Comparison of intracytoplasmic sperm injection outcome of oligoasthenoteratozoospermic and azoospermic men

Abstract

Background: With introduction of intracytoplasmic sperm injection with testicular sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was provided for azoospermic men. The aim of present study was to compare clinical outcome following intracytoplasmic sperm injection using extracted testicular/epididymal sperm or ejaculated severe oligoasthenoteratozoospermic sperm.
Methods: After retrospective evaluation of more than four hundred medical records of patients undergoing intracytoplasmic sperm injection Mehr medical institute (between 2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with azoospermia were included. Patients were treated with gonadotropin releasing hormone agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such as the rate of fertilization, implantation and clinical pregnancy were compared between the two groups. Results were presented as mean±standard deviation and number (percent). Differences between variables were analyzed using student's t test and the chi-square test was used to examine differences between categorical variables. P value less than 0.05 were considered as statistically significant.
Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs. 26.9±3.8), estradiol level on human chorionic gonadotropin administration day (1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs. 9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were ferti-lized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%, P=0.214). There were not statistical differences between groups in number of trans-ferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs. 16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199).
Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm aspiration and testicular sperm extraction are effective methods to treat azoospermic men and its clinical outcome were comparable to ejaculated sever oligoasthenoterato-zoospermic cycles. It can be concluded that the influence of sperm quality and origin on intracytoplasmic sperm injection outcome are the same.

Full text

ﺎﺘﻧﻳﺞرﺰﺗ ﻳﻖﺳ نورد ﻴﻤﺳﻼﭘﻮﺘﻲﻟا رد مﺮﭙﺳا ﻴزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕ وﻣﺮﭙﺳاوزآ ﻲ
229
http://tumj.tums.ac.ir
Tehran Univ Med J
(
TUMJ
)
2014
J
ul
y
;72
(
4
)
:229-34
ﺎﻘﻣﻳﻪﺴ يﺎﺘﻧ ﻳﺞرﺰﺗ ﻳﻖﺳ نورد ﻴﻤﺳﻼﭘﻮﺘﻲﻟا رد مﺮﭙﺳا ﻴﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕﻲﻣﺮﭙﺳاوزآ و ﻲ
اﺰﻓاﺮﻬﻣ ﻪﻴﺿﺮﻣ
1*
ﻲﻓﻮﺋر هدازآ ،
1
نﺎﻴﻤﻴﺣر ﻪﻌﻴﻠﻃ
1
نﺎﻴﻬﻟاﺪﺒﻋ ﻪﻧاوﺮﭘ ،
1
يرﻮﭙﻜﻴﻧ اﺮﻫز
1
ﻞﻛﻮﺗ ﻢﻴﺣر ، ﺎﻴﻧ
1
ﻞﮔ ﻞﻀﻔﻟاﻮﺑا يﺪﻤﺤﻣ
1
ﻲﻨﻴﺴﺣ ﺪﻤﺣا
1و2
1- ﻘﺤﺗ ﺰﻛﺮﻣﻴتﺎﻘرورﺎﺑﺎﻧ ي، ﻪﺴﺳﻮﻣ
وﺎﻨﻓري ﺎﻫيﻮﻧ ﻳﻦﻜﺷﺰﭘ ﻲا ،ﺖﺷر ،ﺮﻬﻣ ﻳناﺮ.
2- ﻘﺤﺗ ﺰﻛﺮﻣﻴتﺎﻘﺑ ﻴژﻮﻟﻮيﻟﻮﻠﺳ ﻲﻟﻮﻜﻟﻮﻣ و ﻲ،
ﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧادﻲﻬﺷ ﻴﺪﺘﺸﻬﺑ ﻲ، ،ناﺮﻬﺗ
اﻳناﺮ.
*
لﻮﺌﺴﻣ هﺪﻨﺴﻳﻮﻧ :ﺖﺷر،يرﺎﺼﻧا ﺪﻴﻬﺷ راﻮﻠﺑ ، نﺎﺑﺎﻴﺧ
دﺎﺷرا، روﺎﻨﻓ ﻪﺴﺳﻮﻣي ﺎﻫيﻮﻧ ﻳﻦﻜﺷﺰﭘ ﺮﻬﻣ ﻲ، ﺰﻛﺮﻣ
ﺎﺑﺎﻧ تﺎﻘﻴﻘﺤﺗيرور. ﻦﻔﻠﺗ :7764270-0131
E-mail: dr.mehrafza@yahoo.com
فﺪﻫ و ﻪﻨﻴﻣز :
ﻓﺮﻌﻣ ﺎﺑﻲرﺰﺗ ﻳﻖﺳ نورد ﻴ ﻤـﺳﻼﭘﻮﺘﻲ مﺮﭙـﺳا (Intracytoplasmic Sperm Injection, ICSI)شور و ﺎـﻫي
ﺑ زا مﺮﭙﺳا جاﺮﺨﺘﺳاﻴﻪﻀ
(Testicular Sperm Extraction, TESE) ﻳﺎﭘا ﻴﺪﻳﺪﻳﻢ (PESA)ﻔﻄﻋ ﻪﻄﻘﻧ ،ﻲ ﺒﻣ نﺎـﻣرد رد ﻼﺘ ـﻳنﺎ
وزآ ﻪﺑاﻣﺮﭙﺳﻲدﺮﮔ ﻞﺻﺎﺣ ﻳﺪ .ﺎﻘﻣ ،ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ زا فﺪﻫﻳﻪﺴ يﺎﺘﻧ ﻳﺞﻟﺎﺑ ﻴﻨﻲرﺰﺗ ﻳﻖﺳ نورد ﻴﻤﺳﻼﭘﻮﺘﻲ هﺪﺷ ﺐﺴﻛ مﺮﭙﺳا
ﻟاﺰﻧا ﻦﻤﺳ زاﻲ ﻼﺘﺒﻣ ﻳنﺎ ﻪﺑ ﻟا ﻴﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕﻲ ﺪﺷ ﻳﺪ
(OAT) مﺮﭙﺳا و ﺎﻫي ﺑ زا هﺪـﺷ جاﺮﺨﺘـﺳا ـﻴﻪﻀ ـﻳﺎ ﭘا ﻴﺪ ـﻳﺪﻳﻢ
ﻼﺘﺒﻣﻳنﺎﻣﺮﭙﺳاوزآ ﻪﺑ ﻲ ﻮﺑد.
ﻲﺳرﺮﺑ شور :
ا ﺲﭘ ﺳرﺮﺑ زﻲ ﻪﺘﺷﺬﮔ ﺑ ﺮﮕﻧﻴﺶ زا 400 ﻜﺷﺰﭘ هﺪﻧوﺮﭘ ﻲ ﻌﻤﺟ ﻪـﺑ طﻮـﺑﺮﻣ ـﻴﺖ ﺑ ﻴ نارﺎـﻤ ﺖـﺤﺗ ICSI ،45
ﺳﻴﻞﻜ ﺖﻠﻋ ﺎﺑ
OAT ﺪﺷ ﻳﺪ و 34 ﺳ ﻴﻞﻜ ﻣﺮﭙﺳاوزآ ﺖﻠﻋ ﺎﺑ ﻲ، ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو .ﺑﻴنارﺎﻤ ﻧﻮﮔآ زا هدﺎﻔﺘﺳا ﺎﺑ ﻴﺖﺴ GnRH
ﺗ ﺖﺤﺗﻴرﺎﻤ ﺪﻨﺘﻓﺮﮔ راﺮﻗ . ﻟﺎﺑ تﺎﻔﺻﻴﻨﻲ ﻧ و ﻴﺰ ﻣ ﻴناﺰ ﻪﻧﻻ ،حﺎﻘﻟ ﺰﮔﻳﻨﻲ ﮕﻠﻣﺎﺣ و ﻲ ﻟﺎﺑ ﻴﻨﻲ ﺎﺘﻧ ناﻮﻨﻋ ﻪﺑ ﻳﺞ ﻠﺻا ﻲ
ICSI ﺑ رد ﻴﻦ
ﺎﻘﻣ درﻮﻣ هوﺮﮔ ودﻳﻪﺴﺖﻓﺮﮔ راﺮﻗ .ﺎﺘﻧﻳﺞﻣ ترﻮﺻ ﻪﺑ هﺪﺷ ﺐﺴﻛ ﻴﮕﻧﺎﻴﻦ
± فاﺮﺤﻧا ﻌﻣﻴرﺎ و داﺪﻌﺗ)ﺪﺻرد (اراﻳدﺮﮔ ﻪﻳﺪ.
