The Outcome Of Different Surgical Methods Sperm Extraction And Assisted Reproductive With Azoospermia

According to the World Health Organization(WHO),about 10 to 15 per cent of couples of childbearing age worldwide are infertile and have complex causes.At present,it is generally accepted by scholars that infertility is divided into female infertility by etiology,accounting for about 60%-70%.Among them male factor causes infertility to account for about 30%,some reports male factor accounts for 30%-50%[1].In today's society,living environment,food,medicine,living habits and so on are the main causes of male infertility.These factors continue to increase the number of male infertility patients.Among the male infertility factors,semen abnormalities,sexual dysfunction and immune factors were mainly included.Azoospermia is the most serious indicator of abnormal semen quality,accounting for 10-20%of male infertility.The treatment of male infertility has made a major breakthrough in the past 20 years.In 1992 the intracytoplasmic sperm injection technology solved the problem of sterility in severe oligozoospermia.In 1992 craft et al[3]successful pregnancy with first testicular biopsy after sperm acquisition ICSI obstructive azoospermia.In 1995,Devroey et al[4]used testicular sperm aspiration for intracytoplasmic sperm injection(TESA-ICSI)to make a successful pregnancy in patients with non-obstructive azoospermia(NOA),it become a routine assisted reproductive technology treatment in patients with azoospermia,and it is possible for azoospermia patients to have their own offspring.In 1998,schlegel[5]reported the advantages of small injury,strong pertinence and high sperm detection rate when the NOA patients were treated with Micro-TESE.Microsurgical techniques combined with intracytoplasmic sperm injection offer hope to non-obstructive azoospermia patients who were previously thought to be unable to treat spermatogenic dysfunction.Meanwhile,the revolution of microsurgical anastomosis of vas deferens and epididymal anastomosis is that the therapeutic effect of obstructive azoospermia(OA)has been significantly improved and has become the preferred treatment for some OA patients?However,whether there is a difference in the outcome of ICSI treatment in patients with obstructive azoospermia and non-obstructive azoospermia has been a hot topic in clinical research,but there is still no consensus on the conclusion.At present,for non-obstructive azoospermia patients,the success of sperm extraction can not be correctly judged before the operation,some patients even with microscopic spermatogenesis,still can not obtain sperm,but also some patients with testicular biopsy negative will give up further spermatogenesis,if the later stage of microscopic spermatogenesis has the opportunity to find sperm.the current available clinical techniques are less able to predict the outcome of microscopic spermatogenesis,which also leads some patients to lack the potential optimal clinical treatment.therefore,it is particularly important to clinically screen patients who are really suitable for Micro-TESE and to find indicators that can predict the outcome of spermatogenesis before operation.Objective1.The effect of intracytoplasmic sperm injection(ICSI)on the outcome of ICSI therapy and the clinical outcome of different surgical methods and testicular spermatogenesis.2.To investigate the factors influencing the success rate of testicular micro exercise in patients with non-obstructive azoospermia.3.To compare the effect of Micro-testicular sperm extraction and the clinical outcome of intracytoplasmic microinjection in patients with non-obstructive azoospermia of different pathological types.Materials and methods1.Retrospective analysis of the patients in the third affiliated hospital of Zhengzhou University were divided into Micro-TESE group,PESA group and TESA group according to the method of operation.The fertilization rate,embryo cleavage rate,high quality embryo rate and transferable embryo rate were compared,and the implant rate,the clinical pregnancy rate,abortion rate and birth rate were compared in three groups.2.128 Non-obstructive azoospermia patients who underwent testicular spermatogenesis were divided into the spermatozoa group(43cases)and the unfertilized group(85cases)according to whether they had sperm,comparing preoperative age,testicular volume,and reproductive hormone levels.3.Retrospectively analyzed the clinical data of patients with non-obstructive azoospermia(NOA)in this center from May 2018 to September 2019.according to the NOA classification proposed by McLachlan in 2007,it was divided