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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
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