ﻪﺘﻓﺎﻳ ﺎﻫ:
ﻣﻴﮕﻧﺎﻴﻦ ﻨﺳ ﻲ، BMI داﺮﺘﺳا ﺢﻄﺳ ،ﻳلﻮ رﺰﺗ زور رد ﻳﻖ hCG ﺳووا ﻞﻛ داﺪﻌﺗ ،ﻴﺖ ﺎﻫي زﺎﻓﺎﺘﻣ ﻪﻠﺣﺮﻣ و هﺪﺷ ﺐﺴﻛ
2 ﻣ و ﻴناﺰ حﺎﻘﻟ ﺑ رد ﻴﻦ ﺎﺑ هوﺮﮔ ود
OAT وزآ و اﻣﺮﭙﺳﻲ دﻮﺑ ﻪﺑﺎﺸﻣ . ﻨﻌﻣ توﺎﻔﺗﺎرادي ﻨﺟ داﺪﻌﺗ رد ﻴﻦ ﺎﻫي لﺎﻘﺘﻧا ﻳ ﻪـﺘﻓﺎ ﺎـﺑ
ﻛﻴﻔﻴﺖﻟﺎﻋ ﻲ) 09/0
P=(ﻣ ،ﻴناﺰﻪﻧﻻ ﺰﮔﻳﻨﻲ) 238/0P= (ﻠﻣﺎﺣ وﮕﻲﻟﺎﺑ ﻴﻨﻲ) 199/0P= (ﺑ ردﻴﻦ هوﺮﮔ ود ﻳﺖﻓﺎﺪﺸﻧ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ :
رﺰﺗﻳﻖ ﺳ نورد ﻴﻤﺳﻼﭘﻮﺘﻲ ﺮﻃ زا هﺪﺷ ﺐﺴﻛ مﺮﭙﺳا ﻳﻖ PESA و TESE شور ، ﺎﻫي ﻔﻣ ﻴﺪي ﻪـﺑ ﻚﻤﻛ ﺖﻬﺟ
ﻣﺮﭙﺳاوزآ ﻪﺑ ﻼﺘﺒﻣ رورﺎﺑﺎﻧ نادﺮﻣﻲ دﻮﺑ ﺎﺘﻧ و ﻳﺞ ﻗ ﻞﺑﺎﻗ ،ﻞﺻﺎﺣ ﻴسﺎ رﺰﺗ ﺎﺑ ﻳﻖ ﺳ نورد ﻴﻢﺳﻼﭘﻮﺘ ﻦﻤﺳ زا هﺪﺷ ﺐﺴﻛ مﺮﭙﺳا
ﻟاﺰﻧاﻲ ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ
OAT ﺪﺷ ﻳﺪ ﻣ ﻲ ﺪﺷﺎﺑ .اﺮﺑﺎﻨﺑﻳﻦ ﻣ ﺮﻈﻧ ﻪﺑ ﻲ ﺪﺳرﺎﺗ ﻪﻛ ﺛﻴﺮﻛ ﻴﻔﻴﺖ ﺎـﺘﻧ ﺮـﺑ نآ ﺐﺴـﻛ ﻊـﺒﻨﻣ و مﺮﭙـﺳا ﻳﺞ
زا ﻞﺻﺎﺣ
ICSIﺪﺷﺎﺑ ﻪﺑﺎﺸﻣ .
تﺎﻤﻠﻛ يﺪﻴﻠﻛ:
ﻣﺮﭙﺳاوزآﻲ،رﺰﺗ ﻳﻖﺳ نورد ،مﺮﭙﺳا ﻴﻤﺳﻼﭘﻮﺘﻲ،ﮕﻠﻣﺎﺣ ﻲ.
ﻲﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕﻴﻟا) يژﻮـﻟﻮﻓرﻮﻣ و ﻦﻴﻳﺎـﭘ كﺮﺤﺗ ،ﻢﻛ داﺪﻌﺗ
مﺮﭙﺳا ﻦﻴﻳﺎﭘ ﻲﻟاﺰﻧا ﻦﻤﺳ رد ﺎﻫ ( ﻲﻣﺮﭙﺳاوزآ و) ﻦﻤـﺳ رد مﺮﭙـﺳا ناﺪﻘﻓ
ﻲﻟاﺰﻧا( ﺮﻣ ﻞﻠﻋ ﻦﻳﺮﺗﺪﻳﺪﺷ زا ، ﻲﻣ بﻮﺴﺤﻣ يرورﺎﺑﺎﻧ ﻪﻧاد ددﺮﮔ.
1
ﺶﻴـﭘ
شور زا هدﺎﻔﺘـﺳا زا يﺎـﻫ يرورﺎـﺑ ﻚـﻤﻛ
(Assisted Reproductive
Technology, ART)
مﺮﭙﺳا زا هدﺎﻔﺘﺳا ، ﻨﻳﺰﮔ ﺎﻬﻨﺗ ﻲﻳاﺪﻫا يﺎﻫـﻪ ﺶﻴﭘ ي
ﻲـﻣ بﻮﺴﺤﻣ رورﺎﺑﺎﻧ ﻦﻴﺟوز زا ﻪﺘﺳد ﻦﻳا ﻪﺑ ﻚﻤﻛ ﺖﻬﺟ ور ﺪـﺷ . ﺎـﺑ
شور ﻲﻓﺮﻌﻣ نورد ﻖـﻳرﺰﺗ و ﻲـﺣاﺮﺟ ﻚـﻤﻛ ﻪـﺑ مﺮﭙﺳا جاﺮﺨﺘﺳا يﺎﻫ
مﺮﭙـﺳا ﻲﻤﺳﻼﭘﻮﺘﻴﺳ
(Intracytoplasmic Sperm Injection, ICSI) رد
ﻪﻫد ود لﻮﻃﺮﻴﺧا ﻞـﺻﺎﺣ نادﺮـﻣ يرورﺎـﺑﺎﻧ نﺎـﻣرد رد ﻲـﻔﻄﻋ ﻪﻄﻘﻧ ،
ﺪﻳدﺮﮔ.
