Y染色体AZFc区缺失患者使用睾丸取精精子与射出精子行ICSI的结局比较  

Comparison of ICSI outcomes of utilizing testicular and ejaculated sperm in patients with Y chromosome AZFc deletion

作　　者：刘项 李罗娟 徐新民 郝开才 孙建华 史圣甲 刘洋 张洲 潘丹 LIU Xiang;LI Luo-juan;XU Xin-min;HAO Kai-cai;SUN Jian-hua;SHI Sheng-jia;LIU Yang;ZHANG Zhou;PAN Dan(Assisted Reproduction Center,Northwest Women’s&Children’s Hospital,Xi’an 710003;Chenggu County Hospital,Hanzhong 723200)

机构地区：[1]西北妇女儿童医院生殖中心,西安710003 [2]城固县医院,汉中723200

出　　处：《生殖医学杂志》2024年第11期1443-1449,共7页Journal of Reproductive Medicine

基　　金：陕西省卫健委健康研究项目(2021E024)。

摘　　要：目的 比较Y染色体长臂无精子症因子(AZF)c区缺失患者使用新鲜射出精子与睾丸取精精子行卵胞浆内单精子注射(ICSI)后的受精情况和妊娠结局。方法 采用回顾性队列研究,分析2017年1月至2022年12月因AZFc区缺失于西北妇女儿童医院行自精ICSI助孕患者的临床资料。根据女方取卵日男方不同取精方式分为两组:男方行睾丸手术取精的患者纳入睾丸取精组(n=68),男方新鲜射出精子的患者纳入对照组(n=242),比较两组的一般资料和ICSI结局。结果 睾丸取精组的男方LH水平显著高于对照组(P<0.05)。两组间的卵裂数、双原核(2PN)数、可用胚胎数、优质胚胎数比较均无显著性差异(P>0.05);睾丸取精组的囊胚形成数显著低于对照组(P<0.05)。睾丸取精组、对照组的首个新鲜移植周期数分别为30个周期和125个周期,睾丸取精组的受精率、正常受精率、卵裂率、可用胚胎率、囊胚形成率均显著低于对照组(P<0.05),两组间的种植率、临床妊娠率、流产率及活产率比较均无显著性差异(P>0.05)。单因素Logistic分析结果显示,取精方式与受精率、正常受精率、可用胚胎率、优质胚胎率、囊胚形成率、种植率、临床妊娠率、流产率及活产率不具有显著关联性(P>0.05),但会显著影响卵裂率[OR=2.62,95%CI(0.87,4.36),P=0.003];多因素Logistic回归分析显示,在校正囊胚形成数及男方LH水平这两个混杂因素后,对照组的卵裂率仍显著高于睾丸取精组[OR=-3.002,95%CI(-5.182,-0.821),P=0.007]。结论 对于AZFc区缺失患者,相较于新鲜射出精子,采用睾丸取精精子行ICSI时的卵裂率明显降低,虽然二者的妊娠结局没有明显差异,但考虑到手术取精的风险及经济成本,仍建议优先选择射精精子来进行ICSI。Objective:To explore the fertilization and pregnancy outcomes of testicular and ejaculated sperm of patients with azoospermia factor(AZF)c-region deletion of Y-chromosome who underwent ICSI.Methods:A retrospective cohort study was conducted for the clinical data of patients with AZFc deletion who underwent ICSI for assisted reproduction at the Northwest Women and Children’s Hospital from January 2017 to December 2022.Two groups were divided according to the method of sperm extraction on the day of female oocyte retrieval:the testicular sperm extraction group in which patients who underwent testicular sperm extraction(n=68),and the control group in which patients who had fresh ejaculated sperm(n=242).A comparative analysis was conducted to evaluate general characteristics and ICSI outcomes between these two groups.Results:The LH level of the testicular sperm extraction group was significantly higher than that in the control group(P<0.05).There was no significant difference in the number of cleavage,bipronuclear(2PN),available embryos,high-quality embryos between the two groups(P>0.05).The number of blastocysts formed in the testicular sperm extraction group was significantly lower than that in the control group(P<0.05).The first fresh transplantation cycles of testicular sperm extraction group and the control group were 30 cycles and 125 cycles,respectively.The fertilization rate,normal fertilization rate,the cleavage rate,available embryo rate,and blastocyst formation rate of testicular sperm extraction group were significantly lower than those of the control group(P<0.05).There were no significant differences in the implantation rate,clinical pregnancy rate,the miscarriage rate,and live birth rate between the two groups(P>0.05).The results of the univariate logistic analysis indicated no significant correlation between the sperm extraction method and the rates of fertilization,normal fertilization,available embryos,high-quality embryos,blastocyst formation,implantation,clinical pregnancy,miscarriage and live b

关 键 词：Y染色体长臂无精子症因子c区缺失 射出精子 睾丸取精 卵胞浆内单精子注射 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]