使用電激取精或粗針睪丸取精對於射精障礙患者之人工生殖預後

潘柏勳¹、黃奕燊^1,2、黃志賢^1,2

¹台北榮民總醫院 泌尿部；²國立陽明交通大學醫學院泌尿學科，書田泌尿科學研究中心

Assisted reproductive technology outcome in patients with ejaculatory dysfunction using EEJ or needle-TESE

Po-Hsun Pan¹, I-Shen Huang ^1,2, William J.S. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

To evaluate the sperm retrieval rate and reproductive outcomes in ejaculatory dysfunction patients associated with spinal cord injury or diabetes using electroejaculation (EEJ) or needle testicular sperm extraction (needle-TESE)

Materials and Methods:

We retrospectively reviewed the electronic medical records (EMR) in our institution (Taipei Veteran General Hospital) from 2005 to 2019 and enrolled patients with ejaculatory dysfunction who received either EEJ or needle-TESE for subsequent intracytoplasmic sperm injection (ICSI). The participants’ data such as age, reproductive endocrine profile, etiology of ejaculatory dysfunction, sperm retrieval rate, and ICSI outcomes were obtained. The parameters were compared for patients receiving EEJ with viable and no viable sperm using the Mann-Whitney test. The difference in reproductive outcome between embryos derived from testicular versus ejaculated sperm was examined with Fisher’s exact test.

Results:

Twenty-two patients received EEJ as an initial attempt for sperm recovery. EEJ was successful in retrieving viable sperm in 17 (77.3 %) cases, and among these cases, the estrogen level is significantly higher than those with no obtainable viable sperm via EEJ (p=0.04). Sixteen patients, including 5 patients with no obtainable viable sperm via EEJ, had undergone needle-TESE, with a reported 100% sperm retrieval rate. These sixteen couples underwent ICSI using testicular spermatozoa retrieved by needle-TESE, while the other seventeen couples underwent ICSI using ejaculatory spermatozoa obtained by EEJ. The reproductive outcome was comparable between the two groups. No significant differences were found regarding fertilization rate (60% and 71%, respectively), biochemical pregnancy rates (50% and 70.6%, respectively), clinical pregnancy rate (22.2% and 41.2%, respectively) or live-birth rates (22.2% and 35.3%, respectively).

Conclusions:

This study demonstrates that ejaculatory dysfunction patients who underwent ICSI using testicular or ejaculated spermatozoa result in similar reproductive outcomes. However, patients with lower estrogen levels may have an unfavorable chance to obtain viable sperm via EEJ for use in assisted reproductive technology.