2و3
شور مﺎـﺠﻧا ياﺮـﺑ مﺮﭙـﺳا ﺐﺴﻛ ﺖﻬﺟ ﻲﻔﻠﺘﺨﻣ يﺎﻫART
ﻲﻣ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ ﻲـﻣ ﺎﻬﻧآ ﻪﻠﻤﺟ زا ﻪﻛ دﺮﻴﮔ نﻮﻴـﺳاﺮﻴﭙﺳآ ﻪـﺑ ناﻮـﺗ
ﺖـﺳﻮﭘ هار زا ﻢﻳﺪـﻳﺪﻴﭘا نﻮﻴـﺳاﺮﻴﭙﺳآ ،مﺪﻳﺪﻴﭘا زا مﺮﭙﺳا ﻲﭘﻮﻜﺳوﺮﻜﻴﻣ
ﻪﻣﺪﻘﻣ
ﻞﻴﺻا ﻪﻟﺎﻘ
ﻣ
،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد ﻪﻠﺠ
ﻣ
ﺮﻴ
ﺗ
139
3
،هرو
د
72
،هرﺎﻤﺷ
4
ﻪﺤﻔﺻ ، يﺎ
ﻫ
22
9
ﺎﺗ 23
4
هﺪﻴﻜﭼ ﺖﻓﺎﻳرد :26/08/1392 شﺮﻳﺬﭘ :19/12/1393 ﻦﻳﻼﻧآ :15/03/1393

230
اﺰﻓاﺮﻬﻣ ﻪﻴﺿﺮﻣ نارﺎﻜﻤﻫ و
،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد ﻪﻠﺠﻣﺮﻴﺗ 1393 هرود ،72 ، هرﺎﻤﺷ4 ،229 ﺎﺗ 234
(Precutaneouse Epididymal Sperm Aspiration, PESA) جاﺮﺨﺘﺳا ،
ﻪﻀﻴﺑ زا مﺮﭙﺳا
(Testicular Sperm Extraction, TESE) نﻮﻴﺳاﺮﻴﭙﺳآ و
دﺮﻛ هرﺎﺷا ﻪﻀﻴﺑ زا مﺮﭙﺳا.
4
ﻲـﻣ راﺮـﻗ ﻪـﺟﻮﺗ درﻮـﻣ ﻪﭽﻧآ ﻲﻟو نآ دﺮـﻴﮔ
مﺮﭙـﺳا ﺐﺴـﻛ ﻊﺒﻨﻣ ﺎﻳآ ﻪﻛ ﺖﺳا) ﻪﻀـﻴﺑ ﺎـﻳ ﻲـﻟاﺰﻧا ﻦﻤـﺳ ( رد ﺖـﻴﻔﻴﻛ
مﺮﭙﺳا ﺎﻫ) ﺐﻴﺳآ ﺮﻈﻧ زا
DNA غﻮﻠﺑ ﺎﻳ ( ﺞﻳﺎﺘﻧ نآ لﺎﺒﻧد ﻪﺑ وICSI ﺮﺛﻮـﻣ
ﺮﻴﺧ ﺎﻳ ﺖﺳا . مﺮﭙـﺳا هدﺎﻔﺘﺳا ياﺮﺑ ﻲﻀﻗﺎﻨﺘﻣ ﺞﻳﺎﺘﻧ ،تﺎﻌﻟﺎﻄﻣ زا يرﺎﻴﺴﺑ
ﻮﺘﻴﺳ نورد ﻖﻳرﺰﺗ ﺖﻬﺟ ﻒﻠﺘﺨﻣ ﻊﺑﺎﻨﻣ زا ﻲـﻣ نﺎﺸـﻧ ﻲﻤﺳﻼﭘ ﺪـﻨﻫد رد
ﺮـﺑ مﺮﭙـﺳا ﺐﺴﻛ ﻊﺒﻨﻣ ﺮﻴﺛﺎﺗ مﺪﻋ زا ﻲﻛﺎﺣ تﺎﻌﻟﺎﻄﻣ زا ﻲﺧﺮﺑ ﻪﻛ ﻲﻟﺎﺣ
ﺞﻳﺎﺘﻧ ﻲﻤﺳﻼﭘﻮﺘﻴﺳ نورد ﻖﻳرﺰﺗ ﺖﺳا .
8-5
ﻦﻴﺑ طﺎﺒﺗرا ﻪﺑ تﺎﻌﻟﺎﻄﻣ ﺮﻳﺎﺳ
دراد هرﺎﺷا ود ﻦﻳا.
11-9
ﺖﻴﻔﻴﻛ و مﺮﭙﺳا ﺐﺴﻛ ﻊﺒﻨﻣ ﺮﺛا ﺎﺗ ﻢﻳﺪﺷ نآ ﺮﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد ﺎﻣ
مﺮﭙﺳا ﺎﻨﻣ نآ زا هﺪﺷ ﺐﺴﻛ يﺎﻫ ﻖـﻳرﺰﺗ ﺞﻳﺎـﺘﻧ ﻲـﺳرﺮﺑ ﻖـﻳﺮﻃ زا ار ﻊﺑ
نآ ﻲﻤﺳﻼﭘﻮﺘﻴﺳ نورد ﻪﻧﻻ ،حﺎﻘﻟ خﺮﻧ نآ لﺎﺒﻧد ﻪﺑ و ﻚﻤﺨﺗ ﻪﺑ ﺎﻫ ﻲﻨﻳﺰﮔ
ﻢﻴﻫد راﺮﻗ ﻲﺑﺎﻳزرا درﻮﻣ ﻲﻨﻴﻟﺎﺑ ﻲﮕﻠﻣﺎﺣ و.
ﺞﻳﺎـﺘﻧ ﻪﺴـﻳﺎﻘﻣ ،ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ زا فﺪﻫ ﻲﻨﻴﻟﺎـﺑ ﻖـﻳرﺰﺗ زا ﻞـﺻﺎﺣ
مﺮﭙﺳا ﻲﻤﺳﻼﭘﻮﺘﻴﺳ نورد هﺪﺷ ﺐﺴﻛ زا رد لاﺰﻧا ﻖﻳﺮﻃ ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ
OAT مﺮﭙﺳا ﺎﺑ ﺪﻳﺪﺷ يﺎﻫ ﻲﺟاﺮﺨﺘﺳا شور ﻖﻳﺮﻃ زاPESA ﺎﻳ TESE
ﻲﻣﺮﭙﺳاوزآ ﻪﺑ ﻼﺘﺒﻣ نادﺮﻣ رددﻮﺑ .
هداد زﺎـﻴﻧ درﻮﻣ يﺎﻫ ﻪﺘـﺷﺬﮔ ترﻮـﺻ ﻪـﺑ ، و ﺮـﮕﻧ ﺲـﭘ ﻲـﺳرﺮﺑ زا
هﺪﻧوﺮﭘ ﻲﻜﺷﺰﭘ يﺎﻫ زا ﺶﻴﺑ 400 ﻪﻌﺟاﺮﻣ جوز ﻪﺑ هﺪﻨﻨﻛ ﺰﻛﺮﻣ يرورﺎـﺑﺎﻧ
ﺮﻬﻣ ﺖـﺷر ﺮﻬﺷ ﻧﺎـﻣز هزﺎـﺑ رد ﻲ91-90 ﻊـﻤﺟ ﺪـﻳدﺮﮔ يروآ. زا ﺲـﭘ
،ﻦﻤﺳ ﺰﻴﻟﺎﻧآ و ﻲﻨﻴﻟﺎﺑ ﻪﻨﻳﺎﻌﻣ ﺎﺑ ﻲﻧادﺮﻣ ﻲﻳﺎﺳﺎﻨﺷ
OAT سﺎـﺳا ﺮﺑ ﺪﻳﺪﺷ
ﻲﻧﺎﻬﺟ ﺖﺷاﺪﻬﺑ نﺎﻣزﺎﺳ ﻂﺳﻮﺗ هﺪﺷ مﻼﻋا يﺎﻫرﺎﻴﻌﻣ) مﺮﭙﺳا داﺪﻌﺗ
> 1
نﻮﻴﻠﻴﻣ/ﻲﻠﻴﻣ ﺶﻴﭘ و ﻊﻳﺮﺳ كﺮﺤﺗ ،ﺮﺘﻴﻟ عﻮﻧ هﺪﻧور
A> 5 % يژﻮﻟﻮﻓرﻮﻣ و
مﺮﭙﺳا لﺎﻣﺮﻧ
> 4 (% ﺖـﻓﺮﮔ مﺎﺠﻧا.
