男性脊髄損傷患者に対する不妊治療の成績

Abstract

男性脊髄損傷16例に不妊治療を行い, 10例で延べ14回の妊娠に至った.14回の内訳は, 配偶者間人工授精(AIH)による妊娠が1回, 体外受精(IVF)によるものが1回, 細胞質内精子注入(ICSI)が12回であり, 合計11児の出産に成功した.AIH, IVFの2例はいずれも初回で妊娠に成功した.ICSIでは妊娠までに1～15回(平均3.8回)を要し, 第1子出産までに2～6回(平均3.1回)のICSIが行われた.ICSI施行例について妊娠成功群と不成功群の比較検討を行ったところ, 成功群は患者の年齢, 配偶者の年齢とも低く, 受傷からの経過年数が少なく, 精液所見(精子濃度, 運動率)が良好な傾向にあったが有意差は認められなかった

It is difficult for male patients with spinal cord injury (SCI) to have children because of an ejaculation and dysfunction of spermatogenesis. However, owing to progress of assisted reproduction technology in recent years, it has become possible to have children even if the male has SCI, and the rate of success is improving gradually. During the 8 years from 1994 to 2002, infertility treatment was performed on 16 male patients with SCI consulting our hospital for acquistion of a child. We extracted their sperm by electroejaculation (EE) or testicular excision sperm extraction (TESE), and the sperm was artificially inseminated by the techniques such as artificial insemination with husband's semen (AIH), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Consequently, it was successful in 14 pregnancies on 10 couples, and resulted in 11 healthy live births on 7 couples. Four cases resulted in abortion. Two spouses are pregnant at present. There were no remarkable differences between the success group and the failure group in the quality of sperm such as concentration and motility. The mean age of the spouses who became pregnant was slightly lower than that of those who did not. Assisted reproduction techniques as EE and ICSI were useful techniques for patients with SCI wishing to have children.