嚴重寡精症之不孕病患使用射精精子或睪丸精子其生育結果的比較
蔡承翰1 黃奕燊1, 2, 3 林登龍1,2,3 陳光國1,2,3 黃志賢1, 2, 3
1臺北榮民總醫院 泌尿部
2國立陽明大學醫學院 泌尿學科3書田泌尿科學研究中心
The Comparison of Fertility Outcomes in Patients with Severe OAT Using Ejaculated Sperm or Testicular Sperm
Cheng-Han Tsai1, I-Shen Huang1,2,3, Alex T.L. Lin1,2,3, Kuang-Kuo Chen1,2,3, William J. Huang1,2,3
1Department of Urology, Taipei Veterans General Hospital
2Department of Urology, School of Medicine and 3Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan
Introduction
With advances in techniques of assisted reproductive technology (ART), oligo-astheno-teratozoospermia (OAT) patients have a chance to father a child. Intracytoplasmic sperm injection (ICSI) is a well-established treatment to achieve clinical pregnancy and live birth for men with impaired sperm parameters. In OAT patients, sperm retrieved from ejaculate or testis are both available and it is uncertain which source of sperm is preferable for the best outcome from ICSI procedure. The aim of our study is to assess fertility outcomes of ICSI using testicular versus ejaculated sperm in OAT men.
Method
We reviewed the case log in our institute from January 2016 to November 2017. Patients with OAT (OA, OT, AT, and OAT) undergoing ICSI using either ejaculated or testicular sperm was included. Definition of oligozoospermia was < 20 million/mL, asthenozoospermia was sperm motility < 50% and teratozoospermia was normal sperm morphology < 30%. We compared the patients received first time and ≧ 1 times ICSI in our institute using semen or testicular sperm (from conventional or microdissection). Fertility outcome included fertilization rates, good embryo rates, pregnancy rates, ongoing pregnancy rates and live birth rates.
Result
Of 36 OAT patients included in our study, 20 patients received first time ICSI in our institute using ejaculated sperm and 16 patients using testicular sperm. The OAT men underwent ≧ 1 times ICSI in our institute using either ejaculated or testicular sperm were 4 and 14 patients respectively.
The demographic and clinical factors, including male and female age, testicular size, varicocele grading, sperm count, sperm morphology, were similar between two groups. Sperm motility, male FSH level, male LH level, were lower in testicular group.
For the OAT patients receiving first time ICSI in our institute, a comparison between testicular sperm extraction (TESE) versus ejaculated sperm revealed significantly higher fertilization rate in testicular sperm group (75.7% vs. 61.0%, p=0.03). There were no significant differences in good embryo rates, pregnancy rates, ongoing pregnancy rates and live birth rates between the two groups. For the patients receiving ≧ 1 times ICSI in our institute, there were no significant differences in Fertility outcome.
Conclusion
Sperm retrieved from testicular sperm are able to achieve higher fertilization rate for ICSI in OAT men.