Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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The Study on Comparison of Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Epididymal Sperm and Testicular Sperm

난자 세포질 내 정자 주입술시 부고환 및 고환 정자의 체외수정능력에 관한 비교 연구

  • Sung, Ki-Cheong (Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University) ;
  • Kang, Moon-Joo (Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University) ;
  • Kim, Hee-Sun (Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University) ;
  • Oh, Sun-Kyung (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Ku, Seung-Yup (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Suh, Chang-Suk (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Kim, Seok-Hyun (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Choi, Young-Min (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Kim, Jung-Gu (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University) ;
  • Moon, Shin-Yong (Department of Obstetrics and Gynecology, College of Medicine, Seoul National University)
  • 성기청 (서울대학교 의학연구원 인구의학연구소) ;
  • 강문주 (서울대학교 의학연구원 인구의학연구소) ;
  • 김희선 (서울대학교 의학연구원 인구의학연구소) ;
  • 오선경 (서울대학교 의과대학 산부인과학교실) ;
  • 구승엽 (서울대학교 의과대학 산부인과학교실) ;
  • 서창석 (서울대학교 의과대학 산부인과학교실) ;
  • 김석현 (서울대학교 의과대학 산부인과학교실) ;
  • 최영민 (서울대학교 의과대학 산부인과학교실) ;
  • 김정구 (서울대학교 의과대학 산부인과학교실) ;
  • 문신용 (서울대학교 의과대학 산부인과학교실)
  • Published : 2003.06.30
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Abstract

Objective: This study was carried out to compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia according to sperm retrieval site and technique; microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESA), testicular sperm extraction by open biopsy (TESE). Methods: The outcomes of ICSI and IVF-ET were evaluated and compared among 3 groups. Seventy three men suffering from infertility due to obstructive azoospermia had 107 ICSI cycles using MESA (21 cycles in 15 patients), PESA (26 cycles in 17 patients) and TESE (60 cycles in 41 patients). Results: In the clinical outcomes in patients undergoing ICSI with epididymal or testicular sperm, there were no significant differences in fertilization rate (66.1% vs. 60.5%), cleavage rate (94.9% vs. 97.6%), cumulative embryo score (CES) (51.3 vs. 58.8), implantation rate (7.9% vs. 6.1), and clinical pregnancy rate per ET (30.4% (14/46) vs. 25.4% (15/59)) between both groups. Also, in the clinical outcomes in ICSI patients using MESA, PESA, TESE, there were no significant differences in fertilization rate (61.8%, 69.4%, 60.5%), cleavage rate (92.1%, 97.3%, 97.6%), CES (38.1, 52.0, 58.8), implantation rate (9.5%, 6.6%, 6.1%), and clinical pregnancy rate per ET (35% (7/20), 26.9% (7/26), 25.4% (15/59)) among 3 groups. Conclusion: When compared with MESA or TESE, PESA, the clinical outcomes were similar in ICSI patients with obstructive azoospermia whatever the origin or the technique of sperm retrieval. However, we considered PESA is more time-saving and cost effective for ICSI in patients with obstructive azoospermia.

