青春期启动前后行睾丸下降固定术对同周期ICSI-microTESE临床结局的比较分析

Objective: To investigate the effect of treatment with orchiopexy at different ages on the clinical outcomes of nonobstructive azoospermia (NOA) patients with a history of cryptorchidism who underwent microdissection testicular sperm extraction (microTESE) combined with intracytoplasmic sperm injection (ICSI). Methods: NOA patients undergoing microTESE combined with ICSI from December 2013 to August 2019 in the ICSI treatment cycle in Assisted Reproduction Center of Northwest Women and Children's Hospital were collected in this retrospective cohort study. According to the history of cryptorchidism, the patients were divided into cryptorchidism group and non-cryptorchidism group. The sperm retrieval rates (SRRs) were assessed between these two groups. Then, based on the timing of treatment with orchiopexy, the NOA patients with orchidopexy were subdivided into prepubertal group and pubertal-postpubertal group. The SRRs and the pregnancy outcomes were also assessed. Results: There were 34 NOA patients with cryptorchidism and 604 NOA patients without cryptorchidism underwent microTESE. The SRRs in NOA patients with or without cryptorchidism were 85.3% (29/34) and 40.2% (243/604), respectively. The differences were statistically significant (P<0.001). In the prepubertal surgery group, sperm was detected in 17 cases, while in the pubertal-postpubertal surgery group, the sperm was detected in 12 cases. The differences were statistically significant (P=0.044). The total clinical pregnancy rate of cryptorchidism NOA patients treated with ICSI was 65.4% (17/26). Among these individuals, the clinical pregnancy rate of the prepubertal group was 62.5% (10/16) and the pubertal-postpubertal group was 70.0% (7/10). There were no statistical differences in clinical pregnancy rate. Some other clinical pregnancy outcomes, including miscarriage rate in early pregnancy, the rate of cycle with 2PN and the rate of cycle with top-quality embryo, also showed no differences between the two groups. In pathology analysis, all the cryptorchidism NOA patients with failure sperm retrieval were Sertoli cell only syndrome (SCOS). The pubertal-postpubertal group had a significant higher morbidity of SCOS [76.5% (13/17)] compared with the prepubertal group [35.3% (6/17)] (P=0.016). In addition, the volume of testis, the level of follicle-stimulating hormone and testosterone were not statistically associated with SRR. Conclusion: The SRR of NOA patients with cryptorchidism was higher than those without cryptorchidism. The age at orchidopexy operation may have little effect on the pregnancy outcome of ICSI. It may be more beneficial for microTESE to obtain sperm by undergoing orchiopexy as early as possible.