Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest
Outcomes of microdissection testicular sperm extraction in men with nonobstructive azoospermia due to maturation arrest
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DOI：
10.1016/j.fertnstert.2015.05.037
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发表时间：
2015-09-01
影响因子：
6.7
通讯作者：
Schlegel, Peter N.
中科院分区：
文献类型：
--
作者：
Bernie, Aaron M.;Shah, Kalee;Schlegel, Peter N.
目的：评价显微解剖睾丸精子提取术在非梗阻性无精子症和成熟停滞（MA）男性中的精子回收效果（微TESE）。设计：回顾性病历回顾。设置：三级转诊中心。患者：接受微TESE的非梗阻性无精子症和MA男性。干预：显微解剖TESE。主要结局指标：精子回收率（SRR）。结果：共有211例患者（13%）在最晚期水平有MA的组织学发现。总体SRR为52%。共有146名患者被归类为早期MA（初级精母细胞阶段的停滞），65名患者被归类为晚期MA（早期精子细胞阶段）。早期与晚期MA男性的SRR分别为40%和78%。在211例MA患者中，51例为弥漫性MA（100%的肾小管显示MA）。弥漫性MA男性患者的SRR显著低于局灶性MA男性患者（35% vs. 57%）。多变量分析显示，晚期MA和较高的促卵泡激素水平与成功取精呈正相关。结论：在微型TESE后，多达一半的MA男性成功识别了精子。在患有MA的男性中，晚期MA似乎是微TESE成功取精的最佳预测因素。(C)2015年，美国生殖医学会（American Society for Reproductive Medicine）
Objective: To evaluate sperm retrieval in men with nonobstructive azoospermia and maturation arrest (MA) undergoing microdissection testicular sperm extraction (micro-TESE).Design: Retrospective chart review.Setting: Tertiary referral center.Patient(s): Men with nonobstructive azoospermia and MA who underwent micro-TESE.Intervention(s): Microdissection TESE.Main Outcome Measure(s): Sperm retrieval rate (SRR).Result(s): A total of 211 patients (13%) had a histologic finding of MA at the most advanced level. The overall SRR was 52%. A total of 146 patients were classified as having early MA (arrest at the primary spermatocyte stage), and 65 as having late MA (early spermatid stage). The SRR in men with early, vs. late, MA was 40% vs. 78%. Of the 211 men with MA, 51 had diffuse MA (100% of tubules showed MA). The SRR was significantly lower in men with diffuse vs. focal MA (35% vs. 57%). On multivariable analysis, late MA and higher follicle-stimulating hormone levels were positively associated with successful sperm retrieval.Conclusion(s): Sperm were successfully identified in up to one half of the men with MA after micro-TESE. Among men with MA, late MA seems to be the best predictor of successful sperm retrieval with micro-TESE. (C) 2015 by American Society for Reproductive Medicine.