閉塞性無精子症に対する精巣上体精子採取法

Abstract

精巣上体精子採取法の適応, 採取方法の選択, 補助生殖技術(ART)とのタイミング, 治療法の問題点について解説した.精巣上体精子採取法は閉塞性無精子症に対する治療法の1つであり, 近年の体外受精・胚移植や顕微授精等のニューテクノロジー, いわゆるARTとの医療連携により多数の産児が得られるようになってきた.しかし本来, 閉塞性無精子症の治療目標は再吻合による閉塞の解除である.閉塞性無精子症におけるマイクロサージェリーの成績向上, 各医の技術の上達が望まれる

Epididymal sperm aspiration technique combined with assisted reproductive technology (ART) including intracytoplasmic sperm injection (ICSI) has provided new frontiers for the treatment of unreconstructable obstructive azoospermia, including congenital bilateral absence of the vas deferens and failed surgical intervention. Epididymal sperm is obtained by several procedures, including microsurgical epididymal sperm aspiration (MESA), mini-MESA (Modified MESA), macroscopic epididymal sperm aspiration (MaESA) and percutaneous epididymal sperm aspiration (PESA). Since 1991 in our department, epididymal sperm aspiration combined with ART was performed by MESA (26 cases, 41 times) and PESA (3 cases, 4 times). Motile sperm retrieval using MESA and PESA was obtained in 34 out of 36 times (94.4%) and 2 out of 4 times (50%), respectively. MESA-ICSI resulted in a 47.3% 2PN (metaphase II) fertilization rate per eggs and a 28.8% pregnancy rate per transfer. With advancement of ICSI technique in which frozen sperm can be used, elective sperm retrieval can be planned at our convenience. PESA is a convenient, inexpensive and effective outpatient clinic procedure for retrieving sperm assisted with ICSI. In summary, infertile couples need to be given realistic options regarding treatment outcome. The fertility potential and age of the female partner need to be considered when addressing male treatment options.