Anglysis Of The Effect Of The Related Factors On Pregnancy Outcomes After ICSI

BackgroundNowadays, fast pace of life, environmental pollution, unhealthy lifestyle andworking pressure cause a great deal of threat of male reproductive health. Manysurveys show that male reproductive ability in declining now, increasing incidencesof male infertility is also more obvious. Male infertility causes disharmony in thefamily not only, but can also causes social disharmony. Azoospermia andoligoasthenozoospermia is a leading cause of male infertility. For male infertility,medication is not only ineffective, but will delayed their condition so that the patientmisses the best time of their treatment. With the birth of the first test-tube baby in1978the world, marking the first test-tube baby technology--in vitrofertilization-embryo transfer (IVF) mature, which is a major leap forward forunderstanding reproductive physiology. It brings the hope to be the biological fatherfor patients with male infertility. However conventional IVF for female sterilityresults are obvious, but for azoospermia and severe asthenospermia patients lessineffective. With the development of assisted reproductive technology, the success offertilization by Plermo microscopically injecting sperm into oocyte in1992, makes the second generation of in vitro fertilization technologies-intracytoplasm sperminjection (ICSI) came into being. The key to ICSI technology is making a sperm canbe microscopically injected into a oocyte. Because there is no natural choice ofoocyte,so small quantities and poor activity of sperm has a chance to enter theoocyte to be a zygote. ICSI is mainly used in the patiens of obstructive azoospermia,severe oligoasthenozoospermia, non-obstructive azoospermia, ejaculation failure,failure of IVF. The spermatozoa of ICSI mainly comes from ejaculation, testis andepididymis.At present there are many scholars have done a lot of research at home and abroadabout the effect of the sperm of different sources and different parameters on thepregnancy outcomes after ICSI,but the conclusion is not clear. The study ofejaculation failure on day of oocyte retrieval, although some scholars at home andabroad for studies, but are case reports, no statistically significant study on analysis.ObjectiveAnalysis in assisted reproduction treatment of the effect of sperm from differentsources, different parameters of sperm and surgical sperm retrieval in EjaculationFailure on Day of Oocyte Retrieval on Pregnancy Outcomes after ICSI.Material and MethodsMatching the condition of the ICSI treatment according to the healthdepartment provision and according to the inclusion criteria and exclusioncriteria,the study selects1125couples with male infertility who come to theReproduction-assisted Centre of my hospital seek medical advice in January2007~July2010.The patients were divided into two groups according to the source ofsperm.The group of surgically obtained sperm has294couples,the group of nonsurgically obtained sperm has831couples.The couples of non surgically obtainedsperm group were divided into two groups according to the parameters of sperm.Thegroup of mild-moderate oligoasthenozoospermia has265couples,the group of severeoligoasthenozoospermia has132couples.In the surgically obtained sperm group,the couples was divided into two groups according to the couse of male infertility.Thegroup of ejaculation failure on day of oocyte retrieval has25couples,the group ofobstructive azoospermia has215couples.The age of the female and infertility,theamount of Gn,the using days of Gn,the rate of fertilization,the rate of cleavage,therate of high quality embryo,the rate of embryo implantation,the pregnancy rate,theabortion rate,the one gestation rate,the two gestation rate,the premature birth rate,thelive birth rate,the malformation rate were compared among2groups of different.Results1、The groups of surgically obtained sperm and nonsurgically obtained sperm.The basics of two groups was on significant difference(P>0.05).There were on significant difference of the rate of fertilization,the rate of highquality embryo,the rate of embryo implantation,the pregnancy rate,the abortionrate,the one gestation rate,the two gestation rate,the premature birth rate,the live birthrate among two groups(P>0.05),but significant difference was boserved in the rate ofcleavage(96.25%vs94.92%)among two groups(P=0.009<0.005).The malformationrate respectively was o and0.96%.The three congenital malformation of the fetuswere birthed in the group of nonsurgically obtained sperm,and the cause ofcongenital malformation respectively was congenital heart disease and Down’ssyndrome(1case),21-three-body syndrome(1case) and congenital heartdisease(1case).2、The groups of mild-moderate oligoasthenozoospermia and severeoligoasthenozoospermia.The basics of two groups was on significant difference(P>0.05).There were on significant difference of the rate of fertilization, the rate ofcleavage,the rate of high quality embryo,the rate of embryo implantation,thepregnancy rate,the abortion rate, the premature birth rate,the live birth rate amongtwo groups(P>0.05). The malformation rate respectively was2.8%and0. The threecongenital malformation of the fetus were birthed in the group of mild-moderate oligoasthenozoospermia,and the cause of congenital malformation respectively wascongenital heart disease and Down’s syndrome(1case),21-three-bodysyndrome(1case) and congenital heart disease(1case).3、The groups of ejaculation failure on day of oocyte retrieval and obstructiveazoospermiaThe basics of two groups was on significant difference(P>0.05).There were on significant difference of the rate of fertilization, the rate ofcleavage,the rate of embryo implantation,the pregnancy rate,the abortion rate, thepremature birth rate,the live birth rate among two groups(P>0.05),but significantdifference was boserved in the rate of high quality embryo (24.84%vs33.22%)amongtwo groups(P=0.032<0.005).There were no fetus of congenital malformation in thetwo groups.Conclusion1.The treantment outcomes of ICSI with sperm retrieved byejaculation,percutaneous epididymal sperm aspiration and testicular sperm aspirationare similar,and the maturity of sperm may not affected the treatment outcomes ofICSI.2.Different parameters of sperm retrieved by ejaculation may not affect thetreatment outcomes of ICSI.3.The treatment outcomes of ICSI with sperm retrieved by surgical spermretrieval in ejaculation failure on day of oocyte Rretrieval and obstructiveazoospermia are similar.It shows that surgical sperm retrieval combining with ICSIis an effectice method for these men with ejaculation failure on day of oocyteRretrieval,and it can avoid missing the best time for treatment.4.Psychological factors can affect the treatment outcomes of ICSI,it can reducethe rate of fertilization, the rate of cleavage,the rate of high quality embryo,the rateof embryo implantation,the pregnancy rate,the abortion rate, the premature birthrate,the live birth rate.