嚴重寡精症患者從睪丸取得精子進行人工生殖之結果
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
The Fertility Results of Intracytoplasmic Sperm Injection by Using Testicular Sperm in Patients with Severe Oligozoospermia
Cheng-Han Tsai1, Wei-Ren Chen1, I-Shen Huang1, William J. Huang1,2,3
Department of Urology, Taipei Veterans General Hospital1,
School of Medicine and Shu-Tien Urological2
Research Center, National Yang-Ming University, Taipei, Taiwan3
Purpose
The aim of this study is to assess the fertility outcomes of intracytoplasmic sperm injection (ICSI) using testicular sperm retrieved by either conventional or microdissection testicular sperm extraction (cTESE or mTESE) in oligozoospermic men who failed to conceive their wives in prior assisted reproductive technology (ART) attempts using ejaculated sperm.
Materials and Methods
We retrospectively reviewed the charts of 32 oligozoospermic men who had failed one or more in vitro fertilization (IVF) or ICSI cycles using ejaculated sperm. They were categorized into 3 subgroups according to the sperm concentration: 5-20, 1-5 and <1 million/mL respectively. cTESE was done for all 3 groups. Nine patients in group <1 million/mL failed in the cTESE cycle and proceeded to mTESE. The sperm isolated were all used for ICSI.
Results
For these 32 patients, mean age was 38.9 ± 5.4 years. Sperm retrieval rate was 100% in both groups. The female partners showed no difference in all groups. The overall fertilization rate per ICSI cycle was 64.8% and pregnancy rate was 46.9%. For patients underwent cTESE, the pregnancy rates were 75%, 18.2% and 15.4% for the group 5-20, 1-5 and <1 million/mL respectively. In 9 patients of <1 million/mL group, sperm retrieval was done by mTESE and the pregnancy rate was 55.6% (P=0.047, compared to cTESE in the <1 million/mL group). There was no complication occurred after testicular sperm extraction.
Conclusions
Testicular sperm retrieval for ICSI is safe and results in much better pregnancy rates in oligozoospermic men who had prior one or more ART failure using ejaculated sperm. Furthermore, mTESE may be considered an effective choice to optimize ICSI outcomes in severe oligozoospermic patients.