Objective: To investigate whether testicular histology influences the clinical outcomes of intracytoplasmic sperm injection (ICSI) in men with non-obstructive azoospermia (NOA).
Methods: We retrospectively analyzed the clinical data about 73 cases of NOA undergoing ICSI, including 105 ICSI cycles and 79 embryo transfer cycles. The infertility of the patients was attributed to male factors only or both male and female tube factors and the females' age was ≤38 years. Based on testicular histology, we divided the ICSI cycles into three groups: hypospermatogenesis (HS, n = 72), maturation arrest (MA, n = 21) and Sertoli cells only (SCO, n = 12). We recorded and analyzed the age of both the males and females, infertility duration, base follicle-stimulating hormone (FSH) level, dose and days of gonadotropin (Gn) administration, estradiol (E2) and progesterone (P) levels on the day of human chorionic gonadotropin (hCG) administration, endometrial thickness, number of metaphase II (MII) oocytes, and rates of fertilization, transferrable embryos, high-quality embryos, clinical pregnancy, and abortion.
Results: The rates of fertilization, failed fertilization, transferrable embryos, and high-quality embryos, and the average number of transferred embryos were 67.03% (553/825), 9.52% (10/105), 85.66% (472/551), 35.03% (193/551), and 2.10, respectively, resulting in 44 pregnancies (55.70%) and 42 live births (53.16%), with no birth defects. No statistically significant differences were observed among the HS, MA and SCO groups in the mean age of the men and women, infertility duration, base FSH level, Gn dose, Gn days, E2 and P levels on the hCG day, endometrial thickness, or number of MII oocytes, nor in the rates of fertilization (68.51% vs 64.39% vs 61.45%), transferrable embryos (85.05% vs 90.48% vs 83.05%), or high-quality embryos (33.09% vs 41.67% vs 38.98%). The rates of clinical pregnancy and embryo implantation were higher in the HS (60.00% and 37.61%) and SCO (62.50% and 50.00%) than in the MA group (37.50% and 21.21%), but with no statistically significant differences (P >0.05).
Conclusions: Once testicular sperm is retrieved, desirable clinical outcomes can be achieved in ICSI for NOA patients, which is not affected by testicular histopathology.
目的： 探讨非梗阻性无精子症（NOA）患者行卵细胞胞质内单精子注射（ICSI）的助孕结局及睾丸组织病理分型对NOA患者的助孕结局有无影响。方法： 回顾性分析2011年1月至2015年12月在我中心行TESE-ICSI助孕的无精子症病例资料，选取不孕原因为单纯男性或男性合并女方输卵管因素且女方年龄在38岁以下的NOA病例73例，共完成105个取卵周期，79个移植周期。按睾丸组织病理分型将ICSI周期分为3组：精子发生低下组、精子成熟阻滞组和唯支持细胞组，统计总体NOA患者和不同组别的男、女方平均年龄、不孕年限、基础FSH值、Gn使用支数、Gn使用天数、hCG日E2值、hCG日P值、内膜厚度、MII卵数、受精、可移植胚胎、优质胚胎、临床妊娠及流产情况。结果： NOA患者的ICSI受精率为67.03%（553/825）、受精失败发生率9.52%(10/105)、可移植胚胎率85.66%（472/551）、优质胚胎率35.03%（193/551）、平均移植胚胎2.10个，临床妊娠44例（55.70%），活婴出生率为53.16%（42/79），未发生出生缺陷。不同组间的男女方平均年龄、不孕年限、基础FSH值、Gn使用支数、Gn使用天数、hCG日E2值、HCG日P值、子宫内膜厚度、MII卵数均无统计学差异。精子发生低下组、精子成熟阻滞组、唯支持细胞组的受精率分别为68.51%、64.39%、61.45%,可移植胚胎率分别为85.05%、90.48%、83.05%，优质胚胎率分别为33.09%、41.67%、38.98%，组间也均无统计学差异(P>0.05)；而在临床妊娠率及胚胎种植率方面虽然精子发生低下组（60.00%、37.61%）与唯支持细胞组（62.50%、50.00%）要高于精子成熟阻滞组（37.50%、21.21%），但是没有统计学差异(P>0.05)。结论： NOA患者一旦获得睾丸精子，借助于ICSI助孕可以得到较好的临床结局，睾丸组织的病理分型对临床结局无明显影响。.
Keywords: clinical pregnancy; intracytoplasmic sperm injection; testicular histopathology; testicular sperm; non-obstructive azoospermia.