Sperm retrieval rates in subgroups of primary azoospermic males
Sperm retrieval rates in subgroups of primary azoospermic males
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DOI：
10.1016/j.eururo.2006.08.032
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发表时间：
2007-02-01
期刊：
影响因子：
23.4
通讯作者：
Payne, Stephen R.
中科院分区：
文献类型：
--
作者：
Bromage, Stephen J.;Falconer, Debbie A.;Payne, Stephen R.
目的：作为卵胞浆内单精子注射(ICSI)的前奏，可为表现为原发不育症和无精子症的男性提供手术取精(SSR)。方法：对106例原发不育症患者进行临床评估和经皮附睾行SSR检查。一名泌尿科医生在五年内进行抽吸(PESA)和/或睾丸精子提取(TESE)。其中10%(11例)有明确的梗阻原因，先天性输精管缺如(CBAVD)，标记为A组。90%(95例)无明确原因的梗阻，标记为B组。结果：A组11例患者均获精子，B组为56%。A组临床妊娠率和活产率分别为47%和44%，B组分别为21%和20%。这一亚组的精子获取率(29%)明显低于睾丸体积正常的男性和促卵泡激素患者(77%)，p=0.0001，相应的LBR分别为28%和14%。结论：在没有睾丸组织学检查的情况下，SSR之前的临床参数可以帮助咨询。睾丸大小和FSH正常的无精子症男性有望通过SSR获得可接受数量的精子进行ICSI。在FSH升高和睾丸小的男性中，只有不到三分之一的人会有成功的SSR。(C)2006年欧洲泌尿外科协会。爱思唯尔出版，版权所有。
Objectives: Men presenting with primary infertility and azoospermia may be offered surgical sperm retrieval (SSR) as a prelude to intracytoplasmic sperm injection (ICSI). We evaluated sperm retrieval rates in subgroups of men with azoospermia, based on obstructive aetiology, testicular volume and FSH.Methods: 106 patients with primary infertility underwent clinical evaluation and SSR with percuataneous epididymal. aspiration (PESA) and/or testicular sperm extraction (TeSE) by a single urologist over a five year period. Ten percent of this group (11 patients) had a clear cause of obstruction, congenital absence of the vas deferens (CBAVD), labelled group A. Ninety percent (95 patients) had no definite cause of obstruction, labelled group B.Results: All eleven patients in group A had adequate sperm retrieved, compared with 56% of 95 men in group B. Clinical pregnancy and live birth rates were 47% and 44% for group A respectively compared with 21% and 20% for group B. Twenty-one men had testes < 4 cm and FSH > 10; a significantly lower sperm retrieval rate was seen in this subgroup (29%) compared to men with normal testicular volume and FSH (77%), p = 0.0001, which corresponded to a LBR of 28% and 14% respectively.Conclusions: In the absence of testicular histology prior to SSR clinical parameters can be used to aid in counselling. Azoospermic males with normal sized testes and normal FSH can expect acceptable numbers of sperm to be retrieved by SSR for ICSI. Less than one third of men with raised FSH and small testes will have successful SSR. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.