精巣内精子採取 : 精子保存の進歩と課題

Abstract

精巣内精子抽出術(TESE)のうち先天性精管欠損, ヘルニア術後, パイプカット術後など明らかな閉塞性無精子症を除いた44例を対象に非閉塞性無精子症で精子の回収を予測するパラメータを検討した.JSC, 精巣容量, FSHで相関がある結果であったがJSC8以上の症例を除外すると相関はなくなり, 絶対的パラメータとはなり得なかった.受精に関しては妻の年齢, 精子運動性の有無, 精巣容量が有意なパラメータとなった.マイクロドロップレット法を用いたCryo TESE-ICSIは新鮮精子を用いたTESE-ICSIと同等の受精率が得られ, 無用なパートナーへの侵襲を避けるのに有用と思われた

We reviewed 44 cases of non-obstructive azoospermia treated by testicular sperm extraction and intracytoplasmic sperm injection (ICSI) from July, 1997 to September 1999 at our institutes. Testicular sperm were retrieved from 32 patients (72.7%). ICSI was performed on 29 patients and the partners of 15 patients (46.9%) became pregnant. Out of 10 patients with histology of Sertoli-cell-only, we could retrieve sperm from 3 patients (30%). Testicular volume, Johnsen's score count (JSC), and FSH were significant parameters to predict the recovery of testicular sperm from the patients, but if only the patients with JSC less than 8, are analyzed, none of them was significant parameter. Chromosomal abnormality was not a significant parameter. The partner's age, motility of recovered sperm and testicular volume correlated with the fertilization rate. Chromosomal abnormality or the usage of cryopreserved sperm was not a significant parameter to predict fertilization.