12
وزآ ﻪـﺑ ﻼﺘـﺒﻣ نادﺮـﻣ ا ﺮـﺑ ،ﻲﻣﺮﭙـﺳ
ﻞـﻤﻋ ﺖﺤﺗ ،يداﺪﺴﻧا ﺮﻴﻏ ﺎﻳ يداﺪﺴﻧا عﻮﻧ ﺺﻴﺨﺸﺗ سﺎﺳا
PESA ﺎـﻳ
TESE ﺪﻨﺘﻓﺮﮔ راﺮﻗ مﺮﭙﺳا ﺐﺴﻛ ﺖﻬﺟ . زا ﺲـﭘ ﺎـﺑ ﻲـﻧادﺮﻣ ﻲﻳﺎـﺳﺎﻨﺷ
OAT ﻧآ ناﺮﺴـﻤﻫ ﻪﻛ ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو يداﺮﻓا ﺎﻬﻨﺗ ،ﻲﻣﺮﭙﺳاوزآ ﺎﻳ ـﻬ ﺎ
ﺖﺴﻴﻧﻮﮔآ شور ﺖﺤﺗ
GnRH و ﻪـﺘﻓﺮﮔ راﺮـﻗ ﻦﻴـﻨﺟ رد ﻞـﺻﺎﺣ يﺎـﻫ
ﺖﻓﺎﻳ لﺎﻘﺘﻧا هزﺎﺗ ترﻮﺻ ﻪﺑ و ﻞﻜﻴﺳ نﺎﻤﻫ . سﺎﺳا ﻦﻳا ﺮﺑ ﻪـﺑ نارﺎـﻤﻴﺑ ،
،ﺖﺴﺨﻧ هوﺮﮔ رد هﺪﺷ ﻢﻴﺴﻘﺗ هوﺮﮔ ود42 رﺎﻤﻴﺑ )45 ﻞﻜﻴﺳ ( ﺎـﺑ
OAT
ﺪﻳﺪﺷ و ،مود هوﺮﮔ 32 رﺎﻤﻴﺑ )34 ﻞﻜﻴﺳ ( وزآ ﺎﺑا ﻲﻳﺎﺳﺎﻨﺷ درﻮﻣ ﻲﻣﺮﭙﺳ
ﺐﻴﺗﺮﺗ ﻪﺑ ،داﺪﻌﺗ ﻦﻳا زا ﻪﻛ ﺪﻨﺘﻓﺮﮔ راﺮﻗ13 و 19 ﺖﺤﺗ رﺎﻤﻴﺑ
TESE و
PESA ﻞﻤﻌﻟارﻮﺘـﺳد سﺎﺳا ﺮﺑ نﺎـﻴﺑ ﻦﻴﺸـﻴﭘ ﻪـﻌﻟﺎﻄﻣ رد هﺪـﺷ
13
راﺮـﻗ
ﺪﻨﺘﻓﺮﮔ .
ﺎـﺑ هوﺮﮔ ود ﻦﻴﺑ رد ﻚﻳﺮﺤﺗ ﻪﺑ طﻮﺑﺮﻣ و ﻪﻳﺎﭘ تﺎﻔﺻ
OAT ﺪﻳﺪـﺷ
)مﺮﭙﺳا ﻲـﻟاﺰﻧا ﻦﻤـﺳ زا هﺪﺷ ﺐﺴﻛ يﺎﻫ ( وزآ وا ﻲﻣﺮﭙـﺳ) مﺮﭙـﺳا يﺎـﻫ
زا هﺪﺷ ﺐﺴﻛ
TESE ﺎﻳ PESA (ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ درﻮﻣ .
ﺖﺴﻴﻧﻮﮔآ زا هدﺎﻔﺘﺳا ﺎﺑ ناﺪﻤﺨﺗ هﺪﺷ لﺮﺘﻨﻛ ﻚﻳﺮﺤﺗ
GnRH مﺎﺠﻧا
ﺪﺷ . زور زا ناﺪﻤﺨﺗ ﻚﻳﺮﺤﺗ ﻂﺳﻮﺗ ﻲﻠﻌﻓ ﻞﻜﻴﺳ مﻮﺳ
FSH ﺐـﻴﻛﺮﺗﻮﻧ
(Gonal-f, Merck KGaA, Darmstadt, Germany) / ﻦﻴﭘوﺮﺗودﺎــﻨﮔ
نﺎﺴــﻧا ﻲﮕﺴــﺋﺎﻳ
Human Menopausal Gonadotropin (HMG)
) Menogon, Ferring GmbH, Kiel, Germany ( ﺢـﺷﺮﺗ رﺎﻬﻣ زا ﺲﭘ و
ﻦﻴﭘوﺮﺗودﺎــﻨﮔ ﺖﺴــﻴﻧﻮﮔآ ﻂــﺳﻮﺗ ﺰﻴﻓﻮــﭙﻴﻫ زا ﺎــﻫ
GnRH) ــﻴﺘﭙﭘﺎﻛدﻞ
mg 25/1 (Ferring GmbH, Kiel, Germany, زور رد 21 ﻞﻜﻴــﺳ
ﺪﻳدﺮﮔ ﺎﻘﻟا ،ﻲﻠﺒﻗ . هزاﺪـﻧا ﻖـﻳﺮﻃ زا ،تﺎﻜﻳﺮﺤﺗ ﻪﺑ ناﺪﻤﺨﺗ ﺦﺳﺎﭘ يﺮـﻴﮔ
ﺖﻓﺮﮔ راﺮﻗ ﻲﺑﺎﻳزرا درﻮﻣ ﺪﻧﻮﺳاﺮﺘﻟوا و ﻲﻣﺮﺳ لﻮﻳداﺮﺘﺳا ﺢﻄﺳ . زا ﺲﭘ
لﻮـﻜﻴﻟﻮﻓ ود ﻞﻗاﺪﺣ هﺪﻫﺎﺸﻣ20-18 ﻲـﻠﻴﻣ ناﺪـﻤﺨﺗ ﻚـﻳﺮﺤﺗ ،يﺮـﺘﻣ
و ﻒـــﻗﻮﺘﻣﺗودﺎـــﻨﮔ ﺮ نﺎﺴـــﻧا ﻲـــﺘﻔﺟ ﻦﻴﭘو
(Human Chorionic
Gonadotropin (hCG)
)Institut Biochimique SA (IBSA),
Switzerland ) 10000 ﺪﺣاو(( ﺪـﺷ ﺰﻳﻮـﺠﺗ . ﺖـﺷﺬﮔ زا ﺲـﭘ39-36
ﺰﻳﻮﺠﺗ زا ﺖﻋﺎﺳ
hCGلﻮﻜﻴﻟﻮﻓ ، ﻲﻣﻮـﻤﻋ ﻲـﺷﻮﻬﻴﺑ ﺖﺤﺗ ناﺪﻤﺨﺗ يﺎﻫ
ﺪﻳدﺮﮔ ﺐﺴﻛ لﺎﻨﻳژاو ﻲﻓاﺮﮔﻮﻧﻮﺳ زا هدﺎﻔﺘﺳا ﺎﺑ و .
