CAJ | 학술논문

目的比较采用新鲜和冻融的睾丸及附睾精子进行卵母细胞胞质内单精子注射(ICSI)的临床效果.方法选择2006年9月-2007年5月因无精症于北京大学第三医院生殖医学中心行ICSI的患者208例,按患者意愿分为冻融组37例和新鲜组171例.冻融组在行ICSI前将冻存的睾丸或附睾精子解冻并复苏.观察冻融组睾丸和附睾精子的临床利用率;比较两组患者的临床结局(包括正常受精率、优质胚胎率、临床妊娠率及胚胎着床率等)和妊娠结局(包括流产率、分娩孕周及新生儿出生体重等).结果 (1)冻融组睾丸精子的临床利用率为92%(23/25),附睾精子为100%(12/12).(2)新鲜组患者的正常受精率、优质胚胎率、临床妊娠率及胚胎着床率分别为62.25%(973/1563)、78.9%(768/973)、44.4%(60/135)和29.3%(84/287),分别与冻融组[分别为64.53%(282/437)、79.1%(223/282)、46.9%(15/32)和33.3%(23/69)]比较,差异均无统计学意义(P＞0.05).(3)新鲜组患者的流产率、单胎妊娠分娩孕周、双胎妊娠分娩孕周、单胎妊娠平均新生儿出生体重及双胎妊娠平均新生儿出生体重分别为11%(6/55)、(39.0±1.4)周、(36.8±1.7)周、(3409±393)g和(2584±266)g,分别与冻融组[分别为7%(1/15)、(38.7±0.6)周、(36.3±1.2)周、(3350±383)g和(2635±171)g]比较,差异均无统计学意义(P＞0.05).结论采用冻融的睾丸或附睾精子行ICSI安全、有效,值得在临床推广.
목적 비교채용신선화동융적고환급부고정자진행란모세포포질내단정자주사(ICSI)적림상효과.방법 선택2006년9월-2007년5월인무정증우북경대학제삼의원생식의학중심행ICSI적환자208례,안환자의원분위동융조37례화신선조171례.동융조재행ICSI전장동존적고환혹부고정자해동병복소.관찰동융조고환화부고정자적림상이용솔;비교량조환자적림상결국(포괄정상수정솔、우질배태솔、림상임신솔급배태착상솔등)화임신결국(포괄유산솔、분면잉주급신생인출생체중등).결과 (1)동융조고환정자적림상이용솔위92%(23/25),부고정자위100%(12/12).(2)신선조환자적정상수정솔、우질배태솔、림상임신솔급배태착상솔분별위62.25%(973/1563)、78.9%(768/973)、44.4%(60/135)화29.3%(84/287),분별여동융조[분별위64.53%(282/437)、79.1%(223/282)、46.9%(15/32)화33.3%(23/69)]비교,차이균무통계학의의(P＞0.05).(3)신선조환자적유산솔、단태임신분면잉주、쌍태임신분면잉주、단태임신평균신생인출생체중급쌍태임신평균신생인출생체중분별위11%(6/55)、(39.0±1.4)주、(36.8±1.7)주、(3409±393)g화(2584±266)g,분별여동융조[분별위7%(1/15)、(38.7±0.6)주、(36.3±1.2)주、(3350±383)g화(2635±171)g]비교,차이균무통계학의의(P＞0.05).결론 채용동융적고환혹부고정자행ICSI안전、유효,치득재림상추엄.
Objective To compare clinical outcome of intracytoplasmic sperm injection(ICSI)cycle by using fresh and cryopreserved-thawed testicular and epididymal spermatozoa in azoospermic patients.Methods Between September 2006 and May 2007,208 azoospermic patients underwent in vitro fertilization(IVF)were treated in Center of Reproductive Medicine,Peking University Third Hospital.Those couples were divided into two groups based on their wishes,including 171 cases in fresh group and 37 cases in cryopreserved-thawed group.The cryopreserved testicular or epididymal spermatozoa were thawed and recovered before ICSI procedure iu thawed group.The outcomes of ICSI in each group were compared.including clinical outcomes(two pronuclear fertilization,high quality embryo,clinical pregnancy and embryo implantation)and pregnancy outcomes(spontaneous miscarriage,gestational weeks and neonatal birth weight).Results (1),The utilization rate were 92%(23/25)in cryopreserved-thawed testicular spermatozoa and 100%(12/12)in epididymal spermatozoa.(2)Between fresh and cryopreserved-thawed groups,no statistical difference was observed in two pronuclear fertilization rate[62.25%(973/1563)vs.64.53%(282/437),P=0.960],high quality embryo rate[78.9%(768/973)vs.79.1%(223/282),P=0.985],clinical pregnancy rate per embryo transfer[44.4%(60/135)vs.46.9%(15/32),P:0.688]and embryo implantation rate[29.3%(84/287)vs.33.3%(23/69),P=0.508].(3)No significant difference between flesh and cryopreserved group was found in spontaneous miscarriage rate (11%vs.7%,P＝1.000),gestational weeks(single birth:39.0 weeks vs.38.7 weeks,P:0.538;twins:36.8 weeks vs.36.3 weeks,P=0.571)and birth weight(single birth:3409 g vs.3350 g,P=0.699;twins:2584 g vs.2635 g,P=0.703).Conclusion It suggested that tissue from the azoospermic patients who underwent diagnostic testieular and epididymal biopsy should be eryopreseved for IVF-ET.