摘要
目的:探讨睾丸穿刺取精术(TESA)联合卵胞浆内单精子注射(ICSI)对逆行射精症(RE)患者临床结局的影响。方法:选择2022年5月至2024年4月在吉林省人民医院生殖男科门诊就诊的因无法通过尿液回收足够活动精子而选择TESA联合ICSI治疗的4例RE不育患者为研究对象,分析纳入患者的病因,口服碳酸氢钠碱化尿液后尿液和精液标本中精子质量,以及行TESA联合ICSI治疗的临床妊娠结局。结果:共纳入4例RE患者,均为糖尿病患者。其中2例患者可获得精液,检测精液精子浓度发现,患者1为无精子症;患者2精液离心后偶可见不活动精子;患者3和患者4无精液排出。常规碱化尿液后,精子浓度检测显示,4例尿液标本中精子浓度均<1×106个/ml;尿液精子活力检测显示,4例尿液标本中均未见活动精子;经TESA取精后分析精子质量发现,4例RE患者睾丸组织悬液中均查到0~1个精子/高倍视野(high power field,HPF);TESA联合ICSI治疗共8个周期,其中4个周期进行了胚胎移植(1个新鲜胚胎移植周期及3个冻融胚胎移植周期),人绒毛膜促性腺激素(HCG)阳性率为50%(2/4),临床妊娠率为50%(2/4)。结论:对于尿液中不能回收到足够数量及活动精子用于辅助生殖的RE患者,TESA结合ICSI是解决RE患者生育问题的一种有效的治疗方法。
Objective:To evaluate the clinical outcomes of testicular sperm aspiration(TESA)combined with intracytoplasmic sperm injection(ICSI)in patients with retrograde ejaculation(RE).Methods:Four infertile male patients with RE who failed to retrieve sufficient motile sperm from urine and underwent TESA-ICSI treatment at the Reproductive Andrology Clinic of Jilin Provincial People's Hospital between May 2022 and April 2024 were enrolled.We analyzed the etiology of infertility,sperm quality in urine and semen samples after oral sodium bicarbonate alkali-zation,and clinical pregnancy outcomes following TESA-ICSI treatment.Results:All four RE patients had diabetes mellitus.Two patients produced semen samples:Patient 1 showed azoospermia,while Patient 2 had rare immotile sperm after centrifugation.Patients 3 and 4 exhibited no semen emission.After standard urine alkalization,all four urine samples showed sperm concentrations<1×106/ml with complete absence of motile sperm.TESA revealed 0-1 sperm per high-power field(HPF)in testicular tissue suspensions from all patients.Across 8 treatment cycles(includ-ing 4 embryo transfer cycles:1 fresh and 3 frozen-thawed),the human chorionic gonadotropin(hCG)positivity rate was 50%(2/4),with a corresponding clinical pregnancy rate of 50%(2/4).Conclusion:For RE patients who can-not obtain adequate numbers of motile sperm from urine for assisted reproduction,TESA combined with ICSI repre-sents an effective treatment approach to address fertility issues.
作者
王金辉
林秀英
付建华
刘磊
米旭光
王起来
王雪
王祺
陈士玲
武梦雪
蔡星建
方艳秋
Wang Jinhui;Lin Xiuying;Fu Jianhua;Liu Lei;Mi Xuguang;Wang Qilai;Wang Xue;Wang Qi;Chen Shiling;Wu Mengxue;Cai Xingjian;Fang Yanqiu(Center of Peproductive Medicine,Jilin Provincial People’s Hospital,Changchun 130021,China;Baoji Central Hospital,Baoji 721000,China)
出处
《微创泌尿外科杂志》
2025年第2期114-118,共5页
Journal of Minimally Invasive Urology
基金
吉林省科技发展计划项目(20250601012RC)。
关键词
睾丸穿刺取精术
卵胞浆内单精子注射
逆行射精症
临床妊娠率
testicular sperm extraction
intracytoplasmic sperm injection
ejaculation,retrograde
pregnancy rate
