射精周期,5,646个附睾精子和9,185个睾丸精子。每个ICSI周期的活产为射精的28.5%,附睾30.6%,睾丸精子周期为28.7%。附睾精子周期的活产率高于睾丸精子周期(OR1.067,95%CI1.014-1.123,p=0.013)。尽管男性平均年龄较高(42.5岁对40.6岁,p<0.001,差异为1.81-1.85岁的95CI)和女性年龄(34.3vs34.0岁,附睾周期与睾丸周期相比,p<0.01,95CI的差异为0.32-0.34年)。种植率(61.2%vs58.0%,OR1.086,95CI1.041-1.133)和临床妊娠率(34.3%vs31.3%,与睾丸周期相比,附睾的OR1.085,95CI1.039-1.132)也较高。与SSR-ICSI的冷冻保存精子相比,使用新鲜精子的周期之间的结果没有统计学上的显着差异。
结论:我们的研究表明,SSR-ICSI的生殖结果至少与使用射精精子的ICSI相当,并且不支持在SSR-ICSI中优先使用新鲜精子而不是冷冻保存的精子。与睾丸精子相比,使用附睾精子的每个SSR-ICSI周期的出生率较高,然而差异很小,这可以为接受这些手术的患者提供保证。必须谨慎解释结果,因为由于数据汇总,无法进行多变量分析。
To determine any significant differences in the reproductive outcome from intracytoplasmic sperm injection (ICSI) with surgical sperm retrieval (SSR) between cycles using fresh and cryopreserved sperm and between cycles using epididymal and testicular sperm.
A retrospective national cohort study using data from the UK Human Fertilisation and Embryology Authority, including all ICSI cycles performed in the United Kingdom over a 10-year period.
Hospital.
All nondonor ICSI cycles from 2008 to 2017 categorized by sperm source and cryopreservation status.
Intracytoplasmic sperm injection with SSR using fresh or cryopreserved sperm and using ejaculated, testicular, and epididymal sperm.
Live birth rate, pregnancy rate, and implantation rate.
We analyzed data from 214,649 ICSI cycles, including 199,818 cycles of ejaculated sperm, 5,646 cycles of epididymal sperm, and 9,185 cycles of testicular sperm. Live births rates per ICSI cycle were 28.5%, 30.6%, and 28.7% for ejaculated, epididymal, and testicular sperm cycles, respectively. Epididymal sperm cycles had a higher live birth rate than that of testicular sperm cycles (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.014-1.123). This was despite a higher mean male age (42.5 vs. 40.6 years; 95% CI of difference, 1.81-1.85 years) and female age (34.3 vs. 34.0 years; 95% CI of difference, 0.32-0.34 years) in epididymal cycles than in testicular cycles. Implantation (61.2% vs. 58.0%; OR, 1.086; 95% CI, 1.041-1.133) and clinical pregnancy rates (34.3% vs. 31.3%; OR, 1.085; 95% CI, 1.039-1.132) were also higher in epididymal cycles than in testicular cycles. There were no statistically significant differences in outcomes between cycles using fresh sperm and those using cryopreserved sperm for SSR-ICSI.
Our study indicates that reproductive outcomes of SSR-ICSI are at least comparable with those of ICSI using ejaculated sperm and does not support the preferential use of fresh sperm over cryopreserved sperm in SSR-ICSI. Births per SSR-ICSI cycle were higher for cycles using epididymal sperm than for cycles using testicular sperm; however, the differences were small, which may provide reassurance to patients undergoing these procedures. The results must be interpreted with caution because multivariable analysis was not possible because of aggregation of data.