Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Comparison of ICSI Outcomes between Fresh and Cryopreserved-Thawed Testicular Spermatozoa

신선 고환조직 정자와 냉동보존-융해 고환조직 정자를 이용한 난자세포질내 정자주입술 결과의 비교 연구

  • Choi, Young-Sik (Department of Obstetrics and Gynecology, Yonsei University College of Medicine) ;
  • Choi, Young-Min (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Kim, Soo-Woong (Department of Urology, College of Medicine, Seoul National University) ;
  • Paick, Jae-Seung (Department of Urology, College of Medicine, Seoul National University) ;
  • Jee, Byung-Chul (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Ku, Seung-Yup (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Suh, Chang-Suk (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Kim, Seok-Hyun (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Kim, Jung-Gu (Department of Obstetrics and Gynecology, College of Medicine) ;
  • Moon, Shin-Yong (Department of Obstetrics and Gynecology, College of Medicine)
  • 최영식 (연세대학교 의과대학 산부인과학교실) ;
  • 최영민 (서울대학교 의과대학 산부인과학교실) ;
  • 김수웅 (서울대학교 의과대학 비뇨기과학교실) ;
  • 백재승 (서울대학교 의과대학 비뇨기과학교실) ;
  • 지병철 (서울대학교 의과대학 산부인과학교실) ;
  • 구승엽 (서울대학교 의과대학 산부인과학교실) ;
  • 서창석 (서울대학교 의과대학 산부인과학교실) ;
  • 김석현 (서울대학교 의과대학 산부인과학교실) ;
  • 김정구 (서울대학교 의과대학 산부인과학교실) ;
  • 문신용 (서울대학교 의과대학 산부인과학교실)
  • Published : 2008.06.30
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Abstract

Objective: To compare the outcomes of intracytoplasmic sperm injection (ICSI) with fresh and cryopreserved-thawed testicular spermatozoa in patients with azoospermia. Methods: One hundred and nine cycles (66 couples) where ICSI was planned with fresh or cryopreserved-thawed testicular spermatozoa were included in this study; Ninety two cycles (61 couples) with fresh testicular spermatozoa (fresh group) and seventeen cycles (13 couples) with cryopreserved-thawed testicular spermatozoa (cryopreserved-thawed group). We compared ICSI outcomes such as fertilization rate, implantation rate, pregnancy rate and miscarriage rate, which were statistically analyzed using Mann-Whitney U test or Fisher's exact test, where appropriate. Results: In 9 out of the 92 cycles where ICSI was planned with fresh testicular spermatozoa, testicular spermatozoa could not be retrieved. Fertilization rate tended to be higher in the fresh group than in the cryopreserved-thawed group ($58.0{\pm}27.8%$ vs. $45.9{\pm}25.0%$, p=0.076). The number of high quality embryos was significantly higher in the fresh group ($0.9{\pm}1.2$ vs. $0.2{\pm}0.5$, p=0.002). However, there were no significant differences in clinical pregnancy rate, implantation rate and miscarriage rate between the two groups. Conclusion: The results of this study suggest that although the use of cryopreserved-thawed testicular sperm for ICSI in patients with azoospermia may reduce fertilization capacity and embryo quality, it may not affect pregnancy rate, implantation rate and miscarriage rate. If testicular sperm can be obtained before ICSI procedure, the use of cryopreserved-thawed testicular sperm may also avoid unnecessary controlled ovarian hyperstimulation and cancellation of oocyte retrieval when spermatozoa cannot be retrieved as well as damage on testicular function by repeated TESE.

목 적: 무정자증 불임부부에서 신선 (fresh) 고환정자 (testicular spermatozoa)와 냉동보존-융해(cryopreserved-thawed) 고환정자를 사용한 난자세포질내 정자주입술 (intracytoplasmic sperm injection, ICSI)의 결과를 비교하고자 하였다. 연구방법: 신선 고환정자 및 냉동보존-융해 고환정자를 사용하여 ICSI 시술을 시행하기로 계획된 총 109주기 (66명)를 대상으로 하였고 신선 고환정자를 사용하기로 계획한 군 (신선 고환정자군, fresh group)에는 92주기 (61명)이 포함되었고 냉동보존-융해 고환정자를 사용하기로 계획한 군 (냉동보존-융해 고환정자군, cryopreserved-thawed group)에는 17주기 (13명)가 포함되었다. 양 군간에 수정률, 착상률, 임신률, 유산률 등 ICSI 시술의 결과들을 비교하였고 통계학적 분석은 Mann-Whitney U 검정 및 Fisher의 정확한 검정을 적절하게 사용하였다. 결 과: 신선 고환정자를 사용하여 ICSI 시술을 시행하기로 계획된 총 92주기 중 9주기에서 고환정자를 추출할 수 없어 시술 주기가 취소되었다. 냉동보존-융해 고환정자군과 비교하여 신선 고환정자군에서 수정률이 높은 경향을 보였고 ($58.0{\pm}27.8%$ vs. $45.9{\pm}25.0%$, p=0.076) 양질의 배아 수는 통계적으로 유의하게 높았다 ($0.9{\pm}1.2$ vs. $0.2{\pm}0.5$, p=0.002). 그러나 임상적 임신율, 착상률, 유산율은 양 군간에 통계적으로 유의한 차이가 없었다. 결 론: ICSI 시술을 위하여 냉동보존-융해 고환정자를 사용하는 경우 수정률 및 배아의 질이 감소하지만 임신율, 착상률, 유산율에는 영향을 미치지 않는 것으로 사료된다. 또한, ICSI 시술이전에 고환정자를 확보하고 냉동보존-융해 고환정자를 사용한다면 난자채취 당일 정자를 확보하지 못하여 주기를 취소하는 경우나 여성배우자의 불필요한 과배란유도를 줄일 수 있으며 반복적인 고환정자추출술로 인한 고환기능의 손상을 줄일 수 있는 유용한 방법으로 사료된다.

Keywords

References

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