双侧输精管结扎术后不同来源精子对卵胞浆内单精子显微注射助孕结局的影响  

Effects of different sperm sources on the outcome of intracytoplasmic sperm injection after bilateral vasectomy

作　　者：薛理烨 安晶晶 XUE Liye;AN Jingjing(Department of Reproductive Medicine Center,Army 73rd Group Hospital of PLA,Xiamen 361003,Fujian,China;Xiamen Assisted Reproductive Technology Quality Control Center,Xiamen 361003,Fujian,China)

机构地区：[1]中国人民解放军陆军第七十三集团军医院生殖医学中心,福建厦门361003 [2]厦门市辅助生殖技术质量控制中心,福建厦门361003

出　　处：《中国性科学》2023年第3期38-42,共5页Chinese Journal of Human Sexuality

基　　金：厦门市医学优势亚专科建设项目(厦卫科教[2018]296号文)。

摘　　要：目的探讨双侧输精管结扎术后不同来源精子对卵胞浆内单精子显微注射(ICSI)助孕结局的影响。方法回顾性分析2012年1月至2020年6月中国人民解放军陆军第七十三集团军医院生殖医学中心诊治的双侧输精管结扎术后或复通失败后患者行ICSI治疗的76个新鲜取卵移植周期,依据精子来源分为经皮附睾精子抽吸术(PESA)组(36个周期)和经皮睾丸精子抽吸术(TESA)组(40个周期)。比较两组的相关指标和妊娠结局。结果两组男方年龄、结扎年限、女方年龄、女方卵泡刺激素(FSH)及女方抗苗勒管激素(AMH)比较,差异无统计学意义(P>0.05);PESA组的正常受精率高于TESA组,差异具有统计学意义(P<0.05);两组2PN卵裂率、胚胎平均评分、优质胚胎率及囊胚养出率比较,差异无统计学意义(P>0.05);TESA组的临床妊娠率和活产率均高于PESA组,差异无统计学意义(P>0.05);两组的胚胎种植率和流产率比较,差异无统计学意义(P>0.05)。结论TESA来源精子的妊娠结局优于PESA来源精子,因此,当输精管结扎术后患者行ICSI助孕时,可优先选择睾丸内精子,以期获得更好的临床妊娠结局。Objective To investigate the effects of different sperm sources on the outcome of intracytoplasmic sperm injection(ICSI)after bilateral vasectomy.Methods A retrospective analysis was performed on 76 cycles of fresh egg collection and transplantation of patients treated with ICSI after bilateral vasectomy or recanalization failure from January 2012 to June 2020 in Department of Reproductive Medicine Center of Army 73rd Group Hospital of PLA.According to the sperm source,they were divided into two groups:percutaneous epididymal sperm aspiration(PESA)group(36 cycles)and percutaneous testicular sperm aspiration(TESA)group(40 cycles).The related indexes and pregnancy outcomes of each group were compared.Results There were no significant differences in male age,vasectomy duration,female age,female′s FSH and AMH level between the two groups(P>0.05).The normal fertilization rate in PESA group was higher than that in TESA group,and the difference was statistically significant(P<0.05).There were no significant differences in 2PN cleavage rate,embryo average score,embryo quality rate and blastocyst rearing rate(P>0.05).The clinical pregnancy rate and live birth rate in TESA group were higher than those in PESA group,but the differences were not statistically significant(P>0.05),while there were no significant differences in embryo implantation rate and abortion rate between the two groups(P>0.05).Conclusions TESA sperm source has better pregnancy outcome than PESA.Therefore,when patients choose ICSI treatment after bilateral vasectomy,testicular sperm can be preferentially selected in order to obtain better clinical pregnancy outcome.

关 键 词：双侧输精管结扎术后 卵胞浆内单精子显微注射 经皮附睾精子抽吸术 经皮睾丸精子抽吸术 妊娠结局 

分 类 号：R697[医药卫生—泌尿科学]