Analysis of the drug efficacy and safety before ICSI from different sources of sperm in patients with obstructive azoospermia

doi:10.11958/20221780

Abstract

Abstract:

Objective To investigate the efficacy, safety and the influence on pregnancy outcome of L-carnitine before intracytoplasmic sperm injection (ICSI) from different sources of sperm in patients with obstructive azoospermia (OA). Methods A total of 141 patients with OA were treated with L-carnitine for three months, and sperms were obtained by testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) respectively. According to the source of sperm, they were divided into the two groups: the TESA group (n=78) and the PESA group (n=63). The general clinical data, sperm quality, embryonic development and clinical outcome of the two groups were compared. Results In the TESA/PESA group, sperm DFI and sperm spontaneous acrosome reaction rate were significantly lower than those before treatment, and sperm acrosome integrity rate was significantly higher than that before treatment (P<0.05). There were no significant differences in sperm DFI, sperm acrosome integrity rate and sperm spontaneous acrosome reaction rate between the two groups(P>0.05). There were no significant differences in the fertilization rate, 2PN fertilization rate, cleavage rate, excellent embryo rate, implantation rate, clinical pregnancy rate, live birth rate, premature birth rate, abortion rate and neonatal malformation rate between the two groups (P>0.05). A total of 103 fresh transplant cycles, 989 MII oocytes, 773 zygotes, 49 clinical pregnancies and 39 live births were obtained (including 17 in the TESA group and 22 in the PESA group). During a 3-month follow-up after birth, it was found that one newborn had cardiac abnormalities in the TESA group, while the other newborns had no abnormalities. Conclusion In OA patients, L-carnitine before TESA-ICSI and PESA-ICSI can improve the sperm quality, optimize clinical outcome, and the medication is safe.

Key words: obstructive azoospermia, testicular sperm, epididymal sperm, L-carnitine, pregnancy outcome

CLC Number:

R699

Figures/Tables 4

References 17

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组别	n	不育年限/年	年龄/岁	睾丸体积/mL	睾酮/（ng/dL）	FSH/（IU/L）	BMI/（kg/m²）
TESA组	78	3.00（2.00，6.00）	31.00（29.00，34.00）	31.00（30.00，32.00）	444.13（338.41，617.43）	4.53（3.24，6.11）	24.05±2.53
PESA组	63	3.00（1.00，5.00）	30.00（28.00，33.00）	31.00（30.00，32.00）	512.89（309.25，687.21）	4.23（3.21，5.28）	23.87±3.54
t或U		2 149.500	1 997.500	2 403.500	2 258.500	2 256.000	0.336

组别	n	不育年限/年	年龄/岁	睾丸体积/mL	睾酮/（ng/dL）	FSH/（IU/L）	BMI/（kg/m²）
TESA组	78	3.00（2.00，6.00）	31.00（29.00，34.00）	31.00（30.00，32.00）	444.13（338.41，617.43）	4.53（3.24，6.11）	24.05±2.53
PESA组	63	3.00（1.00，5.00）	30.00（28.00，33.00）	31.00（30.00，32.00）	512.89（309.25，687.21）	4.23（3.21，5.28）	23.87±3.54
t或U		2 149.500	1 997.500	2 403.500	2 258.500	2 256.000	0.336

组别	n	年龄/岁	基础FSH/（IU/L）	基础LH/（IU/L）	窦卵泡数/个	HCG日子宫内膜厚度/mm	获卵数/个	BMI/（kg/m²）
TESA组	78	30.01±3.67	6.35（5.40，7.37）	4.19（3.11，5.56）	14.00（12.00，18.25）	11.5（10.0，12.7）	12.00（8.00，15.25）	21.00（18.98，22.79）
PESA组	63	29.02±4.02	6.20（5.24，6.88）	4.71（3.40，5.78）	13.00（10.00，19.00）	11.0（10.0，12.0）	10.00（7.00，14.00）	20.70（18.61，23.60）
t或U		1.537	2 343.000	2 209.500	2 127.000	2 366.500	2 099.500	2 421.000

组别	n	年龄/岁	基础FSH/（IU/L）	基础LH/（IU/L）	窦卵泡数/个	HCG日子宫内膜厚度/mm	获卵数/个	BMI/（kg/m²）
TESA组	78	30.01±3.67	6.35（5.40，7.37）	4.19（3.11，5.56）	14.00（12.00，18.25）	11.5（10.0，12.7）	12.00（8.00，15.25）	21.00（18.98，22.79）
PESA组	63	29.02±4.02	6.20（5.24，6.88）	4.71（3.40，5.78）	13.00（10.00，19.00）	11.0（10.0，12.0）	10.00（7.00，14.00）	20.70（18.61，23.60）
t或U		1.537	2 343.000	2 209.500	2 127.000	2 366.500	2 099.500	2 421.000

组别	n	DFI			顶体完整率			自发顶体反应率
组别	n	治疗前	治疗后	Z	治疗前	治疗后	t	治疗前	治疗后	t
TESA组	78	44.00（36.83，58.25）	34.20（26.78，42.63）	7.674^＊	48.40±13.52	61.90±12.11	17.122^＊	10.18±2.15	6.98±2.09	14.078^＊
PESA组	63	42.50（32.30，66.60）	28.90（17.90，51.70）	6.901^＊	34.77±16.81	46.39±16.86	8.256^＊	12.28±3.35	10.10±3.26	14.538^＊
t或U		2 281.000	2 052.500		1.420	1.643		1.140	1.741