CAJ | 학술논문

目的：比较精子浓度介于5~20×106/mL范围内的少精子症患者体外受精（in-vitro fertilization，IVF）与卵胞浆内单精子注射（intracytoplasmic sperm injection，ICSI）临床治疗效果。方法回顾性分析单纯男性因素不孕，且精子浓度在5~20×106/ml范围内的少精子症患者共575例，其中IVF周期195例，ICSI周期380例，并根据世界卫生组织精液分析手册（1999年版）分为4组：（1）少精子症组（IVF n=13, ICSI n=16）；（2）少弱精子症组（IVF n=116, ICSI n=209）；（3）少畸精子症组（IVF n=14, ICSI n=9）；（4）少弱畸精子症组（IVF n=52, ICSI n=146）。比较分析IVF与ICSI的受精率、可利用胚胎率、卵子利用率、胚胎种植率及临床妊娠率。结果4组IVF受精率均低于ICSI，且少弱精子症组（66.8% vs 83.1%）、少畸精子症组（67.6% vs 81.8%）和少弱畸精子症组（52.5%vs 72.0%）组间差异有统计学意义（P＜0.05）；少精子症、少弱精子症组和少畸精子症组ICSI的可利用胚胎率高于IVF，但少弱畸精子症组IVF的可利用胚胎率高于ICSI（73.3% vs 60.7%），差异有统计学意义（P＜0.01）。虽然ICSI各组的卵子利用率均高于IVF，但少弱精子症组和少弱畸精子症组IVF的胚胎种植率（42.5% vs 30.1%，41.6% vs 26.3%）和临床妊娠率（58.1% vs 44.7%,65.3% vs 46.4%）均高于ICSI，差异有统计学意义（P ＜0.05）。结论精子浓度为5~20×106/ml的少精子症患者行ICSI治疗有助于提高卵子受精率和利用率，但少弱精子症组和少弱畸精子症组IVF的胚胎种植率和临床妊娠率均优于ICSI，故ICSI治疗并不是单纯性中度少精子症不育患者的首选治疗方案。
목적：비교정자농도개우5~20×106/mL범위내적소정자증환자체외수정（in-vitro fertilization，IVF）여란포장내단정자주사（intracytoplasmic sperm injection，ICSI）림상치료효과。방법회고성분석단순남성인소불잉，차정자농도재5~20×106/ml범위내적소정자증환자공575례，기중IVF주기195례，ICSI주기380례，병근거세계위생조직정액분석수책（1999년판）분위4조：（1）소정자증조（IVF n=13, ICSI n=16）；（2）소약정자증조（IVF n=116, ICSI n=209）；（3）소기정자증조（IVF n=14, ICSI n=9）；（4）소약기정자증조（IVF n=52, ICSI n=146）。비교분석IVF여ICSI적수정솔、가이용배태솔、란자이용솔、배태충식솔급림상임신솔。결과4조IVF수정솔균저우ICSI，차소약정자증조（66.8% vs 83.1%）、소기정자증조（67.6% vs 81.8%）화소약기정자증조（52.5%vs 72.0%）조간차이유통계학의의（P＜0.05）；소정자증、소약정자증조화소기정자증조ICSI적가이용배태솔고우IVF，단소약기정자증조IVF적가이용배태솔고우ICSI（73.3% vs 60.7%），차이유통계학의의（P＜0.01）。수연ICSI각조적란자이용솔균고우IVF，단소약정자증조화소약기정자증조IVF적배태충식솔（42.5% vs 30.1%，41.6% vs 26.3%）화림상임신솔（58.1% vs 44.7%,65.3% vs 46.4%）균고우ICSI，차이유통계학의의（P ＜0.05）。결론정자농도위5~20×106/ml적소정자증환자행ICSI치료유조우제고란자수정솔화이용솔，단소약정자증조화소약기정자증조IVF적배태충식솔화림상임신솔균우우ICSI，고ICSI치료병불시단순성중도소정자증불육환자적수선치료방안。
Objective To compare the clinical outcome between IVF and intracytoplasmic sperm injection(ICSI) in oligozoospermia infertile males with sperm concentration >5×106/mL and <20×106/mL. Methods Infertile factor of 575 eligible oligozoospermia males were retrospectively analyzed including males underwent IVF (n=195) or ICSI (n=380). According to WHO(1999) labratory manual criterion, these oligozoospermia males were divided into oligozoospermia group (OG, nIVF=13, nICSI=16), oligoasthenozoospermia group (OAG, nIVF=116, nICSI=209), oligoteratozoospermia group (OTG, nIVF=14, nICSI=9) and oligoasthenoteratozoospermia group (OATG, nIVF=52, nICSI=146). Fertility rate, embryo availability, oocyte utilization rate, implantation rate and pregnancy rate were comparatively analyzed between IVF and ICSI treatment in each group. Results Fertility rate after IVF were lower than those of ICSI in all groups, moreover the differences were significant in OAG (66.8% vs 83.1%, P=0.000), OTG (67.6% vs 81.8%, P=0.023) and OATG (52.5%vs 72.0%, P=0.000). Embryo availabilitys after ICSI were higher as compared with those of IVF in OG, OAG and OTG, while in OATG Embryo availabilitys showed higher after IVF than after ICSI (73.3% vs 60.7%, P=0.005). Although ICSI treatment achieved higher oocyte utilization rate in each group, IVF gave higher implantation rates (42.5% vs 30.1%, 41.6%vs 26.3%) and pregnancy rates (58.1% vs 44.7%, 65.3% vs 46.4%) in OAG and OATG. Conclusion ICSI is helpful to improve fertility rate and oocyte utilization rate for oligozoospermia infertile males with sperm concentration >5×106/mL and <20×106/mL. However, IVF technique shows some advantages over ICSI in implantation rate and pregnancy rate for oligoasthenozoospermia males and oligoasthenoteratozoospermia males. Therefore, ICSI treatment is not the first choice for moderate oligozoospermia infertile males with sperm concentration >5×106/mL and <20×106/mL.