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首页> 外文期刊>BJU international >Surgical sperm retrieval after previous vasectomy and failed reversal: clinical implications for in vitro fertilization.
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Surgical sperm retrieval after previous vasectomy and failed reversal: clinical implications for in vitro fertilization.

机译：先前输精管切除术和逆转失败后的手术精子取回：体外受精的临床意义。

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Objective To investigate the effect of the interval between previous vasectomy reversal on retrieval rates of epididymal and testicular spermatozoa using percutaneous epididymal sperm aspiration (PESA), or testicular sperm extraction (TESE), and the subsequent reproductive potential of these gametes in intracytoplasmic sperm injection (ICSI) cycles. Patients and methods Sixty-six consecutive sperm retrievals were considered in patients who were azoospermic after previous vasectomy, of whom 54 had had a previous failed reversal, the remainder deciding against a reversal. PESA and TESE retrieval rates were noted, as were the time since vasectomy and the interval between vasectomy and unsuccessful reversal. The presence of palpable epididymal cysts was noted, with their effect on sperm retrieval rates. Fertilization and pregnancy rates were analysed in subsequent ICSI cycles using freshly retrieved spermatozoa or frozen-thawed cryopreserved spermatozoa. Results All 66 patients had sperm retrieved successfully; the success rates for PESA were not significantly affected by previous failed reversal when compared with patients who had not had a reversal, at 14 of 54 (26%) vs five of 12 (P=0.3). The interval since vasectomy did not affect PESA retrieval rates but there was a significantly poorer retrieval rate for PESA in the presence of palpable epididymal cysts, at seven of 35 (20%) vs 12 of 23 (52%) (P=0.012). Fertilization rates were significantly lower using cryopreserved spermatozoa retrieved from either the epididymis or testis (50% vs 70%, P=0.007), although subsequent implantation and pregnancy rates were not significantly different. Conclusions Surgical sperm retrieval is successful in all cases of azoospermia secondary to vasectomy, either by PESA or TESE. There are no clinical markers to indicate which patients will have successful PESA after vasectomy, although the presence of epididymal cysts is associated with significantly lower retrieval rates. The reduction in fertilising ability of cryopreserved spermatozoa does not affect clinical pregnancy rates in ICSI cycles.
机译：目的探讨前一次输精管切除术之间的间隔对经皮附睾精子抽吸术（PESA）或睾丸精子提取术（TESE）对附睾和睾丸精子取回率的影响以及这些配子在胞浆内注射精子的后续繁殖潜能（ ICSI）周期。患者和方法在先前输精管切除术后无精子症的患者中考虑了66例连续的精子取回，其中54例先前的逆转失败，其余的则决定逆转。记录了PESA和TESE的恢复率，以及自输精管结扎以来的时间以及输精管结扎与不成功逆转之间的间隔。注意到触诊的附睾囊肿的存在及其对精子回收率的影响。在随后的ICSI周期中，使用新鲜取回的精子或冷冻解冻的冷冻精子对受精率和妊娠率进行分析。结果66例患者均成功获得精子。与没有逆转的患者相比，以前的逆转失败对PESA的成功率没有显着影响，分别为54例中的14例（26％）和12例中的5例（P = 0.3）。自输精管结扎以来的时间间隔不影响PESA的检出率，但存在明显的附睾囊肿时，PESA的检出率明显较差，分别为35个中的7个（20％）对23个中的12个（52％）（P = 0.012）。从附睾或睾丸中取出冷冻保存的精子，受精率显着降低（50％vs 70％，P = 0.007），尽管随后的植入和妊娠率没有显着差异。结论在所有输精管切除术后无精症的患者中，无论是通过PESA还是TESE，手术精子均能成功恢复。尽管附睾囊肿的存在与明显降低的取血率相关，但没有临床指标可指示输精管结扎术后哪些患者可成功获得PESA。冷冻保存的精子的受精能力下降不会影响ICSI周期的临床妊娠率。

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