多射精~~幾次??

多射精幾次MAP
Microtese avoidance program?

M. Roberts, L. Spencer, E.D. Grober, K.C. Lo, K. Jarvi
O-27 Monday, October 19, 2009 4:15 PM

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OBJECTIVE: For men with non-obstructive azoospermia (NOA) or crypto-spermia (CS - rare non-motile sperm), microdissection testicular sperm extraction (mTESE) can obtain sperm for in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). In patients with NOA, occasional sperm may be noted on one or more semen analyses (S/A) despite complete azoospermia on others. We investigated the rate of appearance of sperm on serial S/As in men with NOA or CS, and the suitability of these sperm for use with IVF/ICSI. This approach is termed the MicroTESE Avoidance Program (MAP).

DESIGN: Retrospective review.

MATERIALS AND METHODS: Patients with NOA or CS (inadequate for ICSI) produced at least 3 semen samples one month apart. The samples were assessed at 6 independant fertility clinics. Viable sperm were frozen for use with ICSI. Entry criteria were history and physical exam, FSH level, and at least 2 semen analyses (S/A) confirming NOA or CS.

RESULTS: 36 patients enrolled in MAP from 2006-2008, with mean FSH level of 18.6. 26 patients had azoospermia on all pre-MAP S/As (Group 1), and 10 patients had rare non-motile sperm on at least 1 pre-MAP S/A (Group 2). Mean number of S/As produced for MAP was 2.9 in Group 1 and 5.2 in Group 2. Motile sperm (adequate for ICSI) was identified on at least 1 MAP sample in 5/26 patients (19%) in Group 1, and 10/10 patients (100%) in Group 2. In Group 1 patients with sperm found at MAP, 55% of the semen samples contained viable sperm. In Group 2, 54% of the semen samples contained viable sperm.

CONCLUSIONS: 19% of patients with NOA had viable sperm on at least one S/A following multiple repeated samples. This shows that 2 S/As are insufficient to confirm a diagnosis of azoospermia in men with NOA. If rare non-motile sperm were ever present, 100% of the men had viable sperm identified on at least 1 S/A during MAP. MicroTESE may be avoided in a substantial proportion of men if multipe repeated S/As are performed. Further follow-up will determine ICSI outcomes for these patients.

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