論睪丸顯微手術取精與懷孕率的預測因子-單一醫學中心經驗
陳韋辰1、陳卷書1、裘坤元1
1臺中榮民總醫院外科部 泌尿科
Predictive factors in sperm retrieval by microdissection testicular sperm extraction and pregnancy rate-A single center experience
Wei-Cheng, Chen1, Chuan-Shu Chen1, Kun-Yuan Chiu1
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: Male infertility has been bothering couples who were trying to give birth. Non-obstructive azoospermia is the most severe form of male infertility. Microdissection testicular sperm extraction (micro-TESE) combined with intracytoplasmic sperm injection has improved the pregnancy rate of these patients. The aim of this study was to analyze the predictive factors of sperm retrival by micro-TESE and subsequent pregnancy rate.
Materials and Methods: From October 2017 to October 2020, 100 male patients received testicular sperm extraction for sperm retrieval and diagnosis, 97 by micro-TESE while 3 with needle-TESE in our institute. We analyzed the dermographic datas, history of vasovasostomy and vasoepididymostomy, preoperative hormone profile including FSH, LH, Testosterone, Prolactin, Estradiol, semen analysis, spermatogenesis under microscopy, pathologic diagnosis, sperm retrieval result, chromosomal analysis and Y chromosome micro-deletion testing, testis volume by sonography of testes, and finally, pregnancy rate.
Results: Of all 100 patients, 28 of men has obstructive azoospermia, while other 72 men has non-obstructive azoospermia. Among these 72 patients with non-obstructive azoospermia, 36 patients has positive sperm retrieval result and the other 36 has negative result. Average hormone profile are as following.
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FSH (mIU/mL)
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LH (mIU/mL)
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Testosterone (ng/mL)
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Prolactin (ng/mL)
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Estradiol (pg/mL)
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Obstructive azoospermia (N=28)
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5.38
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4.44
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3.16
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10.33
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35.96
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|
Non-obstructive azoospermia with positive sperm retrieval result (N=36)
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14.18
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6.98
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3.20
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11.09
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32.4
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Non-obstructive azoospermia with negative sperm retrieval result (N=36)
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22.51
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10.24
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3.56
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10.82
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30.51
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Conclusions: Lower FSH level could be a predict factor for better sperm retrieval rate. However, larger sample size will be required for better accuracy. On the other hand, we are collecting the fertilization and pregnancy rate. Datas will be available in the later presentation.