Intracytoplasmic Sperm Injection Outcomes 卵胞浆内单精子注射周期结果

Research shows that fertilization and pregnancy rates of IVF with intracytoplasmic sperm injection (ICSI) approach that of conventional IVF in couples with non-male factor infertility. 1 This randomized study showed that although fertilization with ICSI was slightly lower,there was no statistical difference in pregnancy rates. In the setting of azoospermia, ICSI provides an opportunity for fertility when conventional IVF methods have failed. In 2009, 65 percent of couples with fresh non-donor eggs in the US utilized ICSI and only 36 percent of them were diagnosed with male factor infertility. 2 Reports from fertility clinics in the United States indicate that average rate of fertilization for ICSI ranges from 50-80 percent and pregnancy rate is around 33percent,similar to conventional IVF. 3

研究表明，在患有非男性因素不孕症的夫妇中，采用胞浆内单精子注射 (ICSI) 的试管治疗的受精率和妊娠率接近于传统试管治疗周期。1 这项随机研究表明，虽然 ICSI 的受精率略低，但妊娠率没有数据上的差异。在无精子症的情况下，当传统的试管治疗方法失败时，ICSI提供了生育机会。2009 年，使用新鲜的非捐赠卵子的美国夫妇中有65%选择使用了 ICSI这项技术，其中只有 36% 被诊断为男性因素不孕症。2美国试管诊所的报告显示，ICSI 的平均受精率为 50-80%;怀孕率约为 33%，与传统的试管周期结果相似。3

Most studies demonstrate that fertilization and pregnancy rates between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) are similar, provided that sperm can be retrieved. 4-7 From our review, pregnancy rates range from 0-70 percent. In a recent study of 58 couples,motile sperm was retrieved in 17/40 non-obstructive azoospermia patients and 18/18 obstructive azoospermia patients via microdissection TESE. Authors attributed the similar fertilization and pregnancy rates to the ability to extract motile sperm for injection. Vernaeve et al published two different studies which show conflicting results. One studied 274 couples(NOA: 70, OA: 204) and demonstrated that fertility and pregnancy rates were not statistically different while the other study had 595 couples and demonstrated that clinical implantation and pregnancy rate per cycle were lower in NOA as compared to OA. Clinical judgment and expertise often play significant roles in achieving fertility and can complicate experiments when trying to determine the underlying difference between the efficacies seen in OA versus NOA.

大多数研究表明，只要可以取出精子，阻塞性无精子症 (OA) 和非阻塞性无精子症 (NOA) 的受精率和妊娠率相似。4-7 根据我们的统计，妊娠率在 0-70% 之间。在最近一项对 58 对夫妇的研究中，40名非阻塞性无精子症患者的17名和全部18 名阻塞性无精子症患者通过显微解剖TESE术提取了活动的精子。作者将相似的受精率和妊娠率归因于提取用于单精子注射的活动精子的能力。 Vernaeve 等发表了两项不同的研究，结果相互矛盾。一项研究了 274 对夫妇(NOA患者：70，OA患者：204)，结果表明受精率和妊娠率数据上并无差异，而另一项研究对 595 对夫妇进行了对比，结果表明NOA患者每个周期的临床着床率和妊娠率比OA患者低。临床判断和专业知识通常在实现生育能力方面发挥重要作用，并且在试图确定 OA 与 NOA 疗效之间的潜在差异时使实验复杂化。

References 数据来源

1. Van Rumste MM, Evers JL, Farquhar CM. Intra-cytoplasmic sperm injection versus conventional techniques for oocyte insemination during in vitro fertilisation in patients with non-male subfertility. Cochrane Database Syst Rev 2003; (2):CD001301.

2. NationalSummaryReport.(2011).at

3. Patient fact sheet Intracytoplasmic Sperm Injection (ICSI).(2008) .at

4. Kanto S, et al. Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients. Fertil.Steril 2010;90:.e5-2010.e7 (2008) .

5. Palermo GD, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men Hum Reprod 1999; 14: 741-8.

6. De Croo I, Van der Elst J, Everaert K, De Sutter P, Dhont M.Fertilization, pregnancy and embryo implantation rates after ICSI in cases of obstructive and non-obstructive azoospermia.Hum Reprod 2000; 15: 1383-8.

7. Vernaeve V,et al. Pregnancy outcome and neonatal data of children born after ICSI using testicular sperm in obstructive and non-obstructive azoospermia. Hum Reprod 2003;18:2093-7.