射精障碍行卵胞浆内单精子注射治疗的临床结局分析  

Analysis of assisted reproduction outcomes by ICSI for men with ejaculatory dysfunction

作　　者：高靓 汪维卓 王家雄[1] 廖桂芝[1] 丁洁[1] 孟庆霞[1] 李红[1] 杨慎敏[1] GAO Liang;WANG Wei-zhuo;WANG Jia-xiong;LIAO Gui-zhi;DING Jie;MENG Qing-xia;LI Hong;YANG Shen-min(Suzhou Hospital Affiliated to Suzhou College of Nanjing Medical University,Reproductive&Genetic Center of Suzhou Municipal Hospital,Suzhou 215002)

机构地区：[1]南京医科大学姑苏学院附属苏州医院,苏州市立医院生殖与遗传中心,苏州215002

出　　处：《生殖医学杂志》2022年第12期1640-1645,共6页Journal of Reproductive Medicine

基　　金：南京医科大学姑苏学院科研项目(GSKY202110237);苏州市临床重点病种资助项目(LCZX202109)。

摘　　要：目的分析因男性射精障碍采取睾丸穿刺取精术(TESA)联合卵胞浆内单精子注射(ICSI)助孕的临床结局及其可能的影响因素。方法回顾性分析2009年1月至2021年12月在南京医科大学附属苏州医院因射精障碍接受TESA+ICSI助孕的不孕夫妇的临床资料。根据射精障碍类型分为两组:临时性射精障碍(TEF)组(n=26)和病理性射精障碍(OEF)组(n=24),并以同时期就诊的梗阻性无精子症(OA)男性作为对照组(OA组),比较各组患者男女双方的基本资料、ICSI受精率、优质胚胎率、可移胚胎率、临床妊娠率和活产率的差异。结果3组患者的基本资料比较中,除TEF组女方及男方年龄显著高于OEF组外(P<0.05),其余指标在组间均无显著性差异(P>0.05)。受精及妊娠结局比较中,与OA组相比,TEF组的受精率、优质胚胎率和可移植胚胎率均无显著性差异(P>0.05),新鲜移植周期胚胎种植率(5.3%vs.44.9%)、临床妊娠率(9.1%vs.58.5%)以及累积妊娠率(40.7%vs.68.6%)均显著降低(P<0.05),冻融周期胚胎种植率、临床妊娠率、早期流产率及活产率均无显著性差异(P>0.05);OEF组除D3优质胚胎率显著下降(52.7%vs.62.9%,P<0.05)外,其余指标均无显著性差异(P>0.05);TEF组与OEF组相比,新鲜移植周期胚胎种植率(5.3%vs.33.3%)显著降低(P<0.05),其余指标均无显著性差异(P>0.05)。TEF组有12例患者曾获得过射出精子,与以往射出精子周期相比,TESA+ICSI受精率显著下降(46.7%vs.68.6%,P<0.05)。结论不推荐ICSI作为TEF首选的补救性治疗措施;病理性因素导致的射精障碍ICSI结局与OA组相近,应重视明确病因。Objective:To analyze the outcome of assisted reproduction by testicular sperm aspiration(TESA)combined with intracytoplasmic sperm injection(ICSI)due to male ejaculation failure and its possible influencing factors.Methods:The clinical data of infertile couples who received TESA+ICSI for ejaculation failure in Suzhou Hospital Affiliated to Nanjing Medical University from January 2009 to December 2021 were retrospectively analyzed.The patients were divided into two groups according to the type of ejaculation disorders:temporary ejaculation failure(TEF)group(n=26)and organic ejaculation failure(OEF)group(n=24).Men with obstructive azoospermia(OA)at the same time were taken as the control group(OA group).The basic information,ICSI fertilization rate,high quality embryo rate,transferable embryo rate,clinical pregnancy rate and live birth rate were compared among the groups.Results:Comparison of patients’basic data among the three groups,except female and male age of TEF group was significantly higher than that in OEF group(P<0.05),no significant differences were observed for the other parameters.There were no significant differences in fertilization rate,high-quality embryo rate and translatable embryo rate between TEF group and OA group(P>0.05).However,the embryo implantation rate(5.3%vs.44.9%),clinical pregnancy rate(9.1%vs.58.5%)and cumulative pregnancy rate(40.7%vs.68.6%)in fresh transfer cycles of TEF group were significantly lower than those of OA group.No significant differences were found in fertilization and pregnancy outcomes between the OEF and OA groups,except that the rate of high-quality embryo on Day 3 was significantly lower in OEF group(52.7%vs.62.9%,P<0.05).Furthermore,the embryo implantation rate in fresh transfer cycles in the TEF group significantly decreased compared to the OEF group(5.3%vs.33.3%,P<0.05),and the rest of the outcome measurements were not significantly different(P>0.05).There were 12 patients in TEF group who had obtained ejaculated sperm.Compared with previous ejaculated sperm

关 键 词：射精障碍 临时性射精障碍 卵胞浆内单精子注射 临床结局 

分 类 号：R698.2[医药卫生—泌尿科学]