The Clinical Significance Of Sperm Searching In Testicular Biopsy Of Azoospermia At High-power Microscope And Its ICSI Application

BackgroundThe incidence of azoospermia is 1%in the general population and 10%-20%in male infertility,which is the key and difficult point in clinical treatment.Azoospermia is usually divided into obstructive azoospermia(OA)and non obstructive azoospermia(NOA),of which NOA is about 60%in azoospermia,which is a difficult problem in assisted reproductive technology.Surgical sperm retrieval and ICS I have become an important treatment for NOA patients.The key to assisted reproductive treatment in azoospermia patients is to find active sperm.Before the sperm extraction,the testicular spermatogenesis of the patients with azoospermia should be evaluated.Then how to effectively evaluate the testicular spermatogenesis of the azoospermia patients and accurately predict the successful sperm retrieval rate is a key point for the doctors.At present,even the testicular biopsy can not accurately predict the sperm retrieval rate.Therefore,to observe the sperm at high-power microscope in testicular seminiferous tissue suspension is a beneficial supplement to the testicular pathology.At present,there is no study reporting the relationship between the results of sperm retrieval rate in testicular seminiferous tubules,the spermatogenesis and serum hormone levels.In addition,the effect of sperm activity on the clinical outcome of ICSI under high magnification is not reported.Therefore,we hope this study will be able to further answer the above questions.Purpose1.To investigate the relationship between sperm detection results in testicular seminiferous tubules and testicular spermatogenic types and sex hormone levels.2.To study the effect of sperm activity in testicular seminiferous tubules suspension on the clinical outcome of ICSI.3.To explore the effect of different spermatogenesis levels on the clinical outcome of ICSI.MethodThe data of 413 patients with testicular biopsy in our center were collected,including sex hormone levels,testicular pathological reports,whether sperm and sperm were visible in the seminiferous tubule suspension,130 of them were further treated with ICSI in my center.In addition,data on ICSI of 322 couples for azoospermia were collected.1.The relevant information before entering the cycle was improved,including:current medical history,past history and physical examination,semen,sex hormone,chromosome,Y microdeletions and other related examinations.2.Testicular biopsy was performed and grouping according to pathology and testicular seminiferous tubules suspension.3.The male take PESA or TESA for sperm collection and further ICSI.4.Collect relevant data,analyze data in groups and draw conclusions.Results1.There The testicular seminiferous tissue suspension under high magnification can be seen in the testicular spermatogenesis in the active spermatozoa group,and the pathological features are normal,mild and moderate(100%,115/115).At high magnification,most of the testicular spermatogenesis in the group of spermatozoa showed excellent function of spermatogenesis,and the pathological features were normal,light and moderate(94.3%,181/192),of which 8 cases showed severe low spermatogenesis and 3 cases showed spermatogenic block.Under the high magnification,the testicular spermatogenesis in the sperm group was poor,and the pathological manifestations were only support cell syndrome,spermatogenesis block and severe spermatogenesis(97.2%,103/106),of which 3 cases were moderate to moderate spermatogenesis.2.The testicular spermatogenesis function was normal.The total sperm examination rates of light,medium,severe,block and support cell syndrome group were 100%,100%,96.2%,25.8%,12%and 0%,respectively,and 41%,41.9%,29.5%,0%,0%,0%,respectively.The rate of inactive sperm examination was 59%,58.1%,and 0%,respectively.25.8%,12%,0%,there was a significant statistical difference(P<0.05).The better the testicular sperm function was,the higher the sperm detection rate was.There was a significant difference in testicular volume and hormone level between the spermatozoa group and the visible spermatozoon group in the testicular seminiferous tubule suspension,and the standard of the spermatozoa in the cell suspension of the testicular biopsy tissue was 0.975,0.897,and 0.881 of the ROC curve of the testicular pathological type,INHB and FSH respectively.Through the Youden index analysis,the critical value of INHB is 91.31 pg/ml(sensitivity 93.1%,specificity 77.8%),and the critical value of FSH is 6.73 pg/ml(sensitivity 87.1%,specificity 81.9%).3.There was no significant difference in age and testosterone among different spermatogenic groups,but there was significant difference in testicular volume,INHB,FSH and LH levels.The AUC values of testicular volume,FSH,INHB and LH were 0.625,0.573,0.592 and 0.550 respectively,and the value of testicular pathology was low.4.There was no significant difference in the clinical outcome of ICSI between the active sperm group and the immotile sperm group.The normal fertilization rate of normal,light,moderate and severe testicular spermatogenesis was 67.4%,66.7%,63.2%,47.1%,and the normal fertilization rate of the group with severe spermatogenesis was significantly lower than that of the other groups.There was no significant difference in cleavage rate,good embryo rate,clinical pregnancy rate and successful delivery rate among different spermatogenic groups.Conclusions1.When sperms(including active or inactive)are observed in the testicular seminiferous tubules suspension,the testicular spermatogenesis is perfect.Especially in the active sperm group,the testicular spermatogenic function is normal,mild and moderate hypospermatogenesis,but in no sperm group,the spermatogenic function is poor.Therefore,this method is a beneficial supplement to the testicular pathology.2.Testicular pathology is the most effective index for predicting the sperm retrieval rate.Although INHB and FSH can not replace testicular biopsy to evaluate the testicular spermatogenesis in azoospermia patients,it can be used for preoperative assessment of mature spermatozoa in testicular seminiferous tubules.3.The activity of spermatozoa in testicular seminiferous tubules suspension does not affect the clinical outcome of ICSI.4.Severe hypospermatogenesis only affects the normal fertilization rate of ICSI,but has no effect on cleavage rate,excellent embryogeny rate,blastocyst formation rate,clinical pregnancy rate and delivery rate.