经皮附睾穿刺取精行卵胞质内单精子注射对梗阻性无精子症患者夫妇辅助生育结局的影响——一项倾向性评分匹配研究  

Effect of intracytoplasmic single sperm injection using percutaneous epididymal sperm aspiration on outcome of assisted reproduction in couples with obstructive azoospermia:a propensity score matching study

作　　者：刘杨青 嘉若琳 丁孝芹[1] 李真[2] 张玉超[2] 杨险峰[1] Liu Yangqing;Jia Ruolin;Ding Xiaoqin;Li Zhen;Zhang Yuchao;Yang Xianfeng(Department of Andrology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Reproductive Medicine,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院男性科,郑州450052 [2]郑州大学第三附属医院生殖医学科,郑州450052

出　　处：《中国实用医刊》2024年第6期7-11,共5页Chinese Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(2018020199)。

摘　　要：目的探讨经皮附睾穿刺取精行卵胞质内单精子注射(PESA-ICSI)对梗阻性无精子症患者夫妇辅助生育结局的影响。方法回顾性队列研究。分析2015年9月至2019年12月在郑州大学第三附属医院接受PESA-ICSI治疗的215组男方为梗阻性无精子症夫妇及接受体外受精-胚胎移植治疗的2108组男方常规精液分析正常的夫妇的临床资料,考虑到两组的女方年龄、移植胚胎数等混杂因素的影响,行倾向性评分匹配(PSM),1∶3匹配获得PESA组204例和精液分析正常组594例作为最终研究对象,比较两组的正常卵裂率、可利用胚胎率、优胚率、女方妊娠结局、新生儿结局及出生缺陷。结果PESA组可移植胚胎率为83.61%(1388/1660),高于精液分析正常组的79.96%(4049/5064),P<0.05。两组正常卵裂率、优胚率、胚胎着床率、临床妊娠率、早期流产率、异位妊娠率、单/双胎率及性别比(男/女)比较差异未见统计学意义(P>0.05)。无论单胎分娩周期还是双胎分娩周期,两组女方孕周、自然分娩率、剖宫产率、早产率、新生儿出生体质量、低体质量儿比例及性别比(男/女)比较差异均未见统计学意义(P均>0.05)。PESA组出生缺陷率低于精液分析正常组,差异未见统计学意义(P>0.05)。结论除了可利用胚胎率,梗阻性无精子症患者能够获得与精液分析正常患者基本相同的辅助生育结局和妊娠结局。Objective To investigate the effect of intracytoplasmic single sperm injection using percutaneous epididymal sperm aspiration(PESA-ICSI)on outcome of assisted reproduction in couples with obstructive azoospermia.Methods In the retrospective cohort study,the clinical data of 215 couples treated by PESA-ICSI,of which the male partner had obstructive azoospermia,and 2108 couples treated by in vitro fertilization(IVF)embryo transfer,of which the male partner had normal semen analysis results,in the Third Affiliated Hospital of Zhengzhou University from September 2015 to December 2019 were analyzed.Considering the influence of confounding factors such as the age of the woman and the number of embryos transferred,propensity score matching(PSM)was performed on the couples in both groups;in final,204 couples in the PESA-ICSI group and 594 couples in the sperm-normal IVF group were selected as research objects after 1∶3 matching.The normal cleavage rate,available embryo rate,high quality embryo rate,pregnancy outcome of the woman,neonatal outcome,and birth defects of the two groups were compared.Results The available embryos rate in the PESA-ICSI group were 83.61%(1388/1660),which was statistically higher than the 79.96%(4049/5064)in the sperm-normal IVF group(P<0.05).There was no significant difference in normal cleavage rate,high quality embryo rate,embryo implantation rate,clinical pregnancy rate,early miscarriage rate,ectopic pregnancy rate,singleton/twin rate and sex ratio(male/female)between the two groups(P>0.05).There were no statistically significant differences in the week of gestation,rate of natural delivery,rate of cesarean section,rate of preterm delivery,birth weight of newborns,proportion of low-birth-weight babies,and sex ratio(male/female)between the two groups(all P>0.05),whether in singleton or twin delivery.The PESA-ICSI group had a lower rate of birth defects than the sperm-normal IVF group,but the difference was not statistically significant(P>0.05).Conclusions Patients with epididymal obstructive

关 键 词：梗阻性无精子症 经皮附睾精子抽吸术 卵胞质内单精子注射 辅助生育结局 出生缺陷 

分 类 号：R698.2[医药卫生—泌尿科学]