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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 652-657. doi: 10.19723/j.issn.1671-167X.2022.04.011

• 论著 • 上一篇    下一篇

Y染色体无精子症因子c区缺失男性不育患者同步显微取精术后行卵胞浆内单精子显微注射的临床结局

毛加明1,赵连明2,刘德风1,林浩成2,杨宇卓1,张海涛2,洪锴2,李蓉1,姜辉2,*()   

  1. 1. 北京大学第三医院生殖医学中心，北京 100191
    2. 北京大学第三医院泌尿外科，北京 100191
  • 收稿日期:2022-03-24 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 姜辉 E-mail:jianghui55@163.com
  • 基金资助:
    首都卫生发展科研专项(2022-2-4094)

Analysis of clinical outcome of synchronous micro-dissection testicular sperm extraction and intracytoplasmic sperm injection in male infertility with Y chromosome azoospermia factor c region deletion

Jia-ming MAO1,Lian-ming ZHAO2,De-feng LIU1,Hao-cheng LIN2,Yu-zhuo YANG1,Hai-tao ZHANG2,Kai HONG2,Rong LI1,Hui JIANG2,*()   

  1. 1. Reproductive Medicine Centre, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-03-24 Online:2022-08-18 Published:2022-08-11
  • Contact: Hui JIANG E-mail:jianghui55@163.com
  • Supported by:
    the Capital's Funds for Health Improvement and Research(2022-2-4094)

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摘要：

目的: 评价同步显微镜下睾丸切开取精术结合卵胞浆内单精子显微注射(intracytoplasmic sperm injection，ICSI)对Y染色体长臂上无精子症因子c区(azoospermia factor c region，AZFc)缺失所致男性不育患者的临床治疗效果，指导AZFc缺失男性不育患者的临床治疗。方法: 回顾性分析了自2015年1月到2019年12月因AZFc缺失所致男性不育患者在北京大学第三医院生殖医学中心行显微取精术的临床资料，追踪随访了同步显微取精手术中成功获取精子的患者使用睾丸精子行ICSI助孕的临床结局，比较了首次同步显微取精术与第二次同步显微取精术患者的临床结局，包括受精率、临床妊娠率、流产率和活产率等。结果: 共有195例AZFc缺失的男性不育患者接受显微取精术，其中14例为隐匿性精子症，术中均成功发现精子，精子获得率为100%(14/14)；181例为非梗阻性无精子症(non-obstructive aoospermia，NOA)，122例成功发现精子，精子获得率为67.4%(122/181)，余59例NOA患者在显微取精术中未发现精子，占32.6%(59/181)。我们随访了手术成功发现精子的患者中，选择夫妻双方同步取精、取卵且不行胚胎植入前遗传学检测患者的临床结局，纳入研究的99例患者共进行了118人次显微取精术和120个ICSI周期助孕，最终有38例患者成功活产，累积活产率38.4%(38/99)，总共分娩出22个健康男婴和22个健康女婴，其中在首次和二次同步显微取精术的新鲜精子-ICSI周期中，优质胚胎率、新鲜周期临床妊娠率和取卵周期活产率分别为47.7% vs. 50.4%、40.5% vs. 50.0%、28.3% vs. 41.2%，第二次同步手术组略高于首次同步手术组，但组间差异没有统计学意义。结论: 对AZFc缺失导致的男性不育患者，有较大的概率通过显微取精在睾丸中成功获取精子，并结合ICSI生育自己的遗传学后代，对首次同步ICSI周期未成功的患者，有机会通过再次手术取精和ICSI成功孕育后代。

关键词: 无精子症因子c区缺失, 显微取精术, 卵胞浆内单精子显微注射

Abstract:

