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

doi:10.19723/j.issn.1671-167X.2022.04.011

Abstract

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

CLC Number:

R698.2

Jia-ming MAO,Lian-ming ZHAO,De-feng LIU,Hao-cheng LIN,Yu-zhuo YANG,Hai-tao ZHANG,Kai HONG,Rong LI,Hui JIANG. 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[J].Journal of Peking University (Health Sciences), 2022, 54(4): 652-657.

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References 18

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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		0.088^a
Female, ${\bar x}$±s	29.8±4.0	31.3±4.7		0.296^a
Embryonic development
Oocytes retrieved, n, ${\bar x}$±s	15.0±7.4	12.9±9.2		0.354^a
Mature oocytes, n, ${\bar x}$±s	12.0±6.2	10.4±7.4		0.592^a
Fertilization rate	31.6% (377/1 191)	45.8% (81/177)	39.3% (11/28)	0.000^b
Good quality embryo rate	47.7% (257/539)	50.4% (61/121)	43.75% (7/16)	0.587^b
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)	0.299^b
Frozen-thawed embryos transfer cycle	33.3% (12/36)	50.0% (3/6)	100.0% (1/1)	0.649^c
Miscarriage rate	6.7% (2/30)	22.2% (2/9)		0.223^c
Live birth rate	28.3% (28/99)	41.2% (7/17)	50.0% (1/2)	0.285^b
Birth defects, n	0	0	0

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

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