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严重少弱畸精子症患者精液和睾丸中精子的ICSI临床结局比较 被引量:2

Comparison of ICSI clinical outcomes between ejaculate and testicular sperm in patients with severe oligo-astheno-teratozoospermia
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摘要 目的 探讨睾丸取精能否改善严重少弱畸精子症的男性不育患者行卵胞浆内单精子注射(ICSI)的临床结局。方法 回顾性分析2016年1月至2020年6月因男性严重少弱畸形精子症于保定市妇幼保健院生殖医学科行ICSI助孕的58对夫妇的临床资料。按照获取精子的方式不同,将患者分为两组:射出精子ICSI组(E-ICSI组,56个周期)和睾丸精子ICSI组(T-ICSI组,42个周期)。比较两组患者的基础资料、促排卵情况、授精及胚胎发育情况和临床妊娠结局的差异。结果 58对夫妇共接受了98个ICSI周期,56个周期(57.14%)使用射精精子,42个周期(42.86%)使用睾丸精子。两组患者的基础资料、促排卵方案、Gn用量、HCG日E2及P水平、成熟卵数、获卵数比较,均无统计学差异(P>0.05)。E-ICSI组与T-ICSI组的2PN受精率(56.4%vs. 53.4%)、优质胚胎率(8.5%vs. 6.1%)、卵母细胞利用率(25.9%vs. 24.2%)均无统计学差异(P>0.05)。E-ICSI组与T-ICSI组的新鲜周期临床妊娠率(22.7%vs. 27.0%)、冻融周期临床妊娠率(35.7%vs. 66.7%)和一次控制性卵巢刺激(COS)累积活产率(25.0%vs. 40.5%)均无统计学差异(P>0.05)。结论 基于本研究的结果,暂不推荐严重少弱畸精子症患者直接选择睾丸精子进行ICSI,只有当射出精液离心后未发现正常形态活精子的情况下,选择睾丸精子作为继续ICSI的补救性手段。 Objective:To investigate whether sperm aspirated from testis can improve the clinical outcome of intracytoplasmic sperm injection(ICSI) in male infertile patients with severe oligo-astheno-teratozoospermia(sOAT).Methods:The data of 58 couples who underwent ICSI assisted pregnancy due to sOAT in the Department of Reproductive Medicine of Baoding Maternal & Child Health Hospital from January 2016 to June 2020 were selected. According to the different ways of collecting sperm, the patients were divided into two groups: ejaculated sperm group and testicular sperm group. The basic data, ovulation induction, fertilization and embryonic development and clinical outcomes were compared between the two groups of patients.Results:Fifty-eight couples received 98 ICSI cycles, 56(57.14%) cycles using ejaculated sperm and 42(42.86%) cycles using testicular sperm. There were no significant differences in basic data, ovulation induction protocol, Gn dosage, E2and P value on HCG day, and number of mature oocytes retrieved between the two groups(P>0.05). There were no significant differences in 2PN fertilization rate(56.4% vs. 53.4%),high-quality embryo rate(8.5% vs. 6.1%) and oocyte utilization rate(25.9% vs. 24.2%) between ejaculated sperm group and testicular sperm group(P>0.05). The clinical pregnancy rate of fresh cycles(22.7% vs. 27.0%),clinical pregnancy rate of frozen-thawed cycles(35.7% vs. 66.7%),and cumulative live birth rate of one controlled ovarian stimulation(COS)(25.0% vs. 40.5%) were not significantly different between the ejaculated sperm group and the testicular sperm group(P>0.05).Conclusions:Based on the results of this study, it is not recommended to directly select testicular sperm for ICSI in patients with sOAT for the time being. Testicular sperm is chosen as a salvage method for continuing ICSI only when no normal morphological viable sperm is found after centrifugation of ejaculated semen.
作者 邢鹏 袁博 王娜 李澎涛 殷晨星 李克用 孟娜娜 XING Peng;YUAN Bo;WANG Na;LI Peng-tao;YIN Chen-xing;LI Ke-yong;MENG Na-na(Department of Reproductive Medicine,Baoding Maternal&Child Health Hospital,Baoding 071000)
出处 《生殖医学杂志》 CAS 2023年第2期239-244,共6页 Journal of Reproductive Medicine
关键词 男性不育 卵胞浆内单精子注射 睾丸精子抽吸 临床结局 Male infertility Intracytoplasmic sperm injections Testicular sperm aspiration Clinical outcomes
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