ﺳ ندودز زا ﺲﭘلﻮﻠ ﺖﻴـﺳووا فاﺮﻃا سﻮﻟﻮﻣﻮﻛ يﺎﻫ مﺎـﺠﻧا و ﺎـﻫ
ﻞﺣاﺮﻣ
ICSI ﺮﺜﻛاﺪﺣ ،ﻪﺳ ﺪﺷ هداد لﺎﻘﺘﻧا رﺎﻤﻴﺑ ﺮﻫ ﻪﺑ ﻦﻴﻨﺟ . زا ﺖﻳﺎﻤﺣ
مﺎـﺠﻧا ﺖﺑﺎﺛ ﻞﻜﺗوﺮﭘ ﻚﻳ ﺎﺑ نوﺮﺘﺳژوﺮﭘ و لﻮﻳداﺮﺘﺳا ﻂﺳﻮﺗ لﺎﺌﺗﻮﻟ زﺎﻓ
ﺖﻓﺮﮔ . ﺢﻄﺳ
βhCG ،14 راﺮـﻗ ﻲﺑﺎـﻳزرا درﻮﻣ ﻦﻴﻨﺟ لﺎﻘﺘﻧا زا ﺲﭘ زور
ﺖﻓﺮﮔ . ﻣﺎﺣ ﺖﺴﺗ ندﻮﺑ ﺖﺒﺜﻣ ترﻮﺻ رد ﺲﭙـﺳ و ﺪﻌﺑ ﻪﺘﻔﻫ ﻚﻳ ،ﻲﮕﻠ
ﻪﺳ كﺎﺳ داﺪﻌﺗ ،نآ زا ﺲﭘ ﻪﺘﻔﻫ درﻮـﻣ ﻦﻴـﻨﺟ ﺖﻴﻌﺿو و ﻲﮕﻠﻣﺎﺣ يﺎﻫ
ﺖﻓﺮﮔ راﺮﻗ ﻲﺑﺎﻳزرا.
،ﻦــﺳ
BMIداﺪــﻌﺗ ، لﻮــﭙﻣآ يﺎــﻫ درﻮــﻣ هدﺎﻔﺘــﺳا ﺖــﻬﺟ ﻚــﻳﺮﺤﺗ
ﺢﻄـــﺳ ،ناﺪـــﻤﺨﺗ لﻮﻳداﺮﺘـــﺳا رد زور ﻖـــﻳرﺰﺗ
hCG ، داﺪـــﻌﺗ ﻞـــﻛ
ﺖﻴﺳووا يﺎﻫ ﺐﺴﻛ داﺪﻌﺗ ،هﺪﺷ ﺖﻴﺳووا يﺎﻫ ﻪﻠﺣﺮﻣ زﺎـﻓﺎﺘﻣ 2 اﺰـﻴﻣ ،ن
داﺪﻌﺗ ،حﺎﻘﻟ ﻦﻴﻨﺟ يﺎﻫ لﺎﻘﺘﻧا ﻪﺘﻓﺎﻳ ﺎﺑ ﺖﻴﻔﻴﻛ ناﺰﻴﻣ ،ﻲﻟﺎﻋ ﻪـﻧﻻ و ﻲـﻨﻳﺰﮔ
ﻲﮕﻠﻣﺎﺣ ﻪﺑ ﻼﺘﺒﻣ هوﺮﮔ ود رد ﻲﻨﻴﻟﺎﺑ
OAT وزآ و ﺪﻳﺪﺷ ا درﻮـﻣ ﻲﻣﺮﭙـﺳ
شورﻲﺳرﺮﺑ

ﺎﺘﻧﻳﺞرﺰﺗ ﻳﻖﺳ نورد ﻴﻤﺳﻼﭘﻮﺘﻲﻟا رد مﺮﭙﺳا ﻴزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕ وﻣﺮﭙﺳاوزآ ﻲ
231
http://tumj.tums.ac.ir
Tehran Univ Med J
(
TUMJ
)
2014
J
ul
y
;72
(
4
)
:229-34
ﺖﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ . ﻦﻴﮕﻧﺎـﻴﻣ ترﻮـﺻ ﻪﺑ هﺪﺷ ﺐﺴﻛ ﺞﻳﺎﺘﻧ± فاﺮـﺤﻧا
رﺎﻴﻌﻣ ﺪﺻرد و )داﺪﻌﺗ (اراﻳ ﺪﻳدﺮﮔ ﻪ . هدﺎﻔﺘـﺳا ﺎﺑ يرﺎﻣآ ﻞﻴﻠﺤﺗ و ﻪﻳﺰﺠﺗ
ﺮﻧ زام راﺰﻓا
SPSSو ﺖﺳاﺮﻳ 5/11 ﻂـﺳﻮﺗ و نﻮـﻣزآ يﺎـﻫStudent’ s t-
test
و
2
χ ﺖﻓﺮﮔ مﺎﺠﻧا . يرﺎﻣآ ﺮﻈﻧ زا05/0P< ﻨﻌﻣ ﺎ ﻪـﺘﻓﺮﮔ ﺮـﻈﻧ رد راد
ﺪﺷ .
مﺪﻋ ﻞﻴﻟد ﻪﺑﺗﻢﻴﺴﻘ
(Cleavage) ﻞﻜﻴـﺳ ﻪـﺳ و ﻚﻳ رد ﺐﻴﺗﺮﺗ ﻪﺑ ،
وزآ و ﺪﻳﺪــﺷ ﻲﻣﺮﭙــﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕﻴﻟا هوﺮــﮔ ود ردا لﺎــﻘﺘﻧا ،ﻲﻣﺮﭙــﺳ
ﺖﻓﺮﮕﻧ ترﻮﺻ ﻦﻴﻨﺟ . ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ)9/4
±29 ﻞـﺑﺎﻘﻣ رد 8/5±2/30( ،
BMI) 3/5±9/26 ﻞــﺑﺎﻘﻣ رد 8/3±9/26( زور رد لﻮﻳداﺮﺘــﺳا ﺢﻄــﺳ ،
ﻖﻳرﺰﺗ
hCG) 9/843±6/1375 ﻞﺑﺎﻘﻣ رد 1/673±8/1181( ﻞـﻛ داﺪﻌﺗ ،
ﺖﻴﺳووا هﺪـﺷ ﺐﺴـﻛ يﺎﻫ)3/5
±7/9 ﻞـﺑﺎﻘﻣ رد 9/5±2/9 ( ﻪـﻠﺣﺮﻣ و
زﺎــﻓﺎﺘﻣ2 )1/5
±7/7 ﻞــﺑﺎﻘﻣ رد 4/5±5/7 ( حﺎــﻘﻟ ناﺰــﻴﻣ و)2/53 % رد
ﻞﺑﺎﻘﻣ1/52 (%ﻴﺑ ردـﮔ ود ﻦـﺑ هوﺮـ ﺎ
OAT ﻳﺪﺷـوزآ و ﺪاﻪﺑﺎﺸﻣ ﻲﻣﺮﭙﺳ
دﻮﺑ. لﻮﭙﻣآ داﺪﻌﺗ ﻪـﺑ ناﺪﻤﺨﺗ هﺪﺷ لﺮﺘﻨﻛ ﻚﻳﺮﺤﺗ ﺖﻬﺟ زﺎﻴﻧ درﻮﻣ يﺎﻫ
ﻨﻌﻣ ترﻮﺻﺎ رد يراد وزآ ﻪـﺑ ﻼﺘﺒﻣ هوﺮﮔا ﺪـﺷ شراﺰـﮔ ﺮﺘﺸـﻴﺑ ﻲﻣﺮﭙـﺳ
)02/0
P= .( ﻨﻌﻣ توﺎﻔﺗﺎ رد يراد ﻦﻴﻨﺟ داﺪﻌﺗ ﻳ لﺎﻘﺘﻧا يﺎﻫ ﺖـﻴﻔﻴﻛ ﺎﺑ ﻪﺘﻓﺎ
ﻲﻟﺎــﻋ)09/0
P=(ﻪــﻧﻻ ناﺰــﻴﻣ ، ﻲــﻨﻳﺰﮔ)238/0P= ( ﻲﮕﻠﻣﺎــﺣ و ﻲﻨﻴﻟﺎــﺑ
)199/0
P=(ﺪﺸﻧ ﺖﻓﺎﻳ هوﺮﮔ ود ﻦﻴﺑ رد ) لوﺪﺟ1 .(
ﺞﻳﺎﺘﻧ ﺎﺣ ﻪﻌﻟﺎﻄﻣ زا ﻞﺻﺎﺣ توﺎـﻔﺗ ﻪـﻛ ﺖـﺳا ﻦـﻳا زا ﻲﻛﺎـﺣ ﺮـﺿ
ﺎﻨﻌﻣ ﺞﻳﺎﺘﻧ ﺮﻈﻧ زا يراد
ICSI ﻼﺘـﺒﻣ رورﺎـﺑﺎﻧ نادﺮـﻣ هوﺮـﮔ ود ﻦﻴﺑ ، ﻪـﺑ
ﺪﻳﺪﺷ ﻲﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕﻴﻟا و وزآاﻣﺮﭙﺳ ﺖﺤﺗ ﻲ
TESE ﺎـﻳ PESA
دراﺪﻧ دﻮﺟو.
