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比较隐匿性精子症患者采用睾丸精子及精液中精子行ICSI治疗的结局

山大生殖许超医生2018-11-15 13:49:06

FertilSteril. 2016 Jun;105(6):1469-1475.

Use of testicular versus ejaculated sperm for intracytoplasmic sperm injectionamong men with cryptozoospermia: a meta-analysis.

 

作者:Abhyankar N, Kathrins M, Niederberger C.

 

摘要

研究目的:探讨对隐匿性精子症患者采用睾丸精子及精液中精子行ICSI(二代试管)的临床结局。

研究设计:荟萃分析。

干预措施:使用PubMed进行系统搜索。纳入标准为对比隐匿性精子症患者使用射精精液中精子及睾丸精子进行二代试管临床结局的研究。

主要结局:主要结果为ICSI的受精率及妊娠率。二次分析包括获卵数、男女双方的年龄。采用随机效应模型对权重资料进行荟萃分析。对结果的报告采用相对风险及加权均数差。

研究结果:共纳入5篇队列研究,包括272个ICSI周期及4596枚注射精子的卵细胞。在采用睾丸精子及射精精液中精子的患者中,ICSI的妊娠率及受精率均无差异。随着男方及女方年龄的增加,有采用睾丸精子的趋势。余无异常。

研究结论:现有资料不支持对患有隐匿性精子症患者行ICSI助孕治疗时优先采用睾丸精子的建议。

 

个人观点:隐匿性精子症患者在行ICSI治疗时还是应先考虑使用精液中的新鲜精子,只有当天精液中确实无法找到精子或者精子质量较差时才考虑睾丸中的精子。另外,有条件的机构可以在试管治疗前进行精子冷冻保存,以备试管当天所需。

 

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Abstract

OBJECTIVE: To examine outcomes of intracytoplasmic sperm injection (ICSI) using testicular versus ejaculated sperm among men with cryptozoospermia.

DESIGN: Meta-analysis.

SETTING: Not applicable.

PATIENT(S): Men with cryptozoospermia undergoing consecutive ICSI cycles using ejaculated or testicular sperm.

INTERVENTION(S): A systematic search was performed using PubMed (inception to August 2015). Inclusion criteria were studies comparing ICSI outcomes among men with cryptozoospermia using ejaculated and testicular sperm.

MAIN OUTCOME MEASURE(S): Primary outcomes included ICSI fertilization or pregnancy rates (PRs). Secondary analysis included numberof retrieved oocytes, maternal and paternal ages. Meta-analysis of weighted data using a random effects model was performed. Results are reported as relative risk or weighted mean differences (WMD) with 95% confidence intervals (CI).

RESULT(S): Five cohort studies were included, encompassing 272 ICSI cycles and 4,596 injected oocytes. There were no differences in ICSI PRs (relative risk [RR] 0.53, 95% CI 0.19-1.42, I(2) = 67%) or fertilization rates (RR 0.91, 95% CI 0.78-1.06, I(2) = 73%) between testicular and ejaculated sperm groups. There was a significant trend toward increasing maternal age (WMD 1.69 years, 95% CI -2.71 to -0.66) and paternal age (WMD 2.61 years, 95% CI -4.73 to -0.48) with testicular sperm. There was no difference between numbers of oocytes retrieved (WMD 0.95, 95% CI -0.15 to2.05). Post-hoc power analysis revealed pβ <20% for PR analysis and pβ<10% for fertilization rate analysis.

CONCLUSION(S): The existing literature does not support a recommendation for men with cryptozoospermia to use testicular sperm in preference over ejaculated sperm for ICSI.

 


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