Preview

Андрология и генитальная хирургия

Расширенный поиск

Лечение бесплодия у мужчин с необструктивной формой азооспермии методом микродиссекционной техники извлечения сперматозоидов из ткани яичка в программе экстракорпорального оплодотворения с применением техники интрацитоплазматической инъекции единичного...

https://doi.org/10.17650/2070-9781-2014-2-6-22

Полный текст:

Аннотация

Рассматриваются современные методы лечения бесплодия у мужчин с необструктивной азооспермией (НОА). Анализируются прогностические факторы успешного получения сперматозоидов с помощью инвазивных манипуляций на яичках. Особое внимание уделяется результатам исследования состояния AZF-региона Y-хромосомы. Приведена современная классификация биоптатов яичка, описывающая различные формы нарушения сперматогенеза. Рассматриваются вопросы гормональной подготовки пациентов с НОА до оперативного вмешательства препаратами гонадотропин-рилизинг-гормона, хорионическим и менопаузальными гонадотропинами. Эффективность извлечения сперматозоидов возрастает после использования стимуляции сперматогенеза в течение 6 мес и более. Идентификация дополнительных гормональных факторов, таких как фолликулостимулирующий гормон (ФСГ), антимюллеров гормон, ингибин В, в сыворотке крови и семенной плазме позволяет более точно прогнозировать исход микрохирургического извлечения сперматозоидов (микроТЕСЕ). Высокий уровень ФСГ не является противопоказанием для микроТЕСЕ у мужчин с НОА. Ни уровень ФСГ, ни объем яичек не связаны с результативностью операции. Молекулярно-генетические маркеры остаточного сперматогенеза – гены ESX1, VASA, CLU – могут служить предикторами успешного извлечения сперматозоидов при микроТЕСЕ у пациентов с НОА. Рассмотрены преимущества микрохирургической техники выполнения операции и ее результативность в зависимости от патоморфологической картины, осложнения после операции.

Об авторе

Ирина Ивановна Витязева
ФГБУ «Эндокринологический научный центр» Минздрава России
Россия
Москва


Список литературы

1. Willott G.M. Frequency of azoospermia. Forensic Sci Int 1982;20(1):9–10.

2. Jarow J.P., Espeland M.A., Lipshultz L.I. Evaluation of the azoospermic patients. J Urol 1989;142(1):62–5.

3. Черных В.Б. Ген муковисцидоза и нарушение фертильности у мужчин. Андрол и генит хир 2010; (4):23–31.

4. Matsumiya K., Namiki M., Takahara S. et al. Clinical study of azoospermia. Int J Androl 1994;17(3):140–2.

5. Raman J.D., Schlegel P. Testicular sperm extraction with intracytoplasmic sperm injection is successful for the treatment of nonobstructive azoospermia associated with cryptorchidism. J Urol 2003;170(4 Pt 1):1287–90.

6. Silber S.J., Rodriguez-Rigau L.J. Quantitative analysis of testicle biopsy: determination of partial obstruction and prediction of sperm count after surgery for obstruction. Fertil Steril 1981;36(4):480–5.

7. Silber S., Nagy Z., Devroey P. et al. Distribution of spermatogenesis in the testicles of azoospermic men: the presence or abscence of spermatids in the testes of men with germinal failure. Hum Reprod 1997;12(11):2422–8.

8. Palermo G.D., Joris K., Devroey P., Van Steirteghem A.C. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 1992;340(8810):17–8.

9. Van Steirteghem A.C., Nagy Z., Joris H. et al. Higher fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod 1993;8(7):1061–6.

10. Temple-Smith P.D., Southwick G.J., Yates C.A. et al. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert Embryo Transf 1985;2(3):119–22.

11. Craft I., Benett V., Nicholson N. Fertilising ability of testicular spermatozoa (Letter). Lancet 1993;342(8875):864.

12. Schoysman R., Vanderzwalmen P., Nijs M. et al. Pregnancy after fertilisation with human testicular spermatozoa. Lancet 1993;342(8881):1237.

