THE USE OF EPIDIDYMAL AND TESTICULAR SPERMATOZOA FOR INTRACYTOPLASMIC SPERM INJECTION - THE GENETIC-IMPLICATIONS FOR MALE-INFERTILITY
THE USE OF EPIDIDYMAL AND TESTICULAR SPERMATOZOA FOR INTRACYTOPLASMIC SPERM INJECTION - THE GENETIC-IMPLICATIONS FOR MALE-INFERTILITY
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DOI：
10.1093/oxfordjournals.humrep.a136231
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发表时间：
1995-08-01
影响因子：
6.1
通讯作者：
VANSTEIRTEGHEM, AC
中科院分区：
文献类型：
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作者：
SILBER, SJ;NAGY, Z;VANSTEIRTEGHEM, AC
综述了使用睾丸和附睾精子进行胞浆内单精子注射（ICSI）治疗严重男性不育症的结果和原理。针对先天性输精管缺失（CAV）和不可修复的梗阻性无精子症，连续进行了72例显微外科附睾精子抽吸术（MESA），其中90%的病例采用ICSI获得正常胚胎进行移植和受精。总体受精率为46%，正常卵裂率为68%。每次移植的妊娠率和分娩率分别为 58% 和 37%。每个周期的交付率为33%。在许多情况下，没有可用的附睾精子，因此采用睾丸精子提取（TESE）来取精。 TESE 的转移率较低（84% 与 96%），并且精子无法冷冻并保存以供未来周期使用。然而，使用附睾或睾丸精子的妊娠率几乎没有差异。结果不受阻塞是由 CAV 引起还是输精管附睾吻合术失败引起的影响。新鲜和冷冻的精子都给出了相似的结果。唯一重要的因素似乎是女性的年龄。由于与传统 IVF 相比，使用附睾精子进行 ICSI 始终获得良好的结果，并且睾丸组织精子也取得了类似的良好结果，因此 ICSI 对所有未来的 MESA 患者都是强制性的。所有 CAV 患者及其伴侣均应接受囊性纤维化基因筛查；因此，任何全方位服务 MESA 计划都应提供植入前胚胎诊断。现在很清楚，即使是非梗阻性无精症，例如。仅支持细胞或成熟停滞，通常存在一些小的精子发生灶，允许进行 TESE 和 ICSI。这意味着，即使是由于缺乏精子发生或减数分裂受阻而患有无精子症的男性，睾丸中通常也有一些精子足以成功进行 ICSI。最后，某些形式的严重男性因素不育症很可能是通过基因传播的，尽管 ICSI 后代已被证明是完全正常的，但这些不育夫妇的儿子在长大并希望拥有一个家庭时也可能需要 ICSI。
The results and rationale of using testicular and epididymal spermatozoa with intracytoplasmic sperm injection (ICSI) for severe cases of male infertility are reviewed. A total of 72 consecutive microsurgical epididymal sperm aspiration (MESA) cases were performed for congenital absence of the vas (CAV) and for irreparable obstructive azoospermia, ICSI was used to obtain normal embryos for transfer and fertilization in 90% of the cases. The overall fertilization rate was 46% with a normal cleavage rate of 68%. The pregnancy and delivery rates per transfer were 58 and 37% respectively. The delivery rate per cycle was 33%. In many cases, no epididymal spermatozoa were available and so testicular sperm extraction (TESE) was used for sperm retrieval. The transfer rate was lower with TESE (84 versus 96%) and the spermatozoa could not be frozen and saved for use in future cycles. However, there was little difference in pregnancy rates using epidiymal or testicular spermatozoa. The results were not affected by whether the obstruction was caused by CAV or failed vasoepididymostomy. Both fresh and frozen spermatozoa gave similar results; the only significant factor appeared to be the age of the female. Because of the consistently good results obtained using epididymal sperm with ICSI when compared with conventional IVF, and the similarly good results with testicular tissue spermatozoa, ICSI is mandatory for all future MESA patients. All CAV patients and their partners should be offered genetic screening for cystic fibrosis; hence pre-implantation embryo diagnosis should be available in any full service MESA programme. It is now clear that even with non-obstructive azoospermia, e.g. Sertoli-cell only, or maturation arrest, there are usually some small foci of spermatogenesis which allow TESE with ICSI to be carried out. This means that even in men with azoospermia due to absence of spermatogenesis or to a block in meiosis, there are usually a few spermatozoa available in the testes that are adequate for successful ICSI. Finally, it is likely that some forms of severe male factor infertility are genetically transmitted and although ICSI offspring have been shown to be completely normal, it is possible that the sons of these infertile couples will also require ICSI when they grow up and wish to have a family.