严重男性不育症ICSI治疗能获得与同源卵子供精IVF预期的胚胎结局

无精子症、隐匿精子症和死精子症能使自然怀孕率显著下降或不育，但这些严重男性不育症患者还可以选择ICSI治疗成为生物学父亲。本研究分析了这些精子经ICSI治疗后的受精和胚胎发育情况，对照组为同一治疗周期使用供精精子IVF治疗。取卵当天，当两次取精所获的全部精子或手术获取的睾丸精子总数少于卵子数时，剩下的卵子使用供精精子IVF治疗。72对夫妇（73周期）共获取1117个成熟卵子，512个卵子用于夫精ICSI，另外605个用于供精IVF；与对照组相比，夫精非梗阻性无精子症组、隐匿精子症组和死精子症组的受精率都显著下降，分别为65.4% v s .83.2%（P〈0.001）、68.8%vs.75.5...

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Published in亚洲男性学杂志：英文版 no. 5; pp. 845 - 849
Main Author Ju-Fen Zheng Xiao-Bao Chen Lei-Wen Zhao Min-Zhi Gao Jie Peng Xian-Qin Qu Hui-Juan Shi Xing-Liang Jin
Format Journal Article
LanguageEnglish
Published 2015
Subjects
不育症
受精
同源卵子
无精子症
死精于症
胚胎发育
隐匿精子症
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Summary:无精子症、隐匿精子症和死精子症能使自然怀孕率显著下降或不育，但这些严重男性不育症患者还可以选择ICSI治疗成为生物学父亲。本研究分析了这些精子经ICSI治疗后的受精和胚胎发育情况，对照组为同一治疗周期使用供精精子IVF治疗。取卵当天，当两次取精所获的全部精子或手术获取的睾丸精子总数少于卵子数时，剩下的卵子使用供精精子IVF治疗。72对夫妇（73周期）共获取1117个成熟卵子，512个卵子用于夫精ICSI，另外605个用于供精IVF；与对照组相比，夫精非梗阻性无精子症组、隐匿精子症组和死精子症组的受精率都显著下降，分别为65.4% v s .83.2%（P〈0.001）、68.8%vs.75.5%（P〈0.05）、65.0% vs.85.2%（P〈0.05）；非梗阻性无精子症组的卵裂率与对照组相比也显著降低（96.4% vs.99.4%, P〈0.05），但优质胚胎率则无显著差异；隐匿精子症组和死精子症组的卵裂率和优质胚胎率与对照组相比均无显著差异。结论：尽管严重男性不育症所获精子经ICSI治疗后会显著降低受精能力，但已受精的胚胎发育潜能与对照组相比影响并不显著，临床结局令人满意。
Bibliography:Azoospermia, cryptozoospermia and necrospermia can markedly decrease the ability of males to achieve pregnancy in fertile females. However, patients with these severe conditions still have the option to be treated by intracytoplasmic sperm injection （ICSI） to become biological fathers. This study analyzed the fertilization ability and the developmental viabilities of the derived embryos after ICSI treatment of the sperm from these patients compared with in vitro fertilization （IVF） treatment of the proven-fertile donor sperm on sibling oocytes as a control. On the day of oocyte retrieval, the number of sperm suitable for ICSI collected from two ejaculates or testicular sperm extraction was lower than the oocytes, and therefore, excess sibling oocytes were treated by IVF with donor sperm. From 72 couples （73 cycles）, 1117 metaphase Ⅱ oocytes were divided into 512 for ICSI and 605 for IVF. Compared with the control, husbands＇ sperm produced a lower fertilization rate in nonobstructive azoospermia （65.4% vs 83.2%; P〈 0.001）, crytozoospermia （68.8% vs 75.5%; P〈 0.05） and necrospermia （65.0% vs 85.2%; P〈 0.05）. The zygotes derived in nonobstructive azoospermia had a lower cleavage rate （96.4% vs 99.4%; P 〈 0.05）, but the rate of resultant good-quality embryos was not different. Analysis of the rates of cleaved and good-quality embryos in crytozoospermia and necrospermia did not exhibit a significant difference from the control. In conclusion, although the sperm from severe male infertility reduced the fertilization ability, the derived embryos had potential developmental viabilities that might be predictive for the expected clinical outcomes.
31-1795/R
azoospermia; cryptozoospermia; embryonic development; fertilization; infertility; necrospermia; sibling oocytes
ISSN:1008-682X
1745-7262