13. Devroey P., Liu J., Nagy Z. et al. Normal fertilization of human oocytes alter testicular sperm extraction and intracytoplasmic sperm injection. Fertil Steril 1994;62(3):639–41.

14. Devroey P., Liu J., Nagy Z. et al. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in nonobstructive azoospermia. Hum Reprod 1995;10(6):1457–60.

15. Tournaye H., Camus M., Goosens A. et al. Recent concepts in the management of infertility because of non-obstructive azoospermia. Hum Reprod 1995;10(Suppl 1):115–9.

16. Meniru G.I., Gorgy A., Podsiadly B.T., Craft I.L. Results of percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in two major groups of patients with obstructive azoospermia. Hum Reprod 1997;12(11):2443–6.

17. Friedler S., Raziel A., Strassburger D. et al. Testicular sperm retrieval by percutaneous fine needle sperm aspiration compared with testicular sperm extraction by open biopsy in men with non-obstructive azoospermia. Hum Reprod 1997;12(7):1488–93.

18. Rosenlund B., Kvist U., Plöen L. et al. A comparison between open and percutaneous needle biopsies in men with azoospermia. Hum Reprod 1998;13(5):1266–71.

19. Schlegel P.N. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 1999;14(1):131–5.

20. Silber S.J. Microsurgical TESE and the distribution of spermatogenesis in nonobstructive azoospermia. Hum Reprod 2000;15(11):2278–84.

21. Schlegel P.N., Su L.M. Physiological consequences of testicular sperm extraction. Hum Reprod 1997;12(8):1688–92.

22. Tournaye H., Camus M., Vandervorst M. et al. Surgical sperm retrieval for intracytoplasmic sperm injection. Int J Androl 1997;20(Suppl 3):69–73.

23. Gil-Salom M., Romero J., Minguez Y. et al. Testicular sperm extraction and intracytoplasmic sperm injection: A chance of fertility in nonobstructive azoospermia. J Urol 1998;160(6 Pt 1):2063–7.

24. Tash J.A., Schlegel P.N. Histologic effects of testicular sperm extraction on the testicle in men with nonobstructive azoospermia. Urology 2001;57(2):334–7.

25. Ezeh U.I., Moore H.D.M., Cooke I.D. A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in en with non-obstructive azoospermia. Hum Reprod 1998;13(11):3075–80.

26. Van Peperstraten A., Proctor M.L., Johnson N.P., Philipson G. Techniques for surgical retrieval of sperm prior to ICSI for azoospermia. Cochrane Database Syst Rev 2006;(3):CD002807.

27. Foresta C., Garolla A., Betella A. et al. Doppler ultrasound of the testis in azoospermic subjects as a parameter of testicular function. Hum Reprod 1998;13(11):3090–3.

28. Har-Toov J., Eytan O., Hauser R. et al. A new power Doppler ultrasound guiding technique for improved testicular sperm extraction. Fertil Steril 2004;81(2):430–4.

29. Jezek D., Knuth U.A., Schulze W. Successful testicular sperm extraction (TESE) in spite of high serum follicle stimulating hormone and azoospermia: correlation between testicular morphology, TESE results, semen analysis and serum hormone values in 103 infertile men. Hum Reprod 1998;13(5):1230–4.

30. Levin H.S. Testicular biopsy in the study of male infertility : its current usefulness, histologic techniques, and prospects for the future. Hum Pathol 1979;10(5):569–84.

31. Tournaye H., Verheyen G., Nagy P. et al. Are there any predictive factors for successful testicular sperm recovery in azoospermic patients? Hum Reprod 1997;12(1):80–6.

32. Krausz C., Quinatana-Murci L., McElreavey K. Prognostic value of Y deletion analysis: What is the clinical prognostic value of Y chromosome microdeletion analysis? Hum Reprod 2000;15(7):1431–4.

33. Tiepolo L., Zuffardi O. Localization of factors controlling spermatogenesis in the nonfluorescent portion of the human Y chromosome long arm. Hum Genet 1976;34(2):119–24.

34. Vogt P.H., Edelmann A., Kirsch S. et al. Human Y chromosome azoospermia factors (AZF) mapped to different subregions in Yq11. Hum Mol Genet 1996;5(7):933–43.