مﺮﭙـﺳا ﺖـﻴﻔﻴﻛ تاﺮﺛا ﺮـﺑ زا ﺲـﭘ ﻦﻴـﻨﺟ ﻦﻳﻮـﻜﺗ
ICSI ﻲـﻧاﺮﮕﻧ ﻚـﻳ
ﻲﻣ بﻮﺴﺤﻣ دﻮﺷ.
7و14و15
ﻦﻳﻮـﻜﺗ و ﻦﻤـﺳ ﺖـﻴﻔﻴﻛ ﻦﻴـﺑ ﻲـﻔﻨﻣ طﺎـﺒﺗرا
ﺐـﻠﻄﻣ ﻦـﻳا هﺪﻨﻫد نﺎﺸﻧ ،ﻲﻨﻴﻨﺟ مﻮﻧژ نﺪﺷ لﺎﻌﻓ زا ﺶﻴﭘ ﻲﺘﺣ ،ﻦﻴﻨﺟ
ﭙﺳا ﺖﻴﻔﻴﻛ ﻪﻛ ﺖﺳاﻣ مﺮـﻲ ﻧاﻮﺗـﺣاﺮﻣ رد ﺪـﻴﺘﺴﺨﻧ ﻞـﺮﺛﻮﻣ ﺰﻧژﻮﻳﺮﺒﻣا ﻦ
لوﺪﺟ1:ﺎﻘﻣ ﻳﻪﺴﺎﭘ تﺎﻔﺻ ﻳﻪﺮﺤﺗ ﻪﺑ طﻮﺑﺮﻣ و ﻳﻚ ناﺪﻤﺨﺗ هﺪﺷ لﺮﺘﻨﻛ
تﺎﻔﺻ رد ﻲﻟاﺰﻧا ﻦﻤﺳ زا ﻞﺻﺎﺣ مﺮﭙﺳا
نﺎﻳﻼﺘﺒﻣ OAT ﺪﻳﺪﺷ
شور زا هﺪﺷ ﺐﺴﻛ مﺮﭙﺳاTESE ﺎﻳPESA
رد نﺎﻳﻼﺘﺒﻣوزآاﻲﻣﺮﭙﺳ
*
P
ﻞﻜﻴﺳ داﺪﻌﺗ ﺎﻫ
45 34
ﻞﻜﻴﺳ داﺪﻌﺗ ﻦﻴﻨﺟ لﺎﻘﺘﻧا يﺎﻫ
44 31
نز ﻦﺳ
)لﺎﺳ(
9/4
±29 8/5±2/30 339/0
BMI نز)
2
k/m(
3/5
±9/26 8/3±9/26 937/0
لﻮﭙﻣآ داﺪﻌﺗ ناﺪﻤﺨﺗ ﻚﻳﺮﺤﺗ ﺖﻬﺟ هدﺎﻔﺘﺳا درﻮﻣ يﺎﻫ
1/12±8/38 7/19±9/47 02/0
ﻖﻳرﺰﺗ زور رد لﻮﻳداﺮﺘﺳا ﺢﻄﺳ
hCG )pg/ml(
9/843
±6/1375 1/673±8/1181 292/0
ﻦﻴﮕﻧﺎﻴﻣﺖﻴﺳووا ﻞﻛ داﺪﻌﺗ هﺪﺷ ﺐﺴﻛ يﺎﻫ
3/5
±7/9 9/5±2/9 704/0
داﺪﻌﺗﺖﻴﺳووا زﺎﻓﺎﺘﻣ ﻪﻠﺣﺮﻣ يﺎﻫ2
1/5±7/7 4/5±5/7 894/0
حﺎﻘﻟ ناﺰﻴﻣ
)(%
)2/53(232 )1/52(163 214/0
ﻦﻴﻨﺟ داﺪﻌﺗ ﻲﻟﺎﻋ ﺖﻴﻔﻴﻛ ﺎﺑ ﻪﺘﻓﺎﻳ لﺎﻘﺘﻧا يﺎﻫ
2/1±5/1 2/1±1 09/0
ﻪﻧﻻ ناﺰﻴﻣ ﻲﻨﻳﺰﮔ
(%)
)7/22(27 )9/16(14 238/0
ﻲﮕﻠﻣﺎﺣ ناﺰﻴﻣ ﻲﻨﻴﻟﺎﺑ
(%)
)7/47(21 )4/35(11 199/0
نﻮﻣزآ ﺎﻫيﻞﻣﺎﺷ هدﺎﻔﺘﺳا درﻮﻣ يرﺎﻣآ Student’s t-test و
2
χ ﻲﻣ ﺪﺷﺎﺑ . يرﺎﻣآ ﺮﻈﻧ زا05/0P<ﻨﻌﻣ ﺎﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد راد .
ﺖﻴﺳووا ﻞﻛ داﺪﻌﺗ هوﺮﮔ رد هﺪﺷ ﺐﺴﻛ يﺎﻫ يﺎﻫﻟاﻴﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨﺘﺳآﻮﮕ و ﻲﻣﺮﭙﺳاوزآ ﺐﻴﺗﺮﺗ ﻪﺑ ﻲ436 و 313دﻮﺑ .ﻦﻴﻨﺟ ﻞﻛ داﺪﻌﺗ هوﺮﮔ رد هﺪﺷ هداد لﺎﻘﺘﻧا يﺎﻫ يﺎﻫﻟاﻴﺘﺳآﻮﮕﻣﺮﭙﺳوزﻮﺗاﺮﺗﻮﻨ و ﻲ
ﻣﺮﭙﺳاوزآ ﺐﻴﺗﺮﺗ ﻪﺑ ﻲ119 و 83دﻮﺑ .
ﺚﺤﺑ ﻪﺘﻓﺎﻳﺎﻫ

232
اﺰﻓاﺮﻬﻣ ﻪﻴﺿﺮﻣ نارﺎﻜﻤﻫ و
،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد ﻪﻠﺠﻣﺮﻴﺗ 1393 هرود ،72 ، هرﺎﻤﺷ4 ،229 ﺎﺗ 234
ﺪﺷﺎﺑ .ﻦﻳاﺮﺑﺎﻨﺑ و مﺮﭙـﺳا ﺐﺴـﻛ ﻊﺒﻨﻣ ﺮﺛا ﻲﺳرﺮﺑ ﺖﻬﺟ يﺪﻨﭼ تﺎﻌﻟﺎﻄﻣ
ﺖـﺳا ﻪـﺘﻓﺮﮔ ترﻮﺻ ﻲﮕﻠﻣﺎﺣ ﺞﻳﺎﺘﻧ ﺮﺑ نآ ﺖﻴﻔﻴﻛ ﺰﻴﻧ.
