取卵日男方取精困难的应对策略及助孕结局分析  

Analysis of the Assisted Reproduction Outcomes and the Strategy of These Cases with Ejaculation Failue on the Day of Oocyte Retrieval

作　　者：吴欢[1] 张静静[1] 贺小进[1] 邹微微[1] 宋兵[1] 章志国[1] 魏兆莲[1] 曹云霞[1] 

机构地区：[1]安徽医科大学第一附属医院生殖医学中心,合肥230022

出　　处：《生殖与避孕》2014年第10期813-818,共6页Reproduction and Contraception

摘　　要：目的:寻找取卵日男方取精困难的最佳干预对策。方法:回顾性分析取卵日发生取精困难且接受一般辅助取精治疗(心理治疗、影音刺激、妻子协助取精、5-磷酸二酯酶抑制剂治疗)失败后,分别接受经直肠前列腺按摩取精/手术取精[睾丸细针抽吸术(testicular fine needle aspiration,TEFNA)](A组)、采用预先冷冻保存的精子(B组)及行卵子玻璃化冷冻(C组)不孕夫妇的相关资料,比较这3种干预措施的受精率、卵裂率、优质胚胎率、临床妊娠率及流产率。结果:589个周期取卵日发生取精困难但经辅助取精治疗后491个周期成功获取精液,98个周期未能成功取精。A组中10个周期经直肠前列腺按摩取精,31个周期手术获得精子;B组35个周期;C组22个周期,其中有16个周期择期行卵子解冻后卵胞质内单精子注射-胚胎移植(ICSI-ET)治疗。男方年龄、女方年龄、不孕年限、使用Gn总量及卵裂率3组间均无统计学差异(P>0.05);获卵数(13.3±6.5枚vs 14.2±7.1枚vs 13.9±6.7枚)、临床妊娠率(39.02%vs 37.14%vs 26.67%)、流产率(12.20%vs 11.43%vs 13.33%)亦均无显著性差异(P>0.05);A组的受精率(82.63%)显著高于C组(70.51%)(P<0.001),B组(77.35%)与A组、C组间无统计学差异(P>0.05);C组优质胚胎率(17.45%)显著低于A组(36.88%)和B组(38.49%)(P<0.001)。结论:一般辅助取精治疗可以使绝大部分取精困难患者完成取精,这是一种行之有效的应对策略。预先行精液冷冻保存是一种成熟、可靠的方法,通过其可以获得较好的治疗结局,并有避免前列腺按摩取精/手术取精造成的创伤,缩短助孕周期,减少治疗费用等优点。与卵子冷冻后融冻行ICSI治疗相比,经直肠前列腺按摩取精/手术取精行ICSI治疗具有较好的治疗结局。Objective： To analyze and summarize therapies of patients with difficulty to procure semen on the day of oocyte pick-up（OPU）, and to compare the laboratory and clinical outcomes. Methods： The clinical data of ejaculation failure on the day of oocyte retrieval were retrospectively analyzed, and adopted 3 treatments respectively for substitution after failed ordinary assisting procure semen treatments（psychology treatment,video stimulating,wife assised and phosphodiesteras treatment）, which include pressing prostate per rectum or surgical sperm retrieval（testicular fine needle aspiration, TEFNA）, freeze sperm in advance and freeze oocyte. The rates of fertilization, cleavage, high quality embryo, the pregnancy and the abortion were compared among three intervene methods. Results： Five hundred and eighty-nine（8.49%） cases in 6 940 cycles had difficulty of semen retrieval, 491（83.36%） cycles obtained sperm after commen treatments. In those commen treatments failed cycles41（41.84%） cases obtained sperm by pressing prostate per rectum（10 cycles） / surgical sperm retrieval（31 cycles）（group A）; 35 cycles（35.71%） froze sperm in advance（group B）; 22 cycles（22.45%） froze oocyte because of refusing surgical sperm retrieval, and in which 16 cycles had occyte thawed, received ICSI（group C）. The age of male, female and infertility, the amount of Gn, the number of oocyte（13.3±6.5 vs 14.2±7.1 vs 13.9±6.7）, the rate of cleavage, the pregnancy rate（39.02% vs 37.14% vs 26.67%）, and the abortion rate（12.20%vs 11.43% vs 13.33%） had no significant differences among three groups（P〉0.05）; the rate of fertilization had significant differences among three groups（82.63% vs 77.35% vs 70.51%）： group A was higher than group C（P〈0.001）, group B had no significant differences with group A and group C; the rate of high-quality embryo had significant differences among three groups（36.88% vs 38.49% vs 17.45%）： group C was lower than group A and group B�

关 键 词：取精困难 辅助取精治疗 经直肠前列腺按摩 睾丸细针抽吸术(TEFNA) 

分 类 号：R714.8[医药卫生—妇产科学]