Objective

To report fertilization and clinical pregnancy rates based on sperm characteristics at the time of intracytoplasmic sperm injection (ICSI) in men with nonobstructive azoospermia (NOA) following microdissection testicular sperm extraction (mTESE).

Design

Retrospective cohort.

Setting

Tertiary hospital.

Patient(s)

Men with NOA undergoing mTESE between 2013 and 2016 who had successful sperm retrieval and subsequent spermatozoa available for ICSI.

Intervention(s)

Sperm characteristic assessment.

Main Outcome Measure(s)

Fertilization and clinical pregnancy rates.

Result(s)

One hundred ninety-eight men with NOA and successful mTESE were included. The mean ages of the patients and their partners were 35 ± 8 and 31 ± 5 years, respectively. The overall fertilization rate was 44%, and the clinical pregnancy rate was 38%. The absence of twitching sperm motility and the presence of an acrosome defect were associated with decreased fertilization and clinical pregnancy rates on univariable analysis. On multivariable analysis, the presence of motility was associated with higher fertilization rates and greater odds of clinical pregnancy (odds ratio, 4.37; 95% confidence interval, 1.61–11.85). An abnormal acrosome was associated with reduced odds of pregnancy (odds ratio, 0.40; 95% confidence interval, 0.18–0.85). No specific anomaly or combination of sperm abnormalities precluded fertilization or clinical pregnancy with ICSI.

Conclusion(s)

To our knowledge, this is the first comprehensive study evaluating the importance of sperm characteristics and their impact on ICSI outcomes in men with NOA. The results suggest that no specific defect, including the use of nonmotile testicular spermatozoa, precluded a chance of clinical pregnancy. The study evaluated sperm characteristics at the time of ICSI injection; initial evaluation at the time of retrieval may differ significantly from that of spermatozoa selected for ICSI.

中文翻译：

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非梗阻性无精子症男性睾丸精子特征及其对卵胞浆内单精子注射结果的影响

客观的

报告显微解剖睾丸精子提取 (mTESE) 后非阻塞性无精子症 (NOA) 男性在胞浆内单精子注射 (ICSI) 时基于精子特征的受精率和临床妊娠率。

设计

回顾性队列。

环境

三级医院。

患者）

在 2013 年至 2016 年期间接受 mTESE 的 NOA 男性成功取精，随后的精子可用于 ICSI。

干预措施

精子特征评估。

主要观察指标）

受精率和临床妊娠率。

结果）

包括 198 名患有 NOA 和成功的 mTESE 的男性。患者及其伴侣的平均年龄分别为 35 ± 8 岁和 31 ± 5 岁。总体受精率为44%，临床妊娠率为38%。在单变量分析中，不存在抽动精子活力和存在顶体缺陷与受精率和临床妊娠率降低有关。在多变量分析中，运动的存在与较高的受精率和较高的临床妊娠几率相关（优势比，4.37；95% 置信区间，1.61–11.85）。顶体异常与妊娠几率降低相关（优势比，0.40；95% 置信区间，0.18–0.85）。没有特定的异常或精子异常的组合可以排除 ICSI 的受精或临床妊娠。

结论

据我们所知，这是第一项评估精子特征的重要性及其对 NOA 男性 ICSI 结果影响的综合研究。结果表明，没有特定的缺陷，包括使用不活动的睾丸精子，排除了临床怀孕的机会。该研究评估了 ICSI 注射时的精子特征；取精时的初始评估可能与选择用于 ICSI 的精子有显着差异。