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目的:寻找取卵日男方取精困难的最佳干预对策。方法:回顾性分析取卵日发生取精困难且接受一般辅助取精治疗(心理治疗、影音刺激、妻子协助取精、5-磷酸二酯酶抑制剂治疗)失败后,分别接受经直肠前列腺按摩取精/手术取精[睾丸细针抽吸术(testicular fine needle aspiration,TEFNA)](A组)、采用预先冷冻保存的精子(B组)及行卵子玻璃化冷冻(C组)不孕夫妇的相关资料,比较这3种干预措施的受精率、卵裂率、优质胚胎率、临床妊娠率及流产率。结果:589个周期取卵日发生取精困难但经辅助取精治疗后491个周期成功获取精液,98个周期未能成功取精。A组中10个周期经直肠前列腺按摩取精,31个周期手术获得精子;B组35个周期;C组22个周期,其中有16个周期择期行卵子解冻后卵胞质内单精子注射-胚胎移植(ICSI-ET)治疗。男方年龄、女方年龄、不孕年限、使用Gn总量及卵裂率3组间均无统计学差异(P>0.05);获卵数(13.3±6.5枚vs 14.2±7.1枚vs 13.9±6.7枚)、临床妊娠率(39.02%vs 37.14%vs 26.67%)、流产率(12.20%vs 11.43%vs 13.33%)亦均无显著性差异(P>0.05);A组的受精率(82.63%)显著高于C组(70.51%)(P<0.001),B组(77.35%)与A组、C组间无统计学差异(P>0.05);C组优质胚胎率(17.45%)显著低于A组(36.88%)和B组(38.49%)(P<0.001)。结论:一般辅助取精治疗可以使绝大部分取精困难患者完成取精,这是一种行之有效的应对策略。预先行精液冷冻保存是一种成熟、可靠的方法,通过其可以获得较好的治疗结局,并有避免前列腺按摩取精/手术取精造成的创伤,缩短助孕周期,减少治疗费用等优点。与卵子冷冻后融冻行ICSI治疗相比,经直肠前列腺按摩取精/手术取精行ICSI治疗具有较好的治疗结局。
OBJECTIVE: To find out the best intervention strategy for sperm harvesting in male on ovulation day. Methods: A retrospective analysis of the fetus during taking sperm retrieval difficulties and general assisted sperm retrieval (psychological therapy, audio-visual stimulation, wife assisted sperm injection, 5-phosphodiesterase inhibitor treatment) failed to receive transrectal prostate massage The testicular fine needle aspiration (TEFNA) was performed in group A, and pre-cryopreserved sperm (Group B) and ovariectomized vitrified (Group C) infertile couples Of the relevant data, compare the three kinds of interventions fertilization rate, cleavage rate, quality embryo rate, clinical pregnancy rate and abortion rate. Results: There were 589 cycles of ovulation desease but semen was successfully obtained in 491 cycles after assisted de-esgestion. However, 98 cycles failed to obtain semen successfully. A group of 10 cycles of rectal prostate massage sperm, 31 cycles of surgery to obtain sperm; B group of 35 cycles; C group of 22 cycles, of which 16 cycles elective egg thawing after intracytoplasmic sperm injection - embryos Transplantation (ICSI-ET) treatment. There were no significant differences in age, woman’s age, duration of infertility, total amount of Gn and cleavage rate between the three groups (P> 0.05). The number of oocytes retrieved (13.3 ± 6.5 vs 14.2 ± 7.1 vs 13.9 ± 6.7 ), Clinical pregnancy rate (39.02% vs 37.14% vs 26.67%), miscarriage rate (12.20% vs 11.43% vs 13.33%) also showed no significant difference (P> 0.05) (P <0.001). There was no significant difference between group B (77.35%) and group A and group C (P> 0.05). The rate of high quality embryos in group C (17.45%) was significantly lower than that of group A (36.88%) and group B (38.49%) (P <0.001). Conclusion: The general assisted sperm retrieval treatment can make most patients with sperm retrieval difficult to complete sperm retrieval, which is an effective coping strategy. Cryosurgery is a mature and reliable method by which the better therapeutic outcome can be achieved, the avoidance of traumatic injury caused by prostatic massage / sperm injection, the shortening of the pregnancy cycle and the reduction of treatment costs. Compared with frozen-thawed ICSI treatment of ova, transrectal prostate massage and ICSI treatment have good therapeutic outcomes.