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目的探讨自然周期成熟卵母细胞结合未成熟卵母细胞体外成熟方法(natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes,自然周期IVF/M)用于治疗男性因素引起不育的临床价值。方法66例适应证患者分成3组:少弱精子组、偶见活精子组和无精子症组[行经皮附睾精子抽吸术(PESA)、睾丸精子抽吸术(TESA)或睾丸切开取精术(TESE)],接受72个自然周期IVF/M,比较三组受精率和临床妊娠率。结果64例患者完成70个治疗周期。少弱精子组、偶见活精子组和无精子症组分别占完成周期数的54.3%、38.6%和7.1%,共获得卵母细胞812个,平均(11.3±5.2)个。卵母细胞成熟率为61.2%,正常受精率为82.2%,卵裂率为90.0%(377/419)。共26例患者获得临床妊娠,每取卵周期的妊娠率为36.4%(26/72),每移植周期的妊娠率为37.1%(26/70)。三组受精率分别为84.5%、78.9%和80.0%,三组间差异无统计学意义(P>0.05),临床妊娠率分别为39.5%,29.6%和60.0%,PESA/PESE和TESE组的临床妊娠率(60%)显著高于精液中偶见活精子组(29.6%,P<0.05)。结论自然周期IVF/ M技术对于治疗由于男性因素引起的不育如少弱精子症以及无精子症是一种简便有效的方法。
Objective To investigate the clinical value of natural cycle in vitro fertilization combined with in vitro maturation of immature oocytes for the treatment of male infertility. Methods Sixty-six patients with indications were divided into three groups: the oligozoospermia group, the occasional live sperm group and the azoospermia group [percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA) or testicular incision (TESE)] received 72 cycles of native IVF / M and compared the fertilization rates and clinical pregnancy rates of the three groups. Results 64 patients completed 70 cycles of treatment. In the oligozoospermia group, the occasional live sperm group and the azoospermia group accounted for 54.3%, 38.6% and 7.1% of the completed cycles, respectively. A total of 812 oocytes were obtained, with an average of (11.3 ± 5.2). Oocyte maturation rate was 61.2%, normal fertilization rate was 82.2%, cleavage rate was 90.0% (377/419). A total of 26 patients received clinical pregnancy with a pregnancy rate of 36.4% (26/72) per cycle and a pregnancy rate of 37.1% (26/70) per cycle. The fertilization rates of the three groups were 84.5%, 78.9% and 80.0% respectively. There was no significant difference among the three groups (P> 0.05). The clinical pregnancy rates were 39.5%, 29.6% and 60.0% The clinical pregnancy rate (60%) was significantly higher than that of semen occasionally live sperm (29.6%, P <0.05). Conclusion The natural cycle IVF / M technique is a simple and effective method for the treatment of infertility due to male factors such as oligoasthenospermia and azoospermia.