16و17
ﻪـﻌﻟﺎﻄﻣ رد
Aboulghar مﺮﭙﺳا حﺎﻘﻟ ﻲﻳﺎﻧاﻮﺗ ﻪﻛ ﺪﺷ هداد نﺎﺸﻧ زا هﺪـﺷ ﺐﺴـﻛ يﺎﻫ
ﻳا هدﻮﺑ ﻦﻳﺮﺗﻻﺎﺑ لﺎﻣﺮﻧ ﻦﻤﺳ ياﺮـﺑ ﻲﻳﺎـﻧاﻮﺗ ﻦـﻳا ﻪـﻛ ﺖﺳا ﻲﻟﺎﺣ رد ﻦ
مﺮﭙــﺳا يداﺪﺴــﻧا ﺮــﻴﻏ مﺮﭙــﺳاوزآ نادﺮــﻣ ﻪﻀــﻴﺑ زا هﺪــﺷ ﺐﺴــﻛ يﺎــﻫ
ﻦﻴﻳﺎﭘ ﻲﻣ ﻦﻳﺮﺗ ﺪﺷﺎﺑ . ناﺰﻴﻣ رد يرادﺎﻨﻌﻣ توﺎﻔﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ﻦﻴﻨﭽﻤﻫ
رد ﻲـﺣاﺮﺟ زا هﺪـﺷ ﺐﺴﻛ مﺮﭙﺳا و ﻲﻟاﺰﻧا مﺮﭙﺳا ﻦﻴﺑ ﻲﮕﻠﻣﺎﺣ و حﺎﻘﻟ
ﺪﺸﻧ ﺖﻓﺎﻳ يداﺪﺴﻧا ﻲﻣﺮﭙﺳاوزآ.
18
ﻪﻌﻟﺎﻄﻣ رد لﺎﺳ رد ﻪﻛ يا2005 ﻂـﺳﻮﺗ
Mehrafza ﺖـﻓﺮﮔ مﺎـﺠﻧا
رد ﻲﻨﻴﻟﺎـﺑ ﻲﮕﻠﻣﺎـﺣ و ﻲﻟﻮﻠﺳ تﺎﻤﻴﺴﻘﺗ ،حﺎﻘﻟ ناﺰﻴﻣ ﻪﻛ ﺪﺷ هداد نﺎﺸﻧ
ﺖـﺤﺗ مﺮﭙـﺳاوزآ نارﺎﻤﻴﺑ
ICSI شور زا هدﺎﻔﺘـﺳا ﺎـﺑ PESA و TESE
ﻲـﻣ رورﺎـﺑ هﻮﻘﻟﺎﺑ داﺮﻓا ﻦﻳا و هدﻮﺑ ﺮﮕﻳﺪﻜﻳ ﻪﺑﺎﺸﻣ ﺪﻨـﺷﺎﺑ.
13
ﻪـﻌﻟﺎﻄﻣ رد
ﻂﺳﻮﺗ يﺮﮕﻳد
Tsai مﺮﭙﺳا ﺐﺴﻛ ﻊﺒﻨﻣ ﻪﻛ ﺪﺷ هداد نﺎﺸﻧ ) ﻲﻧادﺮﻣ ﻦﻤﺳ
ﺎﺑ
OAT ﻪﻀـﻴﺑ زا ﺺﻴـﻠﺨﺗ ﺎـﻳ ﺪﻳﺪـﺷ ( ﻲﻨﻴﻟﺎـﺑ ﺞﻳﺎـﺘﻧ رد يﺮـﺛاICSI
دراﺪﻧ.
19
ﻦﻴﻨﭽﻤﻫ Naru شور ﻪـﻛ داد نﺎﺸﻧ يﺎـﻫTESE و PESA ﻪـﺑ
نورد ﻖﻳرﺰﺗ هاﺮﻤﻫ ﻪـﻨﻳﺰﮔ ،مﺮﭙـﺳا ﻲﻤﺳﻼﭘﻮﺘﻴﺳ ﺖـﻬﺟ ﻲﺒـﺳﺎﻨﻣ يﺎـﻫ
ﻲﻣ مﺮﭙﺳاوزآ نادﺮﻣ ﻪﺑ ﻚﻤﻛ ﺪﻨـﺷﺎﺑ . زا هﺪـﺷ ﺐﺴـﻛ ﺞﻳﺎـﺘﻧ
ICSI ﻦـﻳا
ﺪﺷ شراﺰﮔ ﻲﻟاﺰﻧا مﺮﭙﺳا ﺎﺑ ﻲﻧادﺮﻣ ﻪﺑﺎﺸﻣ ،داﺮﻓا.
20
ﻌﻟﺎﻄﻣ ردـشور زا ﺮﺿﺎﺣ ﻪ نورد ﻖﻳرﺰﺗ ﺖﻬﺟ مﺮﭙﺳا بﺎﺨﺘﻧا يﺎﻫ
ﺪﺸﻧ هدﺎﻔﺘﺳا ﻲﻤﺳﻼﭘﻮﺘﻴﺳ . ﺞﻳﺎـﺘﻧ ﺮـﺑ ﻦﻤﺳ ﺖﻴﻔﻴﻛ ﺮﻴﺛﺎﺗ ﻲﺳرﺮﺑ ﺖﻬﺟ
ICSI ﻪﻧﻮﻤﻧ ، يﺎﻫOAT ﻲﻟﺎـﺣ رد ﻦـﻳا ﺖـﻓﺮﮔ راﺮﻗ ﺰﻴﻟﺎﻧآ درﻮﻣ ﺪﻳﺪﺷ
ﺎﺗ ﻲﺳرﺮﺑ ﺖﻬﺟ ﻪﻛ ﺖﺳا ﻞﻜﻴـﺳ ،مﺮﭙـﺳا ﺐﺴـﻛ ﻊـﺒﻨﻣ ﺮﻴﺛ ﺖـﺤﺗ يﺎـﻫ
PESA ﺎﻳ TESE ﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد . ﻪﺴﻳﺎﻘﻣ زا ﺲﭘ يﺎﻫﺮﺘﻣارﺎﭘ يICSI
ﻪـﻛ ﺪـﺷ ﺺﺨﺸـﻣ هوﺮـﮔ ود ﻦﻳا ﻦﻴﺑ رد حﺎـﻘﻟ ناﺰـﻴﻣ ﻪـﻧﻻ ، و ﻲـﻨﻳﺰﮔ
ﻲﻨﻴﻟﺎﺑ ﻲﮕﻠﻣﺎﺣ ﻲﻤﻧ نﺎﺸﻧ يرادﺎﻨﻌﻣ توﺎﻔﺗ ﺪﻫد .
