卵胞浆内单精子注射治疗严重男性因素不育症428个周期的临床分析

摘要

Objective:To evaluate the efficacy and safety of intracyoplasmic sperm injection(ICSI)technology used for male infertility treatment. Methods:A retrospective analysis of assisted reproductive outcomes of 428 patients who underwent ICSI in our hospital from January 2009 to December 2010. There were 245 patients with obstructive azoospermia (group 1) and 183 patients with serious oligoasthenoteratozoospermia (group 2). The patients' age, body mass index, the FSH basis level, the number of embryos transferred, fertilization rate, good embryo rate, implantation rate, cancellation rate, clinical pregnancy rate, miscarriage rate, ectopic pregnancy,the birth rate and birth defects rate were compared between the two groups. Results:The fertilization rate in group 1 was(84. 1±17. 1) %, implantation rate 45. 2%,birth rate per transplantation 59. 1 %,miscarriage rate 10. 3%, birth defects rate 3.5%. The fertilization rate in group 2 was( 79. 9 + 20. 9) %, implantation rate 37. 8%, birth rate per transplantation 48. 2% , miscarriage rate 15. 2%,birth defects rate 3.1%. The patients in both groups achieved satisfying pregnancy outcome,but there were significant differences in terms of fertilization rate, implantation rate, birth rate per transplantation and miscarriage rate(P<0.05). Conclusion:The fertilization rate, implantation rate and birth rate per transplantation are higher, and the miscarriage rate is lower in obstructive azoospermia patients compared with serious oligoasthenoteratozoospermia patients. It indicates that obstructive azoospermia patients can get better pregnancy outcomes than serious oligoasthenoteratozoospermia patients. More research is needed to study the safety of ICSI.%目的 分析卵胞浆内单精子显微注射技术(intracytoplasmic sperm injection,ICSI)在治疗严重男性因素不育症时的有效性和安全性. 方法 回顾分析2009年1月至2010年12月间在本院因严重男性不育症行ICSI助孕的428例患者的数据,其中245例梗阻性无精子症组采用经皮附睾穿刺抽吸术取得的附睾精子；183例严重少弱畸精子症组采用的是射出精液中的精子.并且收集患者的年龄、体重指数、基础卵泡刺激素(FSH)、移植胚胎数目、受精率、优胚率、取消率、妊娠率、着床率、流产率、宫外孕发生率、妊娠出生率、移植出生率、出生异常率等资料. 结果 梗阻性无精子症组受精率(84.1±1 7.1)％,着床率45.2％,移植出生率59.1％,流产率10.3％,出生异常率3.5％.严重少弱畸精子症组受精率(79.9±20.9)％,着床率37.8％,移植出生率48.2％,流产率15.2％,出生异常率3.1％.两组均获得了满意的临床结局,但两组的受精率、着床率、移植出生率及流产率均存在统计学差异. 结论 本研究结果提示梗阻性无精子组的受精率,着床率及移植出生率较严重少弱畸精子症组均明显升高,且术后流产率较低,提示梗阻性无精子症患者经附睾穿刺行ICSI较严重少弱畸精子症患者可以获得更好的临床结局.但此技术的安全性,依然需要更多的研究.