35. Черных В.Б. Микроделеционный анализ AZF-локуса в рамках комплексного клинико-генетического обследования мужчин с азооспермией и олигоспермией. Автореф. дис. … канд. vед. наук. М., 2002.

36. Fu L., Ding X., Shen M. et al. [Screening and clinical phenotype analysis of microdeletions of azoospermia factor region on Y chromosome in 1011 infertile men]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2012;29(2):184–7.

37. Brandell R.A., Mielnik A., Liotta D. et al. AZFb deletions predict the absence of spermatozoa with testicular sperm extraction: preliminary report of a prognostic genetic test. Hum Reprod 1998;13(10):2812–5.

38. Foresta C., Moro E., Ferlin A. Prognostic value of Y deletion analysis. The role of current methods. Hum Reprod 2001;16(8):1543–7.

39. Sadeghi-Nejad H., Farrokhi F. Genetics of azoospermia: current knowledge, clinical implications, and future directions. Part II: Y chromosome microdeletions. J Urol 2007;4(4):192–206.

40. Schoor R.A., Elhanbly S., Niederberger C.S., Ross L.S. The role of testicular biopsy in the modern management of male infertility. J Urol 2002;167(1):197–200.

41. McLachlan R.I., Rajpert-De Meyts E., Hoei-Hansen C.E. et al. Histological evaluation of the human testis – approaches to optimizing the clinical value of the assessment: mini review. Hum Reprod 2007;22(1):2–16.

42. Андрология. Мужское здоровье и дисфункция репродуктивной системы. Под ред. Э. Нишлага, Г.М. Бере. М.: ООО «Медицинское информационное агентство», 2005. С. 185–7.

43. Efficacy and safety of highly purified urinary follicle-stimulating hormone with human chorionic gonadotropin for treating men with isolated hypogonadotropic hypogonadism. European Metrodin HP Study Group. Fertil Steril 1998;70(2):256–62.

44. Büchter D., Behre H.M., Kliesch S., Nieschlag E. Pulsatile GnRH or human chorionic gonadotropin / human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases. Eur J Endocrinol 1998;139(3):298–303.

45. Fahmy I., Kamal A., Shamloul R. et al. ICSI using testicular sperm in male hypogonadotrophic hypogonadism unresponsive to gonadotrophin therapy. Hum Reprod 2004;19(7):1558–61.

46. Akarsu C., Caglar G., Vicdan K. et al. Pregnancies achieved by testicular sperm recovery in male hypogonadotrophic hypogonadism with persistent azoospermia. Reprod Biomed Online 2009;18(4):455–9.

47. Tsujimura A. Microdissection testicular sperm extraction: prediction, outcome, and complications. Int J Urol 2007;14(10):883–9.

48. Hibi H., Ohori T., Yamada Y. et al. Probability of sperm recovery in nonobstructive azoospermic patients presenting with testes volume less than 10 ml/FSH level exceeding 20 mIU/ml. Arch Androl 2005;51(3):225–31.

49. Ramasamy R., Lin K., Gosden L.V. et al. High serum FSH levels in men with nonobstructive azoospermia does not affect success of microdissection testicular sperm extraction. Fertil Steril 2009;92(2):590–3.

50. Muttukrishna S., Yussoff H., Naidu M. et al. Serum anti-Müllerian hormone and inhibin B in disorders of spermatogenesis. Fertil Steril 2007;88(2):516–8.

51. Mostafa T., Amer M.K., Abdel-Malak G. et al. Seminal plasma anti-Müllerian hormone level correlates with semen parameters but does not predict success of testicular sperm extraction (TESE). Asian J Androl 2007;9(2):265–70.

52. Ballescá J.L., Balasch J., Calafell J.M. et al. Serum inhibin B determination is predictive of successful testicular sperm extraction in men with non-obstructive azoospermia. Hum Reprod 2000;15(8): 1734–8.

53. Von Eckardstein S., Simoni M., Bergmann M. et al. Serum inhibin B in combination with serum follicle-stimulating hormone (FSH) is a more sensitive marker than serum FSH alone for impaired spermatogenesis in men, but cannot predict the presence of sperm in testicular tissue samples. J Clin Endocrinol Metab 1999;84(7):2496–501.