Objective: To analyze the clinical treatment results of male infertility caused by Y chromosome azoospermia factor c region(AZFc) deletion after synchronous micro-dissection testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI) and to guide the treatment of infer- tile patients caused by AZFc deletion. Methods: The clinical data of infertile patients with AZFc deletion who underwent synchronous micro-TESE in Peking University Third Hospitalfrom January 2015 to December 2019 were retrospectively analyzed. The clinical outcomes of ICSI in the patients who successfully obtained sperm were followed up and we compared the outcomes between the first and second synchronous procedures, including fertilization rate, high-quality embryo rate, clinical pregnancy rate, abortion rate and live birth rate. Results: A total of 195 male infertile patients with AZFc deletion underwent micro-TESE. Fourteen patients were cryptozoospermia and their sperms were successfully obtained in all of them during the operation, and the sperm retrieval rate (SRR) was 100%(14/14). The remaining 181 cases were non obstructive azoospermia, and 122 cases were successfully found the sperm, the SRR was 67.4%(122/181). The remaining 59 patients with NOA could not found mature sperm during micro-TESE, accounting for 32.6% (59/181). We followed up the clinical treatment outcomes of the patients with successful sperm retrieved by synchronous micro-TESE and 99 patients were enrolled in the study. A total of 118 micro-TESE procedures and 120 ICSI cycles were carried out. Finally 38 couples successfully gave birth to 22 male and 22 female healthy infants, with a cumulative live birth rate of 38.4% (38/99). In the fresh-sperm ICSI cycle of the first and second synchronous operation procedures, the high-quality embryo rate, clinical pregnancy rate of the fresh embryo transfer cycle and live birth rate of the oocyte retrieve cycle were 47.7% vs. 50.4%, 40.5% vs. 50.0%, and 28.3% vs. 41.2%, respectively. The second operation group was slightly higher than that of the first synchronous operation group, but there was no significant difference between the groups. Conclusion: Male infertility patients caused by AZFc deletion have a high probability of successfully obtaining sperm in testis through micro-TESE for ICSI and give birth to their own offspring with their own biological characteristics. For patients who failed in the first synchronous procedure, they still have the opportunity to successfully conceive offspring through reoperation and ICSI.

Key words: Azoospermia factor c region deletion, Micro-dissection testicular sperm extraction, Intracytoplasmic sperm injection

中图分类号: 

  • R698.2

表1

Y染色体无精子症因子c区缺失患者首次及第二、三次同步显微取精术后行卵胞浆内单精子显微注射治疗结局比较"

