[논문]비폐쇄성 무정자증 환자에서 고환의 조직병리학적 진단에 따른 체외수정시술 결과의 비교

박찬우; 서주태; 박용석; 김혜옥; 양광문; 김진영; 궁미경; 강인수; 송인옥

비폐쇄성 무정자증 환자에서 고환의 조직병리학적 진단에 따른 체외수정시술 결과의 비교
Effect of Testicular Histopathology on Pregnancy Outcomes in Non-Obstructive Azoospermia 원문보기

대한생식의학회지= The Korean journal of reproductive medicine, v.35 no.4, 2008년, pp.293 - 301

박찬우 (관동의대 제일병원 산부인과) , 서주태 (관동의대 제일병원 비뇨기과) , 박용석 (제일병원생식내분비 및 불임연구실) , 김혜옥 (관동의대 제일병원 산부인과) , 양광문 (관동의대 제일병원 산부인과) , 김진영 (관동의대 제일병원 산부인과) , 궁미경 (관동의대 제일병원 산부인과) , 강인수 (관동의대 제일병원 산부인과) , 송인옥 (관동의대 제일병원 산부인과)

초록
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목 적: 비폐쇄성 무정자증 환자에서 고환의 조직병리학적 진단에 따라 고환조직내 정자채취술 (Testicular sperm extraction, TESE) 후 난자세포질내 정자주입술 (Intracytoplsmic sperm injection, ICSI)의 체외수정시술 결과를 알아보고자 하였다. 연구방법: 비폐쇄성 무정자증으로 고환조직내 정자채취술 후 난자세포질내 정자주입술을 이용하여 배아 이식을 시행한 122주기를 분석하였다. 고환의 조직병리학적 진단에 따라 Germ-cell aplasia (GA, 40주기), Maturation arrest (MA, 32주기) and severe hypospermatogenesis (S-HS, 50주기)로 구분하여 체외수정시술 결과를 비교하였으며, 이들 결과를 난자세포질내 정자주입술을 이용한 폐쇄성 무정자증 환자의 체외수정시술 결과와 비교하였다. 결 과: 고환조직내 정자채취술 후 난자세포질내 정자주입술시 수정율은 각각 58.1% in GA, 42.2% in MA and 48.0% in S-HS로 조직병리학적 진단에 따른 차이는 없었으며, 폐쇄성 무정자증 환자의 72.9%에 비해 유의하게 낮은 수정율을 보였다 (p<0.001). 고환조직내 정자채취술시 채취된 정자 (spermatozoa, 94주기)로 난자세포질내 정자주입술을 시행한 주기의 배아 이식 후 임신율은 각각 22.6% in GA, 29.4% in MA와 26.1% in S-HS이었으며, 출생률은 각각 16.1%, 29.4%와 19.6%로 조직병리학적 진단에 따른 차이는 없었다. 정자세포 (spermatid, 16주기)를 사용하여 난자세포질내 정자주입술을 시행한 주기의 임신율은 각각 0.0% (0/3 주기), 9.1% (1/11주기)와 0.0% (0/2주기)이었으며, 출생률은 각각 0.0%이었다. 정모세포 (spermatocyte, 12주기)를 사용한 주기의 임신율은 각각 0.0% (0/6주기), 0.0% (0/4주기)와 0.0% (0/2주기)이었으며, 출생률도 각각 0.0%이었다. 결 론: 비폐쇄성 무정자증환자의 배아이식을 시행한 주기에서 고환의 조직병리학적 진단에 따른 난자세포질내 정자주입술시 수정율은 차이가 없었으며, 폐쇄성 무정자증 환자에 비해 유의하게 낮은 수정율을 보였다. 비폐쇄성 무정자증환자에서 고환조직내 정자채취술시 정자를 채취하여 난자세포질내 정자주입술을 시행한 주기의 체외수정시술 결과는 고환의 조직병리학적 진단에 따라 차이를 보이지 않는다.