Keywords

References

  1. Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992; 340:17-8 https://doi.org/10.1016/0140-6736(92)92425-F
  2. 문신용, 김석현, 김광례, 채희동, 이재훈, 정경남 등. 남성인자 불임 환자에서의 체외수정시술시 난자 세포질 내 정자 주입술을 이용한 미세보조 수정술의 임상적 효용성에 관한 연구. 대한산부회지 1996;39: 2310-23
  3. Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril 1971; 22: 469-74 https://doi.org/10.1016/S0015-0282(16)38400-X
  4. Friedler S, Raziel A, Strassburger D, Soffer Y, Komarovsky D, Ron-El R. Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997; 12: 1488-93 https://doi.org/10.1093/humrep/12.7.1488
  5. Schoysman R, Vanderzwalmen P, Nijs M, Segal-Bertin G, van de Casseye M. Successful fertilization by testicular spermatozoa in an in-vitro fertilization programme. Hum Reprod 1993; 8: 1339-40
  6. Devroey P, Nagy P, Tournaye H, Liu J, Silber S, Van Steirteghem A. Outcome of intracytoplasmic sperm injection with testicular spermatozoa in obstructive and non-obstructive azoospermia. Hum Reprod 1996;11: 1015-8 https://doi.org/10.1093/oxfordjournals.humrep.a019288
  7. Schlegel PN, Palermo GD, Goldstein M, Menendez S, Zaninovic N, Veeck LL, Rosenwaks Z. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology 1997;49: 435-40 https://doi.org/10.1016/S0090-4295(97)00032-0
  8. Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A. Using ejaculated, fresh, and frozenthawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril 1995; 63: 808-15 https://doi.org/10.1016/S0015-0282(16)57486-X
  9. 김석현, 정병준, 지병철, 최성미, 김희선, 류범용 등. 폐쇄성 무정자증 환자에서 정자 채취부위 및 방법에 따른 난자 세포질 내 정자 주입술의 결과 비교. 대한산부회지 1999; 42: 997-1005
  10. Craft I, Tsirigotis M, Bennett V, Taranissi M, Khalifa Y, Hogewind G, Nicholson N. Percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in the management of infertility due to obstructive azoospermia. Fertil Steril 1995; 63:1038-42 https://doi.org/10.1016/S0015-0282(16)57544-X
  11. Gil-Salom M, Minguez Y, Rubio C, Remohi J, Pellicer A. Intracytoplasmic testicular sperm injection: an effective treatment for otherwise intractable obstructive azoospermia. J Urol 1995; 154: 2074-7 https://doi.org/10.1016/S0022-5347(01)66698-9
  12. Schlegel PN, Palermo GD, Alikani M, Adler A, Reing AM, Cohen J, Rosenwaks Z. Micropuncture retrieval of epididymal sperm with in vitro fertilization: importance of in vitro micromanipulation techniques. Urology 1995; 46: 238-41 https://doi.org/10.1016/S0090-4295(99)80199-X
  13. 김석현, 지병철, 정경남, 김희선, 류범용, 오선경 등. 체외수정시술시 다태임신의 예방에 관한연구: 배아 등급과 누적배아지수의 의의. 대한산부회지 1995; 38: 2333-46
  14. Veeck L. The morphological assessment of human oocytes and early concepti. In:Keel BA, Webster BW, editors. Handbook of the laboratory diagnosis and treatment of infertility. Boca Raton: CRC Press, 1990: 353
  15. Hovatta O, Moilanen J, Von Smitten K, Reima I. Testicular needle biopsy, open biopsy, epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia. Hum Reprod 1995; 10: 2595-9 https://doi.org/10.1093/oxfordjournals.humrep.a135752
  16. Young WC. Astudy of the function of the epididymis: functional changes undergone by spermatozoa during their passage through the epididymis and vas deferens in the guinea pig. J Exp Biol 1931; 8: 151-62
  17. Silber SJ. Results of microsurgical vasoepididymostomy: role of epididymis in sperm maturation. Hum Reprod 1989; 4: 298-303 https://doi.org/10.1093/oxfordjournals.humrep.a136892
  18. Tsirigotis M, Pelekanos M, Yazdani N, Boulos A, Foster C, Craft IL. Simplified sperm retrieval and intracytoplasmic sperm injection in patients with azoospermia. BrJ Urol 1995; 76: 765-8 https://doi.org/10.1111/j.1464-410X.1995.tb00771.x
  19. Goldstein M, Sheynkin Y, Li PS, Schlegel PN. MESA/TESE reaching the hard to reach sperm. Annual Meeting Postgraduate Course IV: 20th century ART-embracing change. Cincinnati, Ohio. October 18-19, 1997
  20. Tsirigotis M, Craft I. Sperm retrieval methods and ICSI for obstructive azoospermia. Hum Reprod 1995; 10: 758-60 https://doi.org/10.1093/oxfordjournals.humrep.a136030
  21. Craft I, Tsirigotis M. Simplified recovery, preparation and cryopreservation of testicular spermatozoa. Hum Reprod 1995; 10: 1623-6 https://doi.org/10.1093/oxfordjournals.humrep.a136142
  22. 김석현, 정병준, 지병철, 김희선, 류범용, 오선경 등. 난자 세포질 내 정자 주입술을 이용한 체외수정시술 환자의 임신율 예측에 있어서 누적배아지수의 임상적 의의. 대한산부회지 1998;41:807-18
  23. 김석현, 정병준, 지병철, 김희선, 류범용, 오선경 등. 난자 세포질 내 정자 주입술을 이용한 체외수정시술 시 연령이 임신율에 미치는 영향에 관한 연구. 대한산부회지 1998; 41: 1811-9