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目的:总结单精子卵细胞质内注射治疗梗阻性无精子症的诊疗经验。方法:回顾总结2006年1月～2008年12月间107例梗阻性无精子症病例ICSI助孕资料,比较先天性输精管缺如组与非先天性输精管缺如组之间受精率、卵裂率以及妊娠率的差异。结果:107例梗阻性无精子症病例ICSI助孕中共行单精子卵细胞质内注射949枚卵子,形成受精卵678枚(受精率71.4%),获得胚胎卵裂605枚(卵裂率89.2%),临床妊娠44例,临床妊娠率41.1%。其中先天性输精管缺如49例,行单精子卵细胞质内注射442枚卵子,形成受精卵308枚(受精率69.6%),获得胚胎卵裂279枚(卵裂率90.6%),临床妊娠27例,临床妊娠率55.1%;炎症或手术等原因引起的梗阻性无精子症58例,行单精子卵细胞质内注射507枚卵子,形成受精卵370枚(受精率72.9%),获得胚胎卵裂326枚(卵裂率88.1%),临床妊娠17例,临床妊娠率29.3%。两组比较受精率、卵裂率无统计学差异(P>0.05),临床妊娠率有统计学差异(P<0.01)。结论:采用经皮附睾或睾丸穿刺抽吸精子结合ICSI技术助孕是治疗梗阻性无精子症的安全有效方法。先天性输精管缺如较其它原因所导致的梗阻性无精子症有更高的临床妊娠率。炎症或手术等原因除引起精道梗阻外也可能影响精子的质量,导致胚胎发育潜能下降。
Objective: To summarize the diagnosis and treatment of obstructive azoospermia by intracytoplasmic sperm injection. Methods: The data of ICSI in 107 cases of obstructive azoospermia from January 2006 to December 2008 were reviewed retrospectively. The fertilization rate, cleavage rate of congenital vas deferens and non-congenital absence of vas deferens As well as the difference in pregnancy rates. Results: A total of 678 fertilized eggs (fertilization rate 71.4%) were fertilized with 949 oocytes in 107 ICSI-assisted pregnancies, and 605 embryos (cleavage rate 89.2%) were obtained. , 44 cases of clinical pregnancy, clinical pregnancy rate of 41.1%. Among them, 49 cases of congenital vas deferens were absent, 442 eggs were injected into the intracytoplasmic spermatozoa to form 308 fertilized eggs (fertilization rate 69.6%), 279 embryo cleavages (cleavage rate 90.6%), 27 clinical pregnancy , Clinical pregnancy rate of 55.1%; 58 cases of obstructive azoospermia caused by inflammation or surgery, intracytoplasmic sperm injection of 507 eggs, forming 370 fertilized eggs (fertilization rate of 72.9%), to obtain embryonic cleavage 326 Pieces (cleavage rate 88.1%), clinical pregnancy in 17 cases, the clinical pregnancy rate of 29.3%. There was no significant difference in the cleavage rate between the two groups (P> 0.05). The clinical pregnancy rate was significantly different (P <0.01). CONCLUSIONS: The use of percutaneous epididymal or testicular aspiration of sperm in combination with ICSI techniques in the treatment of obstructive azoospermia is a safe and effective method. Absence of congenital vas deferens has a higher clinical pregnancy rate than obstructive azoospermia caused by other causes. In addition to the cause of inflammation or surgery in addition to causing obstruction, sperm quality may also be affected, resulting in decreased embryonic development potential.