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睾丸取精卵浆内显微注射受精治疗无精症的疗效分析
Testicular sperm extraction and intracytoplasmic sperm injection for management of azoospermic infertility
【摘要】 目的 评价采用睾丸取精卵浆内显微注射法治疗无精症的疗效。方法 对 2 0 0 0年 7月~ 2 0 0 2年 7月来我所就诊的 35例患者 ,女方取卵当日 ,男方取精。手术时 ,患者取平卧位 ,术野常规消毒 ,用 1%利多卡因局麻 ,新鲜人体睾丸组织通过切口活检取材 ,立即放入装有培养液的培养皿中。取部分睾丸组织在体视显微镜下 ,用无菌针头划开曲精小管 ,在显微镜下检查是否存在精子。如果找到精子 ,将存有睾丸组织的培养皿放入培养箱 ,直到注射前取出。B超引导下经阴道取卵 ,常规去卵丘结构处理。在倒置显微镜下进行胞浆内单精子注射 (ICSI)。注射后 15~ 18小时检查有无原核 ,4 8小时观察卵裂 ,经阴道宫腔内移植质优胚胎 1~ 3个。移植后 11天进行妊娠试验检查 ,7周进行B超检查 ,了解有无胎心搏动。结果 35例无精症患者全部在睾丸曲精小管中找到精子。女方取卵 4 6 6个 (5~ 32个 ) ,其中MⅡ期卵 36 7个 ,显微注射 337个 ,有 2 70个受精卵见到两个原核 ,受精率为 80 11% ,35对全部获得受精卵。临床妊娠率为 4 0 %。结论 睾丸取精卵浆内显微注射技术是目前治疗无精症最有效的方法
【Abstract】 Objective To evaluate the effect of testicular sperm extraction and intracytoplasmic sperm injection(ICSI) in the management of azoospermic infertility.Methods Thirty-five adult males,aged 27-50 years and married for 2-11 years,were included in the study.After local anesthesia with 1% lidocaine and a small incision at the testis,a minute piece of testicular tissue is obtained to see whether there are aperm under a dissecting microscope.Ova are obtained through the vagina after controlled superovulation treatment with B-ultrasonographic monitoring.After removal of the cumulus oopherous a single sperm is injected into the ovum over an inverted microscope,the presence of the pronucleus is observed 15-18 hours later and cleavage 48 hour later.Seven days after the implantation of 1-3 high quality embryos,a pregnancy test is performed and 11 days later the presence of fetal heart beat is monitored with B-ultrasonography.Results In the 35 azoospermic cases,sperm are found within the seminiferous tubules.466 ova are obtained from the spouses(5-32/woman),and 367 ova are at the stage MII.ICSI are performed in 337 ova and two pronuclei are observed in 270(fertilization rate is 80.11%).All the 35 pairs obtained fertilized ova.94 embryo are implanted in the 35 women and 14 are proved by B-untrasonography to be pregnant with a pregnancy rate of 40.0%.Conclusion Testicular sperm extraction for ICSI is an effective.
【Key words】 Azoospermia Intracytoplasmic sperm injection Testicular sperm;
- 【文献出处】 中国全科医学 ,Chinese General Practice , 编辑部邮箱 ,2003年11期
- 【分类号】R698
- 【下载频次】102