54. Tunc L., Kirac M., Gurocak S. et al. Can serum Inhibin B and FSH levels, testicular histology and volume predict the outcome of testicular sperm extraction in patients with non-obstructive azoospermia? Int Urol Nephrol 2006;38(3–4):629–35.

55. Nagata Y., Fujita K., Banzai J. et al. Seminal plasma inhibin-B level is a useful predictor of the success of conventional testicular sperm extraction in patients with non-obstructive azoospermia. J Obstet Gynaecol Res 2005;31(5):384–8.

56. Duvilla E., Lejeune H., Trombert-Paviot B. et al. Significance of inhibin B and anti-Müllerian hormone in seminal plasma: a preliminary study. Fertil Steril 2008;89(2):444–8.

57. Tsujimura A., Matsumiya K., Miyagawa Y. et al. Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia. J Urol 2004;172(5 Pt 1):1944–7.

58. Rodrigo L., Rubio C., Mateu E. et al. Analysis of chromosomal abnormalities in testicular and epididymal spermatozoa from azoospermic ICSI patients by fluorescence insitu hybridization. Hum Reprod 2004;19(1):118–23.

59. Bonaparte E., Moretti M., Colpi G.M. et al. ESX1 gene expression as a robust marker of residual spermatogenesis in azoospermic men. Hum Reprod 2010;25(6):1398–403.

60. Ando M., Yamaguchi K., Chiba K. et al. Expression of VASA mRNA in testis as a significant predictor of sperm recovery by microdissection testicular sperm extraction in patient with nonobstructive azoospermia. J Androl 2012;33(4):711–6.

61. Castrillon D.H., Quade B.J., Wang T.Y. et al. The human VASA gene is specifically expressed in the germ cell lineage. Proc Natl Acad Sci USA 2000;97(17):9585–90.

62. Nayernia K., Adham I.M., Burkhardt-Göttges E. et al. Asthenozoospermia in mice with targeted deletion of the sperm mitochondrion-associated cysteine-rich protein (Smcp) gene. Mol Cell Biol 2002;22(9):3046–52.

63. Zalata A., El-Samanoudy A.Z., Shaalan D. et al. Seminal clusterin gene expression associated with seminal variables in fertile and infertile men. J Urol 2012;188(4):1260–4.

64. Schlegel P.N., Tanrikut A., Li P.S. Microdissection testicular sperm extraction (TESE) in non-obstructive azoospermia. Fertil Steril 2006;86:S519.

65. Okada H., Dobashi M., Yamazaki T. et al. Conventional versus microdissection testicular sperm extraction for non obstructive azoospermia. J Urol 2002;168:1063–7.

66. Amer M., Ateyah A., Hany R., Zohdy W. Prospective comparative study between microsurgical and conventional sperm extraction in non-obstructive azoospermia: follow-up by serial ultrasound examinations. Hum Reprod 2000;15(3):653–6.

67. Ramasamy R., Yagan N., Schlegel P.N. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65(6):1190–4.

68. Mulhall J.P., Ghaly S.W., Aviv N., Ahmed A. The utility of optical loupe magnification for testis sperm extraction in men with nonobstructive azoospermia. J Androl 2005;26(2):178–81.

69. Tsujimura A., Matsumiya K., Miyagawa Y. et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod 2002;17(11):2924–29.

70. Okubo K., Ogura K., Ichioka K. et al. Testicular sperm extraction for non-obstructive azoospermia: results with conventional and microsurgical techniques. Hinyokika Kiyo 2002;48(5):275–80.

71. Donoso P., Tournaye H., Devroey P. Which is the best sperm retrieval technique for nonobstructive azoospermia? A systematic review. Hum Reprod Update 2007;13(6):539–49.

72. Tsujimura A., Miyagawa Y., Takao T. et al. Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol 2006;175(4):1446–9.

73. Ramasamy R., Schlegel P.N. Microdissection testicular sperm extraction: effect of prior biopsy on success of sperm retrieval. J Urol 2007;177(4):1447–9.

