Li Lei, Ming Li, Na Zhang, Qingqing Tao, Qin Li, Shengli Lin, Xiulian Ren, Xinjie Zhuang, Ping Liu, Rong Li
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引用次数: 0
Abstract
Background: Whether sperm source influences intracytoplasmic sperm injection (ICSI) outcomes in men with obstructive azoospermia (OA) remains uncertain.
Objective: To compare embryological, clinical, and neonatal outcomes of ICSI using percutaneous epididymal sperm aspiration (PESA)- versus testicular sperm aspiration (TESA)-derived sperm in men with OA.
Materials and methods: This single-center retrospective cohort study enrolled a total of 1368 ICSI cycles from couples diagnosed with OA at a tertiary reproductive medical center between January 2015 and August 2022. Embryological outcomes were analyzed in 1368 ICSI cycles (PESA, n = 516; TESA, n = 852). Clinical outcomes were evaluated in 869 fresh day-3 cleavage-stage embryo transfer cycles (PESA, n = 399; TESA, n = 470). Neonatal outcomes were assessed among 262 singleton live births following fresh day-3 embryo transfer (PESA, n = 128; TESA, n = 134). Multivariable regression models were used to adjust for prespecified covariates.
Results: In adjusted analyses, TESA (vs. PESA) was associated with a lower 2-pronuclear (2PN) fertilization rate (β = -0.03, p = 0.010) and a lower usable embryo rate (β = -0.12, p < 0.01). In the fresh day-3 transfer cohort, sperm source was not significantly associated with clinical pregnancy, miscarriage, or live birth per transfer (all p > 0.05). Among singleton live births, TESA was associated with lower birth weight (β = -209.01 g, p < 0.01) and lower odds of large for gestational age (OR = 0.45, p = 0.03), whereas gestational age, preterm birth, and small for gestational age were similar between groups.
Discussion: PESA was associated with better early embryological outcomes, but these differences did not translate into improved clinical pregnancy or live birth rates. Differences in neonatal growth were also observed, which remain to be further verified in subsequent studies.
Conclusion: In men with OA undergoing ICSI and PESA- and TESA-derived sperm showed distinct embryological and neonatal growth characteristics, which merits clinical attention. The choice between PESA and TESA should therefore be individualized according to the clinical context and patient-specific considerations.
背景：精子来源是否影响阻塞性无精子症（OA）男性胞浆内单精子注射（ICSI）的结果仍不确定。目的：比较经皮附睾精子抽吸（PESA）与睾丸精子抽吸（TESA）来源精子的ICSI在OA男性患者中的胚胎学、临床和新生儿结局。材料和方法：本单中心回顾性队列研究纳入了2015年1月至2022年8月在某三级生殖医疗中心诊断为OA的夫妇共1368例ICSI周期。分析1368例ICSI周期的胚胎学结果（PESA, n = 516； TESA, n = 852）。临床结果评估869个新鲜第3天卵分裂期胚胎移植周期（PESA, n = 399； TESA, n = 470）。对262例在第3天胚胎移植后的单胎活产新生儿的新生儿结局进行了评估（PESA, n = 128； TESA, n = 134）。多变量回归模型用于调整预先指定的协变量。结果：在校正分析中，TESA（相对于PESA）与较低的2-原核（2PN）受精率（β = -0.03, p = 0.010）和较低的可用胚胎率（β = -0.12, p 0.05）相关。在单胎活产婴儿中，TESA与较低的出生体重相关（β = -209.01 g, p）。讨论：PESA与较好的早期胚胎学结局相关，但这些差异并未转化为临床妊娠或活产率的改善。新生儿生长的差异也被观察到，这在随后的研究中有待进一步证实。结论：男性OA行ICSI后，来自PESA和tesa的精子表现出明显的胚胎学和新生儿生长特征，值得临床关注。因此，在PESA和TESA之间的选择应根据临床情况和患者的具体考虑进行个性化。
期刊介绍：
Andrology is the study of the male reproductive system and other male gender related health issues. Andrology deals with basic and clinical aspects of the male reproductive system (gonads, endocrine and accessory organs) in all species, including the diagnosis and treatment of medical problems associated with sexual development, infertility, sexual dysfunction, sex hormone action and other urological problems. In medicine, Andrology as a specialty is a recent development, as it had previously been considered a subspecialty of urology or endocrinology
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