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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (4): 652-657. doi: 10.19723/j.issn.1671-167X.2022.04.011

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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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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

Table 1

Comparison of intracytoplasmic sperm injection outcomes in azoospermia factor c region deletion patients after the first, second and third synchronous procedure"

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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