不同手术方式来源精子对ICSI助孕结局影响的研究  

Effect of Sperm from Different Surgical Methods on the Clinical Outcomes of ICSI-assisted Pregnancy

作　　者：陈鑫 徐鸿毅 刁红录 张颖 张昌军 CHEN Xin;XU Hong-yi;DIAO Hong-lu;ZHANG Ying;ZHANG Chang-jun(Department of Reproductive Medicine Center,Renmin Hospital,Hubei University of Medicine;Hubei Cinical Research Center for Reproductive Medicine;Biomedial Reaserch Institute,Hubei University of Medicine;Biomedical Engineering College,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]十堰市人民医院·湖北医药学院附属人民医院生殖医学中心 [2]湖北省生殖医学临床医学研究中心 [3]湖北医药学院生物医药研究院 [4]湖北医药学院生物医学工程学院,湖北十堰442000

出　　处：《湖北医药学院学报》2021年第2期129-133,138,共6页Journal of Hubei University of Medicine

基　　金：湖北自然科学基金创新群体(2020CFA021)。

摘　　要：目的:探讨无精子症患者不同手术方式来源精子对卵胞浆内单精子注射技术(intracytoplasmic sperm injection, ICSI)助孕结局的影响。方法:回顾分析因男方无精子症在本院生殖中心接受PESA、TESA和micro-TESE手术方式获取精子行ICSI助孕治疗的248个鲜胚移植周期患者的基本情况。按精子来源分为:PESA精子组116个周期,TESA精子组69个周期,micro-TESE精子组43个周期,比较各组行ICSI助孕后的胚胎发育和妊娠结局情况。结果:PESA组、TESA组、micro-TESE组的女方年龄、不孕年限、女方体质指数、平均获卵数和优质胚胎率差异均无统计学意义(P>0.05)。PESA组正常受精率、2PN卵裂率、可用胚胎率高于TESA组和micro-TESE组(P<0.05),TESA组、micro-TESE组间胚胎发育情况各项指标差异均无统计学意义(P>0.05)。3组间新鲜移植周期胚胎种植率、临床妊娠率、早期流产率及异位妊娠率差异均无统计学意义(P>0.05)。结论:PESA、TESA和micro-TESE手术方式获取精子行ICSI助孕影响正常受精率和卵裂率,但对后期胚胎发育无显著影响,都能获得较好的妊娠结局。Objective To analyze the effect of sperm origin on pregnancy outcome after intracytoplasmic sperm injection(ICSI).Methods A retrospective study was carried out on 248 fresh cycles which had undergone ICSI treatment.Patients were divided into three groups according to the source of sperm:percutaneous epididymal aspiration(PESA)group(116 cycles),testicular sperm extraction(TESA)group(69 cycles),micro-dissection of testicular sperm extraction(micro-TESE)group(43 cycles).The embryonic development and pregnancy outcomes and other indicators were compared.Re⁃sults There were no statistically significant differences in female age,length of infertility,body mass index,average num⁃ber of eggs obtained and the rate of high-quality embryos of the woman in the PESA group,TESA group and micro-TESE group(P>0.05).The normal fertilization rate,2PN cleavage rate,and usable embryo rate in the PESA group were higher than those in the TESA group and the micro-TESE group(P<0.05).There was no significant difference in embryo devel⁃opment between the TESA group and the micro-TESE group(P>0.05).There was no significant difference in embryo im⁃plantation rate,clinical pregnancy rate,early miscarriage rate and ectopic pregnancy rate in the fresh transfer cycle among the three groups(P>0.05).Conclusion PESA,TESA and micro-TESE surgical methods for sperm acquisition and ICSIassisted conception affect the normal fertilization rate and cleavage rate,but have no significant effect on the late embryonic development.These methods can achieve better pregnancy outcomes.

关 键 词：无精子症 经皮附睾穿刺取精 睾丸穿刺取精 显微切开睾丸取精 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]