Abstract ▼ AI-Helper

Objective: To evaluate outcomes of patients with non-obstructive azoospermia (NOA) undergoing the testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI) with different histopathologic subgroups. Method: A total of 122 embryo-transferred TESE/ICSI cycles were compared among NOA subgroups; Germ-cell aplasia (GA, 40 cycles), Maturation arrest (MA, 32 cycles) and severe hypospermatogenesis (S-HS, 50 cycles). Obstructive azoospermia (OA, 667 cycles) patients were served as a control. TESE/ICSI outcomes such as fertilization rate (FR), clinical pregnancy rate (CPR) and live birth rate (LBR) were evaluated. Results: The 2PN FR of embryo-transferred TESE/ICSI cycle was 58.1% in GA, 42.2% in MA and 48.0% in S-HS, which was significantly lower than that of OA (72.9 %, p<0.001). For ICSI-spermatozoa cycles, there were no significant differences in CPR (22.6%, 29.4% and 26.1%) and LBR (16.1%, 29.4% and 19.6%) among NOA subgroups. The CPR of ICSI-spermatid cycles was 0.0%, 9.1% and 0.0% without a live birth. For ICSI-spermatocyte cycles, no clinical pregnancies occurred in any group. Conclusion: There was no significant difference in the FR of embryo-transferred TESE/ICSI cycles among NOA subgroups. The FR among all NOA subgroups was significantly lower than that of OA. Testicular histopathology in NOA did not affect successful pregnancy if spermatozoa extraction from the testis is successful and embryo transfer is possible.

주제어

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문제 정의

The aim of this study was to evaluate TESE/ICSI outcomes of embryo-transferred cycles in NOA patients with different histopathologic subtypes and compare the results with those of a control group, OA patients.

제안 방법

Each patient was evaluated with a physical examination, semen analysis and hormonal profile, and testicular biopsy was performed in NOA patients. Each seminiferous tubule in the biopsy specimen was evaluated and classification was made based on the most advanced pattern of spermatogenesis: Hypospermatogenesis (HS), reduction in the degree of normal spermatogenesis and focal spermatogenesis with spermatid stage arrest.
Each patient was evaluated with a physical examination, semen analysis and hormonal profile, and testicular biopsy was performed in NOA patients. Each seminiferous tubule in the biopsy specimen was evaluated and classification was made based on the most advanced pattern of spermatogenesis: Hypospermatogenesis (HS), reduction in the degree of normal spermatogenesis and focal spermatogenesis with spermatid stage arrest. Maturation arrest (MA), spermatocyte stage arrest with absence of the later stages of germ cells in spermatogenesis and Germ-cell aplasia (GA), absence of germ cells in the seminiferous tubules.
First, the diagnostic testicular biopsy was performed. Therapeutic testicular biopsy for TESE was performed under general anesthesia at the time of ICSI or before ICSI.
Oocyte retrieval was performed via a transvaginal approach with sonographic guidance 36 hours after the administration of 10,000 IU of human chorionic gonadotropin (hCG) (Pregnyl®, Organon, Netherland).

이론/모형

A single spermatoza was inserted through the zona pellucida to the metaphase II oocyte using the ICSI procedure. The procedures have been described previously.

성능/효과

After mTESE/ICSI, 2PN FR in NOA subgroups were 58.1% in GA, 42.2% in MA and 48.0% in S-HS, which were significantly lower than the 72.9% FR of OA patients (p<0.001) (Table 1).
For ICSI with spermatozoa cycles in NOA, the FR of GA in NOA subgroup was higher than those of other subgroups, and a significant difference was found between GA and S-HS (64.0% vs. 497.%, p=0.02). However, there were no significant differences in CPR and LBR with regard to embryo transfer among NOA subgroups.
For ICSI with spermatozoa cycles, CPR and LBR per embryo transfer were higher in OA compared with NOA subgroups without significant differences and there were no difference among NOA subgroups. For ICSI with spermatocyte or spermatid, there were no live births in any subgroup.
In our study, NOA patients were divided into subgroups according to testicular histopathology. For each NOA subgroup receiving embryo-transferred mTESE/ ICIS cycles, the FR was significantly lower than that of OA and there were no significant differences among NOA subgroups. For ICSI with spermatozoa cycles, the FR of each NOA subgroup was lower than that of OA.
001). The CPR and LBR per embryo transfer of OA was 31.8% and 26.5%, respectively, which was higher than that of NOA subgroups without a significant difference (Table 2).
The FR of OA, 72.8% was higher than that of the NOA subgroups, and significant differences were found compared with MA (55.5%, p=0.005) and S-HS (49.7%, p<0.001).

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저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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