The Cost-Effectiveness of Y Chromosome Microdeletion Testing in Men with Severe Oligozoospermia
嚴重寡精男性接受Y染色體缺損檢測之研究
Cheng-Han Tsai1、Wei-Ren Chen1、I-Shen Huang1、William J. Huang1、2、3
Department of Urology, Taipei Veterans General Hospital1
Department of Urology, School of Medicine and Shu-Tien Urological2
Research Center, National Yang-Ming University, Taipei, Taiwan3
蔡承翰1, 陳威任1, 黃奕燊1, 黃志賢1、2、3
臺北榮民總醫院泌尿部1; 書田泌尿科學研究中心2; 國立陽明大學醫學院泌尿學科3
Objectives: Microdeletions of Y chromosome are the most common genetic causes of severe infertility in men. Approximately 10- 15% of men with non-obstructive azoospermia and 5-6% of men with severe oligozoospermia may have an underlying Y chromosome microdeletion. Guidelines of male infertility has suggested testing Y chromosome microdeletion for men with severe oligozoospermia, however, not every specialist offers this test for the patients. Via artificial reproductive technology, men with Y chromosome microdeletion may have high chance to father a child, and the microdeletion may also pass on to his male offspring. The aim of this study is to analyze the cost-effectiveness of Y chromosome testing in men with severe oligozoospermia.
Methods: We retrospectively reviewed the Y chromosome testing profiles from 272 men with severe oligozoospermia (concentration < 10 million/CC). The pattern of microdeletion were compared among patients of different sperm concentration groups, i.e. <1 million/CC, 1-5 million/CC and 5 to 10 million/CC respectively. Multiple STS in AZFc region (sY 1161, 1191, 1206 and 1291) were also examined as partial-AZFc microdeletion testing. The patients’ demographic data were also compared for analysis.
Results: Y chromosome microdeletion (all with AZFc deletion) was found in 15 patients (5.5%). The ratio was increased to 12.9% in the group of <1 million/CC. It was 2% in the group of 1-5 million/CC. While for patient with 5 to 10 million/CC, there was no microdeletion detected (0%). Overall, 17.1% of patients demonstrated partial AZFc microdeletion, and with 5.8%, 7.8% and 3.5% in group <1, 1-5 and 5-10 million/CC respectively. Sperm concentration offers the most significant power in differentiating change of Y chromosome microdeletion (OR 7.3, CI 1.61-33.33, p= 0.01). Besides the change of Y microdeletion, there was no other difference in the demographic data or partial AZFc microdeletion between groups.
Conclusion: For severe oligozoospermic men, Y chromosome microdeletion testing is cost-effective especially in men with sperm concentration less than 1 million/CC.