into three types.15 cases with Supporting Cell Syndrome(SCOS),11 patients with maturation arrest(MA)and 7 cases with hypo-spermatogenesis(H-S).the patients with acquired sperm were treated with ICSI,compared with age,testicular volume,hormone level and sperm acquisition rate in three groups.At the same time,the fertilization rate,available embryo rate and clinical pregnancy rate after ICSI were analyzed.Results1.There were 37 cases in Micro-TESA group,175 cases in PESA group and 20 cases in TESA group in testicular Micro-TESA group.There was no significant difference in the age of women,infertility,BMI of women and BMI of men among three groups(p>0.05),(see table 1).2.There was significant difference in the fertility rate and 2 PN fertility rate and the rate of cleavage among the three groups,(p<0.05).(see table 2).3.There was no significant difference in the rate of implantation,pregnancy and abortion among the three groups(p>0.05),(see table 3).4.The overall sperm retrieval rate was 33.59%in 43 out of 128 NOA patients undergoing Micro-TESE surgery.among them,the acquired NOA,the SRR was 83.3%,the congenital NOA group was 34.29%,the idiopathic NOA sperm retrieval rate was 25.5%,and the difference was statistically significant among the three groups.Between congenital and acquired,idiopathic and acquired,the difference was statistically significant,p<0.05.(see table 4).5.Among three groups,the difference was not statistically significant in the clinical pregnancy rate,abortion rate,p>0.05.There was a significant difference between the three groups in the fertilization rate,between the three groups,p<0.05.(see table 5).6.Three different pathological types of NOA patients,found that the Hypo-spermatogenesis group had higher sperm retrival rate than Maturation arrest group and Supporting Cell Syndrome,compared between the three groups,p<0.05,the difference was statistically significant,(see table 6).7.128 patients who underwent testicular sperm extraction were divided into Acquisition of sperm groups and no sperm groups according to whether the sperm was acquired.The age,testicular volume and reproductive hormone levels were compared between the two groups.Micro-TESE surgery was performed in 128 NOA patients,and sperm was obtained in 43 patients,with an overall SRR was 33.59%.the FSH level(20.34±9.26 vs 8.19±5.37)IU/l,p<0.05,it was statistically significant;the LH level(6.81±6.51 vs 6.37±10.48)IU/l,p<0.05,it was statistically significant.but there were no statistically significant differences in age,testicular volume,estradiol,testosterone,(see table 7).8.Among the 36 patients with different pathological types NOA,SCOS was 15,MA was 14 and H-S was 7.Sex hormone analysis showed that the follicular estrogen(FSH),SCOS group vs MA group vs H-S group was 8.01±6.37vs8.08±5.10vs25.43±10.73 IU/l,the difference was statistically significant between the three groups(p<0.05;luteinizing hormone(LH).SCOS group vs MA group vs H-S group was 4.12±2.34 vs 4.52±2.84 vs 7.74±3.71 IU/l,There was significant difference between the three groups(p<0.05).There was no significant difference in mean age,testicular volume and testosterone,(see table 8).9.There was no significant difference in fertilization rate,available embryo number,high quality embryo number and clinical pregnancy rate among 9.three groups of NOA patients with different pathological types and all ICSI injections(p>0.05),(see table 9).Conclusions1.In the three groups,the rates of fertilization,cleavage and high-quality embryos were lower in the micro-TESA group than in the TESA group and the PESA group,but there was no significant difference in implantation rate,clinical pregnancy rate and abortion rate among the three groups;2.The patients with non-obstructive azoospermia underwent microscopic spermatogenesis.Among the NOA patients with different etiology,the patients with acquired NOA had the highest rate of spermatogenesis.Compared with age and testicular volume,the difference was not statistically significant,and the reproductive hormone level about FSH?LH,the difference was statistically significant.But clinical pregnancy rate,abortion rate comparison,the difference is not statistically significant.3.Micro-TESE was an effective means to obtain sperm in patients with non-obstructive azoospermia.the success rate of spermatogenesis in three NOA patients with different pathological types.the three groups were compared in age and testicular volume,p>0.05,the difference was not statistically significant.the difference was statistically significant p<0.05 when compared to FSH?LH.The H-S group had higher SRR than the MA group and the SCOS group.