| The increasing incidence of infertility has drawn the focus of researchers of the world. A study showed that nearly20percent couples in the world suffered from infertility. Male-cause infertility constitutes nearly50%of these couples, and a recently study indicated that this proportion has grown to66%. There are causes lead to male infertility, such as oligospermatism, asthenospermia, teratozoospermia and azoospermia. Azoospermia, which is a major conundrum for assistant reproduction technology, is diagnosed as at least three consecutively semen analysis evaluations after centrifugation of3000g for15min showed no sperm under the microscope according to the WHO guideline, not including retrograde ejaculation and anejaculation.The incidence of azoospermia in the whole population was1%, and take up nearly7%to14%of the male-infetility causes. There are etiologies lead to azoospermia, such as infection, immunity factors, endocrine dyscrasia, abnormal chromosome, varicocele, deficiency of trace elements, unhealthy lifestyle, congenital testicular hypoplasia, injury of reproduction system, torsion of spermatic cord, iatrogenic injury after herniorrhaphy and prostatectomy. Theses etiologies mentioned above could play a adverse role for the testis function at some extend and then impact spermatogenesis, leading to azoospermia.Nowadays, it is still hard for doctors to select a non-invasive, available method to treat patient with azoospermia. However, a therapy method which comprises percutaneous epididymal sperm aspiration (PESA), percutaneous testicular sperm aspiration(TESA) and intracytoplasmic sperm injection (ICSI) turned out to be effective for these patients. As the development of this therapy method, problems followed, that is, no treatment effect were found in some patients who repeatedly performed with ICSI after PESA or TESA. A retrospective analysis of the pathological diagnosis and the evaluation of severity in spermatogenesis dysfunction of testis samples in patients with azoospermia showed that the rate of fertilization, cleavage, excellent embryogeny, pregnancy of embryo shwoed a decresing trend which were changed with the severity in spermatogenesis dysfunction of testis, indicating a strong positive correlation between embryo development and spermatogenesis function of testis. The more severe of spermatogenesis dysfunction of testis, the lower rate of fertilization, cleavage, excellent embryogeny, pregnancy of embryo. This may somehow explain the reason why these patients failed to pregnancy after treating with ICSI repeatedly. It is interesting to investigate what other therapy methods can be chose to help these couples.The objective of this research was to investigation the effect of various severity in spermatogenesis dysfunction of testis samples in patients with azoospermia in the embryo development. This study included content as follow:ObjiectiveDifferent spermatogenic dysfunction patients with azoospermia are treated by ICSI using PESA or TESA sperm retrieval, the normal fertilization rate, cleavage rate, excellent embryo rate and pregnancy rate are analyzed for personalized treatment of patients with different degree of spermatogenic failure. Thus optimize medical resources, Alleviate the patient’s physical and psychological pressur, reduce the burden on the economy and enable patients to achieve the best therapeutic effect.Methods1. Diagnostic testicular biopsy, and thus the functional assessment of the spermatogenic cells, divided into four groups of spermatogenic function in normal, mild, moderate and severe, etc.2. Program of controlled ovarian hyperstimulation based on patient age or ovarian reserve selection, appropriate to adjust the dose according to B ultrasound monitoring and serum E2levels, intramuscular HCG4000-10000IU when more than three dominant follicle diameter up to18mm the B ultrasound-guided oocyte retrieval after36h.3. Using percutaneous epididymal sperm aspiration (PESA) or percutaneous testicular sperm aspiration (TESA) to extract the sperm of different spermatogenic dysfunction4. Remove granulosa cells of egg, installing micro-injection needle, commissioning a micromanipulator, selecting the maturity of oocytes to sperm cytoplasmic injection (ICSI). Completed, the fertilization eggs are placed in37℃,6%CO2incubator.5. Embryonic development,18h,42h,66h, respectively, record and analyze the embryo fertilization rate, cleavage rate, good embryo formation rate after transplantation12d pregnancy rates.6. Depending on the degree of spermatogenic dysfunction, combined with ICSI embryos fertilized, development and pregnancy data analysis, concluded.ResultsPESA and TESA group compared with the normal fertilization rate (%)74.9± 19.6the VS66.3±22.7(P>0.05) cleavage rate (%)96.7±8.6vs92.8±19.8(P>0.05), good embryo rate (%) were43.5±26.2the VS35.0±29.4(P>0.05) and pregnancy rate (%)44.0VS52.0(P>0.05), The fertilization rate, cleavage rate, good embryo rate and pregnancy has no statistical difference between PESA and TESA group treated with ICSI.Normal fertilization rate (%) changes of spermatogenic dysfunction from normal to severe group were77.8±18.3,68.4±18.4,73.5±19.9,51.6±27.4, mild and normal spermatogenesis group difference (P<0.05),severe and other groups have significant difference (P<0.05); changes in the embryo cleavage rate (%) were96.7±9.3,93.7±22.2,94.0±12.0,93.7±11.1, each group in turn was no significant difference; good embryo rate (%) followed by47.1±25.8,40.3±27.6,36.1±23.2,15.0±24.6, with severe spermatogenic failure group and other groups were significantly different (P<0.05); pregnancy rate (%change)followed by54.8%,50.0%,13.6%,10.0%, a significant difference (p<0.001). With the deepening of the degree of spermatogenic dysfunction, embryonic normal fertilization rate, good embryo rate, pregnancy rate has significantly decreased, and in the cleavage rate of each group has no statistically significant differenceConclusion1. There were no difference of patient outcomes between PESA and TESA sperm retrieval.2. With the deepening of the degree of spermatogenic dysfunction, normal fertilization rates decline with the aggravation of the spermatogenic failure in the cleavage rate was no significant difference, it can not assess the cleavage rate of spermatogenic impairment of embryonic development impact. Good embryo rate, the degree of spermatogenic failure and its negative correlation with the aggravation of the spermatogenic impairment, good embryo rate has declined, there is a statistically significant difference. Varying degrees of spermatogenic impairment is more pronounced difference in the pregnancy rate, from spermatogenic failure group began the rapid decline in the deepening of moderate to severe degree of only10%pregnancy rate, spermatogenic failure had a significant impact on the developmental potential of embryonicCombined with literature data, to explore the treatment of moderate and severe spermatogenic dysfunction in patients with azoospermia, PESA or TESA patients with sperm frozen,sperm function remained in relatively good condition,so as to get the maximum treatment effect in the subsequent treatment,. This is worthy of further study. |
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