目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性...目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析,探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果:共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究,总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%,两组间比较差异没有统计学意义(P>0.05);两组睾丸体积和血清卵泡刺激素水平分别为(4.3±1.4)m L vs.(8.5±2.4)m L和(36.1±5.2)IU/L vs.(26.1±3.5)IU/L,组间比较差异具有统计学意义(P<0.05)。在睾丸穿刺活检的患者中,术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%(7/7),术中镜检或术后病理可见精子的患者,精子获得率为47.2%(17/36),术中镜检及术后病理均未见精子的患者,精子获得率为11.0%(10/91),3组间比较差异具有统计学意义(P<0.05)。结论:睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子;睾丸穿刺活检结果(包括术中镜检及术后病理能否发现精子)对后期进行显微镜下睾丸切开取精有一定的预测作用,其中术中镜检及术后病理均未见精子的患者,显微取精术找到精子的概率较低。展开更多
The aim of our study was to compare the sperm retrieval rates(SRRs)and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sper...The aim of our study was to compare the sperm retrieval rates(SRRs)and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection(micro-TESE-ICSI).We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing,China,from January 2014 to December 2017.This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI.Patients with azoospermia were classified into Group A(Klinefelter syndrome,n=284,125 cycles),Group B(azoospermia Y chromosome factor c[AZFc]microdeletion,n=91,64 cycles),Group C(cryptorchidism,n=52,39 cycles),Group D(previous mumps and bilateral orchitis,n=23,23 cycles),and Group E(idiopathic azoospermia,n=319,96 cycles).Clinical characteristics,SRR,embryonic development,and pregnancy outcomes of the patients were compared between all groups.Patients in Group D had the highest and most successful SRR.The average SRR for all patients was 46.0%.The rates of clinical pregnancy,implantation,and live birth in Group D were 78.3%,65.0%,and 74.0%,respectively,which were higher than those in all other groups(P<0.05).Group B patients had the lowest clinical pregnancy,implantation,and live birth rates of all groups(P<0.05).No differences were found in the miscarriage rate or birth defects among the groups(P>0.05).Patients with orchitis had the highest SRR and best clinical outcomes.Although AZFc microdeletion patients had a higher SRR,their clinical outcomes were worse.展开更多
We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate （SRR） of microdissection testicular sperm extraction （TESE） in patients with nonobstructive azoo...We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate （SRR） of microdissection testicular sperm extraction （TESE） in patients with nonobstructive azoospermia （NOA）. All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis： follicle-stimulating hormone （FSH）, testicular volume, and testicular histopathological findings which included three patterns： hypospermatogenesis （HS）, maturation arrest （MA）, and Sertoli-cell-only syndrome （SCOS）. If there was a threshold effect, only the area under the summary receiver operating characteristic curve （AUSROC） was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio （PLR）, negative likelihood ratio （NLR）, and the diagnostic odds ratio （DOR） were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.展开更多
Prior studies have investigated sperm retrieval rates in men with non obstructive azoospermia(NOA)secondary to specific etiologies,yet most cases of NOA are idiopathic.We compared sperm retrieval rates and testicular ...Prior studies have investigated sperm retrieval rates in men with non obstructive azoospermia(NOA)secondary to specific etiologies,yet most cases of NOA are idiopathic.We compared sperm retrieval rates and testicular histopathology in idiopathic NOA(iNOA)and nonidiopathic NOA(niNOA).We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction(microTESE)between 2000 and 2016.Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic.Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology.Among 224 men,86(38.4%)were idiopathic,75(33.5%)were nonidiopathic,and 63(28.1%)did not undergo genetic testing.Median age and serum testosterone were higher among iNOA or no testing versus niNOA.Median follicle-stimulating hormone(FSH)was lower among iNOA or no testing versus niNOA.A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele.Sperm retrieval rates were similar between iNOA,niNOA,and no testing(41.8%vs 48.0%vs 55.6%,respectively;P=0.255).Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA(31.4%and 27.0%vs 16.0%,P=0.073).On multivariable analysis,iNOA was not associated with sperm retrieval or spermatogenesis(P=0.430 and P=0.078,respectively).Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA.These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.展开更多
Varicocele adversely affects semen parameters.However,the effect of varicocele repair on the sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia has not been widely re...Varicocele adversely affects semen parameters.However,the effect of varicocele repair on the sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia has not been widely reported.We retrospectively assessed the sperm retrieval rates and testicular histopathological patterns in men with nonobstructive azoospermia who were referred to the Urology Clinic in Dr.Cipto Mangunkusumo Hospital(Jakarta,Indonesia)and Bunda General Hospital(Jakarta,Indonesia)between January 2009 and December 2019.We compared patients who had undergone a surgical sperm retrieval procedure for assisted reproductive technology no earlier than three months after varicocele repair and those who had not undergone varicocele repair.The study included 104 patients(age range:26–54 years),42 of whom had undergone varicocele repair before the sperm retrieval procedure and 62 who had not.Motile spermatozoa were found in 29(69.1%)and 17(27.4%)patients who had undergone varicocele repair before the sperm retrieval procedure and those who had not undergone the repair,respectively(relative risk:2.51;95%confidence interval:1.60–3.96;P<0.001).A predicted probabilities graph showed consistently higher sperm retrieval rates for patients with varicocele repair,regardless of their follicle-stimulating hormone levels.Patients who underwent varicocele repair showed higher testicular histopathological patterns(P=0.001).In conclusion,men with nonobstructive azoospermia and clinical varicocele who underwent varicocele repair before the sperm retrieval procedure had higher sperm retrieval rates compared to those who did not undergo varicocele repair.展开更多
文摘目的:探讨特发性非梗阻性无精子症患者中,睾丸穿刺活检对显微取精成功率的预测作用。方法:回顾性分析了从2014年1月至2017年8月在北京大学第三医院生殖医学中心接受显微取精术的特发性非梗阻性无精子症患者的临床资料,并对是否行诊断性穿刺活检、以及不同穿刺活检结果患者的精子获得率进行分析,探讨睾丸穿刺活检结果对显微取精成功率的预测作用。结果:共237例接受显微取精术的特发性非梗阻性无精子症患者入选研究,总体的精子获得率为25.7%。未行诊断性睾丸穿刺活检的103例患者与行诊断性睾丸穿刺活检的134例患者精子获得率分别为26.2%和25.4%,两组间比较差异没有统计学意义(P>0.05);两组睾丸体积和血清卵泡刺激素水平分别为(4.3±1.4)m L vs.(8.5±2.4)m L和(36.1±5.2)IU/L vs.(26.1±3.5)IU/L,组间比较差异具有统计学意义(P<0.05)。在睾丸穿刺活检的患者中,术中镜检及术后病理均偶见少量精子患者的精子获得率为100.0%(7/7),术中镜检或术后病理可见精子的患者,精子获得率为47.2%(17/36),术中镜检及术后病理均未见精子的患者,精子获得率为11.0%(10/91),3组间比较差异具有统计学意义(P<0.05)。结论:睾丸体积较小的特发性非梗阻性无精子症患者仍有一定机会通过显微取精术发现精子;睾丸穿刺活检结果(包括术中镜检及术后病理能否发现精子)对后期进行显微镜下睾丸切开取精有一定的预测作用,其中术中镜检及术后病理均未见精子的患者,显微取精术找到精子的概率较低。
基金This research was sponsored by the National Key Research and Development Project(SQ2018YFC100243)National Key Research and Development Project(2016YFC1000302)+4 种基金National Key Research and Developmental Program of China(2018YFC1003600)Young Scientists Fund of the National NaturalScience Foundation of China(Grant No.81601272)Clinical MedicinePlusX-Young Scholars Project,Peking University(Grant No.2102018237)Beijing Municipal Natural Science Foundation(7182177)National KeyResearch and Development Program of China(Grant No.2017YFC1002001).