Items First synchronous procedure (n=99) Second synchronous procedure (n=17) Third synchronous procedure (n=2) P(comparison beteeen first and second procedure)
Age/years
    Male, ${\bar x}$±s 31.4±5.1 34.1±6.7 0.088a
    Female, ${\bar x}$±s 29.8±4.0 31.3±4.7 0.296a
Embryonic development
    Oocytes retrieved, n, ${\bar x}$±s 15.0±7.4 12.9±9.2 0.354a
    Mature oocytes, n, ${\bar x}$±s 12.0±6.2 10.4±7.4 0.592a
    Fertilization rate 31.6% (377/1 191) 45.8% (81/177) 39.3% (11/28) 0.000b
    Good quality embryo rate 47.7% (257/539) 50.4% (61/121) 43.75% (7/16) 0.587b
Embryo transfer
    Fresh embryo transfer rate 53.5% (53/99) 70.6% (12/17) 50.0% (1/2)
    No embryo availability rate 21.2% (21/99) 11.8% (2/17)
    Total embryo cryopreservation rate 25.3% (25/99) 17.6% (3/17) 50.0% (1/2)
Clinical pregnancy rate
    Fresh embryos transfer cycle 40.5% (18/53) 50.0% (6/12) 0% (0/1) 0.299b
    Frozen-thawed embryos transfer cycle 33.3% (12/36) 50.0% (3/6) 100.0% (1/1) 0.649c
Miscarriage rate 6.7% (2/30) 22.2% (2/9) 0.223c
Live birth rate 28.3% (28/99) 41.2% (7/17) 50.0% (1/2) 0.285b
Birth defects, n 0 0 0
1 Ashok A , Saradha B , Neel P , et al. Male infertility[J]. Lancet, 2021, 397 (10271): 319- 333.
doi: 10.1016/S0140-6736(20)32667-2
2 Tournaye H , Krausz C , Oates RD . Novel concepts in the aetiology of male reproductive impairment[J]. Lancet Diabetes Endocrinol, 2017, 5 (7): 544- 553.
doi: 10.1016/S2213-8587(16)30040-7
3 Colaco S , Modi D . Genetics of the human Y chromosome and its association with male infertility[J]. Reprod Biol Endocri, 2018, 16 (1): 14.
doi: 10.1186/s12958-018-0330-5
4 Yuen W , Golin AP , Flannigan R , et al. Histology and sperm retrieval among men with Y chromosome microdeletions[J]. Transl Androl Urol, 2021, 10 (3): 1442- 1456.
doi: 10.21037/tau.2020.03.35
5 Schlegel PN . Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision[J]. Hum Reprod, 1999, 14 (1): 131- 135.
doi: 10.1093/humrep/14.1.131
6 Flannigan R , Bach PV , Schlegel PN . Microdissection testicular sperm extraction[J]. Transl Androl Urol, 2017, 6 (4): 745- 752.
doi: 10.21037/tau.2017.07.07
7 Bernie AM , Mata DA , Ramasamy R , et al. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis[J]. Fertil Steril, 2015, 104 (5): 1099- 1103.
doi: 10.1016/j.fertnstert.2015.07.1136
8 赵连明, 姜辉, 洪锴, 等. 非嵌合型克氏综合征患者显微取精成功3例报告[J]. 北京大学学报(医学版), 2012, 44 (4): 547- 550.
9 杨晓玉, 刘贵华, 安淼. 男性生殖相关基因检测专家共识[J]. 中华男科学杂志, 2020, 26 (9): 844- 851.
10 赵连明, 姜辉, 洪锴, 等. Y染色体AZFc区缺失患者的治疗结局分析[J]. 北京大学学报(医学版), 2016, 48 (4): 607- 611.
doi: 10.3969/j.issn.1671-167X.2016.04.008
11 Liu XH , Qiao J , Li R , et al. Y chromosome AZFc microdeletion may not affect the outcomes of ICSI for infertile males with fresh ejaculated sperm[J]. J Assist Reprod Genet, 2013, 30 (6): 813- 819.
doi: 10.1007/s10815-013-0009-y
12 Zhang L , Mao JM , Li M , et al. Poor intracytoplasmic sperm injection outcome in infertile males with azoospermia factor c microdeletions[J]. Fertil Steril, 2021, 116 (1): 96- 104.
doi: 10.1016/j.fertnstert.2021.01.025
13 Kalsi J , Thum MY , Muneer A , et al. In the era of micro-dissection sperm retrieval (m-TESE) is an isolated testicular biopsy necessary in the management of men with non-obstructive azoospermia?[J]. BJU Int, 2012, 109 (3): 418- 424.
doi: 10.1111/j.1464-410X.2011.10399.x
14 Golin AP , Yuen W , Flannigan R . The effects of Y chromosome microdeletions on in vitro fertilization outcomes, health abnormalities in offspring and recurrent pregnancy loss[J]. Transl Androl Urol, 2021, 10 (3): 1457- 1466.
doi: 10.21037/tau-19-672
15 Zhou Y , Deng CC , Liu WJ , et al. Reproductive outcomes of intracytoplasmic sperm injection using testicular sperm and ejaculated sperm in patients with AZFc microdeletions: a systematic review and meta-analysis[J]. Asian J Androl, 2021, 23 (5): 495- 500.
doi: 10.4103/aja.aja_1_21
16 Stuppia L , Calabrese G , Franchi PG , et al. Widening of a Y-chromosome interval-6 deletion transmitted from a father to his infertile son accounts for an oligozoospermia critical region distal to the RBM1 and DAZ genes[J]. Am J Hum Genet, 1996, 59 (6): 1393- 1395.
17 Chang PL , Sauer MV , Brown S . Y chromosome microdeletion in a father and his four infertile sons[J]. Hum Reprod, 1999, 14 (11): 2689- 2694.
doi: 10.1093/humrep/14.11.2689
18 Oates RD , Silber S , Brown LG , et al. Clinical characterization of 42 oligospermic or azoospermic men with microdeletion of the AZFc region of the Y chromosome, and of 18 children conceived via ICSI[J]. Hum Reprod, 2002, 17 (11): 2813- 2824.
doi: 10.1093/humrep/17.11.2813
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ISSN 1671-167X
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