74. Ostad M., Liotta D., Ye Z., Schlegel P.N. Testicular sperm extraction for nonobstructive azoospermia: results of a multibiopsy approach with optimized tissue dispersion. Urology 1998;52(4):692–6.

75. Schlegel P.N., Palermo G.D., Goldstein M. et al. Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology 1997;49(3):435–40.

76. Ramasamy R., Fisher E.S., Ricci J.A. et al. Duration of microdissection testicular sperm extraction procedures: relationship to sperm retrieval success. J Urol 2011;185(4):1394–7.

77. Ghalayini I.F., Al-Ghazo M.A., Hani O.B. et al. Clinical comparison of conventional testicular sperm extraction and microdissection techniques for non-obstructive azoospermia. J Clin Med Res 2011;3(3):124–31.

78. Nicopoullos J.D., Gilling-Smith C., Almeida P.A., Ramsay J.W. The results of 154 ICSI cycles using surgically retrieved sperm from azoospermic men. Hum Reprod 2004;19(3):579–85.

79. Mercan R., Urman B., Alatas C. et al. Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia: percutaneous aspiration versus open biopsy. Hum Reprod 2000;15(7):1548–51.

80. Khadra A., Abdulhadi I., Ghunain S., Kilani Z. Efficiency of percutaneous sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia. J Urol 2003;169(2):603–5.

81. Karacan M., Alwaeely F., Erkan S. et al. Outcome of intracytoplasmic sperm injection cycles with fresh testicular spermatozoa obtained on the day of or the day before oocyte collection and with cryopreserved testicular sperm in patients with azoospermia. Fertil Steril 2013;100(4):975–80.

82. Esteves S.C., Agarwal A. Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review. Clinics (São Paulo) 2013;68(Suppl 1):141–50.

83. Gul U., Turunc T., Haydardedeoglu B. et al. Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience. Andrology 2013;1(1):47–51.

84. Harrington T.G., Schauer D., Gilbert B.R. Percutaneous testis biopsy: an alternative to open testicular biopsy in the evaluation of the subfertile man. J Urol 1996;156(5):1647–51.

85. Ron-El R., Strauss S., Friedler S. et al. Serial sonography and colour flow Doppler imaging following testicular and epididymal sperm extraction. Hum Reprod 1998;13(12):3390–3.

86. Schill T., Bals-Pratsch M., Küpker W. et al. Clinical and endocrine follow-up of patients after testicular sperm extraction. Fertil Steril 2003;79(2):281–6.

87. Andersson A.M., Jorgensen N., Frydelund Larsen L. et al. Impaired Leydig cell function in infertile men: A study of 357 idiopathic infertile men and 318 proven fertile controls. J Clin Endocrinol Metab 2004;89(7):3161–7.

88. Everaert K., De Croo I., Kerckhert W. et al. Long term effects of micro-surgical testicular sperm extraction on androgen status on patients with non obstructive azoospermia. BMC Urol 2006;6:9.

89. Oliveira Filho A.B., Souza R.S., Azeredo Oliveira M.T. et al. Microdissection testicular sperm extraction causes spermatogenic alterations in the contralateral testis. Genet Mol Res 2010;9(3):1405–13.


Для цитирования:


Витязева И.И. Лечение бесплодия у мужчин с необструктивной формой азооспермии методом микродиссекционной техники извлечения сперматозоидов из ткани яичка в программе экстракорпорального оплодотворения с применением техники интрацитоплазматической инъекции единичного... Андрология и генитальная хирургия. 2014;15(2):6-22. https://doi.org/10.17650/2070-9781-2014-2-6-22

For citation:


Vityazeva I.I. In vitro fertilization with intracytoplasmatic sperm injection in treatment of infertility in men with non-obstructive azoospermia: microdissection technique of sperm extraction from testicular tissue. Review of literature Andrology and Genital Surgery. 2014;15(2):6-22. (In Russ.) https://doi.org/10.17650/2070-9781-2014-2-6-22

Просмотров: 422


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 2070-9781 (Print)
ISSN 2412-8902 (Online)