文摘The aim of our study was to compare the sperm retrieval rates(SRRs)and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection(micro-TESE-ICSI).We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing,China,from January 2014 to December 2017.This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI.Patients with azoospermia were classified into Group A(Klinefelter syndrome,n=284,125 cycles),Group B(azoospermia Y chromosome factor c[AZFc]microdeletion,n=91,64 cycles),Group C(cryptorchidism,n=52,39 cycles),Group D(previous mumps and bilateral orchitis,n=23,23 cycles),and Group E(idiopathic azoospermia,n=319,96 cycles).Clinical characteristics,SRR,embryonic development,and pregnancy outcomes of the patients were compared between all groups.Patients in Group D had the highest and most successful SRR.The average SRR for all patients was 46.0%.The rates of clinical pregnancy,implantation,and live birth in Group D were 78.3%,65.0%,and 74.0%,respectively,which were higher than those in all other groups(P<0.05).Group B patients had the lowest clinical pregnancy,implantation,and live birth rates of all groups(P<0.05).No differences were found in the miscarriage rate or birth defects among the groups(P>0.05).Patients with orchitis had the highest SRR and best clinical outcomes.Although AZFc microdeletion patients had a higher SRR,their clinical outcomes were worse.
文摘We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate （SRR） of microdissection testicular sperm extraction （TESE） in patients with nonobstructive azoospermia （NOA）. All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis： follicle-stimulating hormone （FSH）, testicular volume, and testicular histopathological findings which included three patterns： hypospermatogenesis （HS）, maturation arrest （MA）, and Sertoli-cell-only syndrome （SCOS）. If there was a threshold effect, only the area under the summary receiver operating characteristic curve （AUSROC） was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio （PLR）, negative likelihood ratio （NLR）, and the diagnostic odds ratio （DOR） were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.
文摘Prior studies have investigated sperm retrieval rates in men with non obstructive azoospermia(NOA)secondary to specific etiologies,yet most cases of NOA are idiopathic.We compared sperm retrieval rates and testicular histopathology in idiopathic NOA(iNOA)and nonidiopathic NOA(niNOA).We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction(microTESE)between 2000 and 2016.Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic.Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology.Among 224 men,86(38.4%)were idiopathic,75(33.5%)were nonidiopathic,and 63(28.1%)did not undergo genetic testing.Median age and serum testosterone were higher among iNOA or no testing versus niNOA.Median follicle-stimulating hormone(FSH)was lower among iNOA or no testing versus niNOA.A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele.Sperm retrieval rates were similar between iNOA,niNOA,and no testing(41.8%vs 48.0%vs 55.6%,respectively;P=0.255).Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA(31.4%and 27.0%vs 16.0%,P=0.073).On multivariable analysis,iNOA was not associated with sperm retrieval or spermatogenesis(P=0.430 and P=0.078,respectively).Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA.These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.
基金This study was supported and financed by the International Publication Research Grant of Universitas Indonesia(Grant No.NKB-1598/UN2.RST/HKP.05.00/2020).
文摘Varicocele adversely affects semen parameters.However,the effect of varicocele repair on the sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia has not been widely reported.We retrospectively assessed the sperm retrieval rates and testicular histopathological patterns in men with nonobstructive azoospermia who were referred to the Urology Clinic in Dr.Cipto Mangunkusumo Hospital(Jakarta,Indonesia)and Bunda General Hospital(Jakarta,Indonesia)between January 2009 and December 2019.We compared patients who had undergone a surgical sperm retrieval procedure for assisted reproductive technology no earlier than three months after varicocele repair and those who had not undergone varicocele repair.The study included 104 patients(age range:26–54 years),42 of whom had undergone varicocele repair before the sperm retrieval procedure and 62 who had not.Motile spermatozoa were found in 29(69.1%)and 17(27.4%)patients who had undergone varicocele repair before the sperm retrieval procedure and those who had not undergone the repair,respectively(relative risk:2.51;95%confidence interval:1.60–3.96;P<0.001).A predicted probabilities graph showed consistently higher sperm retrieval rates for patients with varicocele repair,regardless of their follicle-stimulating hormone levels.Patients who underwent varicocele repair showed higher testicular histopathological patterns(P=0.001).In conclusion,men with nonobstructive azoospermia and clinical varicocele who underwent varicocele repair before the sperm retrieval procedure had higher sperm retrieval rates compared to those who did not undergo varicocele repair.
