Use of surgical sperm retrieval in azoospermic men: a meta-analysis
Use of surgical sperm retrieval in azoospermic men: a meta-analysis
复制标题
DOI：
10.1016/j.fertnstert.2004.02.116
复制
发表时间：
2004-09-01
影响因子：
6.7
通讯作者：
Ramsay, JWA
中科院分区：
文献类型：
--
作者：
Nicopoullos, JDM;Gilling-Smith, C;Ramsay, JWA
目的：比较卵胞浆内单精子注射（ICSI）周期[1]在梗阻性无精子症（OA）患者中使用附睾和睾丸精子; [2]在OA和非梗阻性无精子症（NOA）患者中使用手术取出的精子;[3]使用新鲜和冻融精子的结局。设计：对已发表数据进行荟萃分析。设置：辅助受孕单位。患者：10份报告（734个周期：677次转移）被确定为适合评估精子来源; 9份报告（1 103个周期：998次转移），以评估病因; 17份报告（1，476个周期：1，377次移植），以评估冷冻保存的效果。干预措施：手术取精/ICSI。主要结局指标：受精率（FR），种植率（IR），临床妊娠率（CPR），和持续妊娠率（OPR）每次胚胎transfer. Results（s）：荟萃分析表明，在任何结果之间的测量使用附睾或睾丸精子在OA男性没有显着差异。荟萃分析显示，与NOA相比，OA男性患者的FR（相对风险[RR] 1.18; 95%置信区间[CI]：1.13-1.23）和CPR（RR 1.36; 95% CI：1.10-1.69）显著改善，OPR无显著增加。两组之间的IR或流产率没有差异。新鲜与冷冻解冻的附睾精子相比，FR或IR无差异，CPR显著升高（RR 1.20; 95%CI：1.0-1.42），OPR无差异。当单独分析睾丸周期时，受精或妊娠结果没有差异，但使用冷冻解冻精子时，IR显著受损（RR 1.75; 95% CI：1.10-2.80）。对已发表数据的荟萃分析证实，无精子症的病因和手术取出精子的冷冻保存对ICSI结局有影响，并使我们能够为临床实践提出一些建议。在具有相似病因的男性中，精子来源不影响结果。(C)2004年，美国生殖医学会。
Objective: To compare the outcome of intracytoplasmic sperm injection (ICSI) cycles [1] using epididymal and testicular sperm in patients with obstructive azoospermia (OA); [2] using surgically retrieved sperm in patients with OA and nonobstructive azoospermia (NOA); and [3] using fresh and frozen-thawed sperm.Design: Meta-analysis of published data.Setting: Assisted conception unit.Patient(s): Ten reports (734 cycles: 677 transfers) were identified as suitable to assess source of sperm; 9 reports (1,103 cycles: 998 transfers) to assess etiology; and 17 reports (1,476 cycles: 1,377 transfers) to assess the effect of cryopreservation.Intervention(s): Surgical sperm retrieval/ICSI.Main Outcome Measure(s): Fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) per embryo transfer.Result(s): Meta-analysis demonstrated no significant difference in any outcome measure between the use of epididymal or testicular sperm in men with OA. Meta-analysis showed a significantly improved FR (relative risk [RR] 1.18; 95% confidence interval [CI]: 1.13-1.23) and CPR (RR 1.36; 95% CI: 1.10-1.69) in men with OA as compared to NOA with a nonsignificant increase in OPR. There was no difference in either IR or miscarriage rate between the two groups. Comparing fresh with frozen-thawed epididymal sperm there was no difference in FR or IR, a significantly higher CPR (RR 1.20; 95% CI: 1.0-1.42), and no difference in OPR. No difference in fertilization or pregnancy outcome was noted when the testicular cycles were analyzed separately, but IR was significantly impaired using frozen-thawed sperm (RR 1.75; 95% CI: 1.10-2.80).Conclusion(s): Meta-analysis of published data confirms that etiology of azoospermia and cryopreservation of surgically retrieved sperm impacts on ICSI outcome, and allows us to make several recommendations for clinical practice. Origin of sperm, in men with similar etiology, does not affect outcome. (C) 2004 by American Society for Reproductive Medicine.