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  • Title: [Clinical outcomes of intracytoplasmic sperm insemination with micro amount frozen-thawed diagnostic sperm in the treatment of azoospermia].
    Author: Shi SL, Shi QY, Jin HX, Yao GD, Liu Y, Guo YH.
    Journal: Zhonghua Yi Xue Za Zhi; 2021 Mar 02; 101(8):591-596. PubMed ID: 33663191.
    Abstract:
    Objective: To investigate the efficacy and clinical outcomes of intracytoplasmic sperm injection (ICSI) with micro amount frozen-thawed diagnostic sperm obtained by microdissection testicular sperm extraction (microTESE), percutaneous epididymal sperm as-piration (PESA) and testicularsperm extraction (TESA) in the treatment of azoospermia. Methods: A retrospective analysis was performed on 736 ICSI cycles of azoospermia patients.In Reprocluctive Medicine Center of the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019. Including 199 ICSI cycles (microTESE 47cycles, PESA 75cycles and TESA 77 cycles) with micro amount frozen-thawed diagnostic sperm and 537 ICSI cycles (microTESE 23 cycles, PESA 111 cycles and TESA 403 cycles) with fresh micro amount sperm. The general conditions, embryo development conditions and clinical outcomes of patients were compared between and within the two groups. Results: The recovery rate of PESA group was significantly lower than that of TESA group (89.3% vs 98.7%), P<0.05. The rate of 2PN in the fresh control group was significantly higher than that in the experiment group (75.5% vs 71.3%) and the rate of 2PN in the fresh microTESE and PESA groups were also significantly higher than those of the frozen-thawed microTESE and PESA groups (74.2% vs 64.6%) and (78.5% vs 72.4%), P<0.05. Both the rate of D5 blastocyst formation and high quality blastocyst in the fresh group were significantly lower than that in the experiment group (26.9% vs 32.9%) and (15.1% vs 18.0%), P<0.05; both the rate of early cleavage and blastocyst formation in the fresh microTESE group were significantly lower than that in the frozen-thawed microTESE group (55.1% vs 68.3%) (27.3% vs 39.3%), P<0.05. Both the rate of 8 cells embryos and blastocyst formation in the fresh TESA group were significantly lower than those of the TESA frozen-thawed group (41.3% vs 46.0%) (26.5% vs 32.4%), P<0.05. There was no significant difference in pregnancy rate and planting rate between or within the groups(P>0.05). The abortion rate in the frozen-thawed group was significantly higher than the fresh group (12.0% vs 4.0%), P<0.05, especially the abortion rate in the PESA frozen-thawed group was significantly higher than the fresh group (18.0% vs 1.7%), P<0.05. There was no significant difference in gender, weight and body length between the fresh group and the frozen-thawed group (P>0.05), but there were two malformed babies born in the frozen-thawed group. Conclusions: Frozen-thawed microinjection of diagnostic microspermatozoa is a feasible method for the treatment of asthenospermia.There was on significonty difference in pregnancy rate and planting rate between of with in the groups. However, significantly higher than the fresh PESA group of the influence on offspring needs to be further studied. 目的： 探讨冻融诊断性微量精子行卵胞浆单精子显微注射（ICSI）的疗效及临床结局情况。 方法： 回顾性分析2018年1月至2019年12月在郑州大学第一附属医院生殖中心因男方无精子症采用睾丸切开显微取精术（microTESE）、经皮附睾精子抽吸术（PESA）、经皮睾丸精子抽吸术（TESA）获得的精子行ICSI治疗的736个周期，其中诊断性微量精子冻融组199个周期（包括microTESE 47个周期，PESA 75个周期，TESA 77个周期），新鲜精子对照组537个周期（包括microTESE 23个周期，PESA 111个周期，TESA 403个周期）。比较诊断性微量精子冻融组和新鲜精子组以及冻融和新鲜组间（包括microTESE组、PESA组和TESA组）患者的一般情况以及ICSI的受精率、优胚率、早期卵裂率和D5、D6囊胚形成率等实验室指标和临床结局。 结果： PESA冻融组复苏率显著低于TESA冻融组复苏率（89.3% 比98.7%），P<0.05；新鲜精子组2原核（PN）率显著高于冻融组（75.5% 比71.3%），P<0.05；新鲜microTESE组2PN率显著高于冻融组（74.2% 比64.6%），新鲜PESA组显著高于冻融组（78.5% 比72.4%），均P<0.05；新鲜精子组D5囊胚形成率和优质囊胚率显著低于冻融组（26.9% 比32.9%和15.1% 比18.0%），均P<0.05；新鲜microTESE组早卵裂率和D5囊胚形成率均显著低于冻融microTESE组（55.1% 比68.3%和27.3% 比39.3%），均P<0.05；新鲜TESA组早卵裂率、8细胞胚胎率和D5囊胚形成率显著低于冻融TESA组（分别为49.6% 比56.7%、41.3% 比46.0%和26.5% 比32.4%），均P<0.05；冻融组和新鲜精子组以及冻融和新鲜组间（microTESE组、PESA组和TESA组）妊娠率和种植率差异均无统计学意义（P>0.05），但冻融组流产率显著高于新鲜组（12.0% 比4.0%），P<0.05，冻融PESA组流产率显著高于新鲜PESA组（18.0% 比1.7%），P<0.05。新鲜组和冻融组出生婴儿性别、体重、身长差异均无统计学意义（P>0.05），但冻融组出生2例畸形婴儿。 结论： 冻融诊断性微量精子行ICSI是治疗无精症的一种可行方法，其妊娠率和种植率与新鲜精子组相似；但冻融组流产率偏高，对子代的影响也有待于进一步研究。.
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