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대한생식의학회지 제22권 제2호 2010년
폐색성 무정자증환자의 치료로써 미세적 부고환 정자흡입술(MESA) 및 정자직접주입법(ICSI)의 효과
차병원 비뇨기과;차병원 비뇨기과;차병원 여성의학연구소;차병원 여성의학연구소;차병원 산부인과;차병원 산부인과;차병원 산부인과;차병원 산부인과;차병원 산부인과;
김현주;김영찬;엄기붕;오종훈;이우식;한세열;최동희;윤태기;차광열;,
The Effect of Microsurgical Epididymal Sperm Aspiration (MESA) and Intracytoplasmic Sperm Injection (ICSI) as a Treatment for Obstructive Azoosperimia
Kim, H.J.;Kim, Y.C.;Oum, K.B.;Oh, J.H.;Lee, W.S.;Han, S.Y.;Choi, D.H.;Yoon, T.K.;Cha, K.Y.;
Department of Urology, CHA General Hospital;Department of Urology, CHA General Hospital;Infertility Medical Center, CHA General Hospital;Infertility Medical Center, CHA General Hospital;Department of Obstetrics and Gynecology, CHA General Hospital;Department of Obstetrics and Gynecology, CHA General Hospital;Department of Obstetrics and Gynecology, CHA General Hospital;Department of Obstetrics and Gynecology, CHA General Hospital;Department of Obstetrics and Gynecology, CHA General Hospital;
To present and assess the efficacy of combination of microsurgical epididymal sperm aspiration(MESA) and intracytoplasmic sperm injection(ICSI) for the treatment of infertility due to unreconstructable obstructive azoospermia or congenital bilateral agenesis of vas deferens (CBAVD), MESA was performed in the 45 husbands ( 16 CBAVD, 29 unreconstructable genital tract obstruction), followed by ICSI of oocytes recovered from the wives hyperstimulated by GnRH agonist in combination with hMG and FSH. Cleaving embryos were transfered to the uterine cavity or follopian tube(ZIFT) 18 or 24 hours after ICSI procedure. In 45 cycles of MESA, 492 oocyte complexes were recovered. ICSI was carried out on 355 metaphase II oocytes and 226 oocytes (63.7%) showed normal two pronucleus fertilization. After 198 embryos were transferred in 43 cycles, an average of 5 per cycle, 20 patients presented a positive HCG and intrauterine pregnancy was confirmed by US. So, the clinical ongoing pregnancy rate per transfer was 46.5%. Until now, 8 patients have given birth to 9 babies, 5 male and 4 female, including 1 twin. The babies were all healthy except 1 twin female baby. There was 1 miscarriage at 7 weeks and chromosomal study of abortus revealed as 45X, monosomy. These results suggested that it was possible to achieve high normal fertilization and pregnancy rate by ICSI using epididymal sperm.
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