مﺮﭙـﺳا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد نﻮﻴـﺳﺎﺘﻧﺎﻤﮔاﺮﻓ ﺮـﻈﻧ زا ﺎـﻫ
DNA درﻮـﻣ
ﺮﻗ ﻲﺳرﺮﺑ ﺪﻨﺘﻓﺮﮕﻧ را ﻦﻳا زا يور ﻲﻣ دﺎﻬﻨﺸﻴﭘ ﺰـﻴﻧ ﺮﺘﻣارﺎـﭘ ﻦـﻳا ﻪﻛ ددﺮﮔ
دﺮﻴﮔ راﺮﻗ ﻲﺑﺎﻳزرا درﻮﻣ . ﻲـﻣ هﺪﺷ ﺐﺴﻛ ﺞﻳﺎﺘﻧ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﻪـﺠﻴﺘﻧ ناﻮـﺗ
ﻖـﻳﺮﻃ زا هﺪـﺷ ﺐﺴـﻛ مﺮﭙـﺳا ﻲﻤـﺳﻼﭘﻮﺘﻴﺳ نورد ﻖـﻳرﺰﺗ ﻪﻛ ﺖﻓﺮﮔ
PESA و TESEشور ، رورﺎـﺑﺎﻧ نادﺮـﻣ ﻪـﺑ ﻚـﻤﻛ ﺖـﻬﺟ يﺪﻴﻔﻣ يﺎﻫ
ﺣ ﺞﻳﺎﺘﻧ و ﺖﺳا ﻲﻣﺮﭙﺳاوزآ ﻪﺑ ﻼﺘﺒﻣ نورد ﻖـﻳرﺰﺗ ﺎـﺑ سﺎﻴﻗ ﻞﺑﺎﻗ ،ﻞﺻﺎ
ﻪـﺑ ﻼﺘـﺒﻣ نادﺮـﻣ ﻲـﻟاﺰﻧا ﻦﻤـﺳ زا هﺪﺷ ﺐﺴﻛ مﺮﭙﺳا ﻢﺳﻼﭘﻮﺘﻴﺳ
OAT
ﻲﻣ ﺪﻳﺪﺷ ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻦﻳاﺮﺑﺎﻨﺑ ﺪﺷﺎﺑ ﻊـﺒﻨﻣ و مﺮﭙـﺳا ﺖـﻴﻔﻴﻛ ﺮﻴﺛﺎﺗ ﻪﻛ ﺪﺳر
زا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ ﺮﺑ نآ ﺐﺴﻛ
ICSIﺪﺷﺎﺑ ﻪﺑﺎﺸﻣ .
يراﺰﮕـــﺳﺎﭙﺳ :
ﺪﺑﻨﻳـــﺳﻮﻴﻪﻠﺎﻣزآ مﺮـــﺘﺤﻣ نارﺎـــﻜﻤﻫ زا ـــﻳهﺎﮕﺸ
ﻨﺟﻴﻦ ﺳﺎﻨﺷﻲ ﺘﺳﺮﭘ و ﻠﻛ نارﺎﻴﻨﻴﻚ ﺼﺼﺨﺗ ﻲ رورﺎـﺑﺎﻧ نﺎـﻣرد ﻪﺴـﺳﻮﻣ ي
ا مﺎﺠﻧا رد ﻪﻛ ،ﺖﺷر ﺮﻬﻣ ـﻳﻦ ار ﺎـﻣ ﺶﻫوﮋـﭘ ـﻳرﺎي و ﺮﻜﺸـﺗ ﺪـﻧدﻮﻤﻧ
ﻧادرﺪﻗﻲﻣ ﻲ دﻮﺷ.
1. Irvine DS. Epidemiology and aetiology of male infertility. Hum
Reprod 1998;13 Suppl 1:33-44.
2. Palermo GD, Schlegel PN, Hariprashad JJ, Ergün B, Mielnik A,
Zaninovic N, et al. Fertilization and pregnancy outcome with in-
tracytoplasmic sperm injection for azoospermic men. Hum Re-
prod 1999;14(3):741-8.
3. Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnan-
cies after intracytoplasmic injection of single spermatozoon into
an oocyte. Lancet 1992;340(8810):17-8.
4. Khorram O, Patrizio P, Wang C, Swerdloff R. Reproductive
technologies for male infertility. J Clin Endocrinol Metab
2001;86(6):2373-9.
5. Nagy ZP, Verheyen G, Tournaye H, Van Steirteghem AC. Spe-
cial applications of intracytoplasmic sperm injection: the influ-
ence of sperm count, motility, morphology, source and sperm
antibody on the outcome of ICSI. Hum Reprod 1998;13 Suppl
1:143-54.
6. Kamal A, Fahmy I, Mansour R, Serour G, Aboulghar M, Ramos
L, et al. Does the outcome of ICSI in cases of obstructive azoo-
spermia depend on the origin of the retrieved spermatozoa or the
cause of obstruction? A comparative analysis. Fertil Steri
2010;94(6):2135-40.
7. Verza S Jr, Esteves SC. Sperm defect severity rather than sperm
Source is associated with lower fertilization rates after intracyto-
plasmic sperm injection. Int Braz J Urol 2008;34(1):49-56.
8. Kanto S, Sugawara J, Masuda H, Sasano H, Arai Y, Kyono K. Fresh
motile testicular sperm retrieved from nonobstructive azoospermic
patients has the same potential to achieve fertilization and pregnancy
via ICSI as sperm retrieved from obstructive azoospermic patients.
Fertil Steril 2008;90(5):2010.e5-7.
9. Vernaeve V, Tournaye H, Osmanagaoglu K, Verheyen G, Van
Steirteghem A, Devroey P. Intracytoplasmic sperm injection with
testicular spermatozoa is less successful in men with nonobstructive
azoospermia than in men with obstructive azoospermia. Fertil Steril
2003;79(3):529-33.
10. Balaban B, Urman B, Isiklar A, Alatas C, Mercan R, Aksoy S, et al.
Blastocyst transfer following intracytoplasmic injection of ejacu-
lated, epididymal or testicular spermatozoa. Hum Reprod
2001;16(1):125-9.
11. Göker EN, Sendag F, Levi R, Sendag H, Tavmergen E. Comparison
of the ICSI outcome of ejaculated sperm with normal, abnormal pa-
rameters and testicular sperm. Eur J Obstet Gynecol Reprod Biol
2002;104(2):129-36.
References
Mehrafza M. et al.

ﻣ ﺖﻧﻮﻔﻋ ﺺﻴﺨﺸﺗ ياﺮﺑ ﺶﻳﺎﭘ شور ود ﻲﻳارﺎﻛﻲﺣاﺮﺟ ﻞﺤ ﻲﻣﻮﻤﻋ ﻲﺣاﺮﺟ يﺎﻬﺸﺨﺑ رد
233
http://tumj.tums.ac.ir
Tehran Univ Med J
(
TUMJ
)
2014
J
ul
y
;72
(
4
)
:229-34
12. World Health Organization. WHO Laboratory Manual for the
Examination of Human Semen and Sperm-Cervical Mucus In-
teraction. 3rd ed. London: Cambridge University Press; 1992.
13. Mehrafza M, Tavakolnia R, DashtDar H, Farzi F, Oudi M,
Hosseini A. Investigation of the pregnancy rate after intracyto-
plasmic sperm injection in patients with obstructive and non-
obstructive azoospermia. JBUMS 2005;7(3):40-5.
14. Loutradi KE, Tarlatzis BC, Goulis DG, Zepiridis L, Pagou T,
Chatziioannou E, et al. The effects of sperm quality on embryo
development after intracytoplasmic sperm injection. J Assist Re-
prod Genet 2006;23(2):69-74.
15. Aytoz A, Camus M, Tournaye H, Bonduelle M, Van
Steirteghem A, Devroey P. Outcome of pregnancies after intra-
cytoplasmic sperm injection and the effect of sperm origin and
quality on this outcome. Fertil Steril 1998;70(3):500-5.
16. Tesarik J. Paternal effects on cell division in the human preim-
plantation embryo. Reprod Biomed Online 2005;10(3):370-5.
17. Desai N, AbdelHafez F, Sabanegh E, Goldfarb J. Paternal effect on
genomic activation, clinical pregnancy and live birth rate after ICSI
with cryopreserved epididymal versus testicular spermatozoa. Re-
prod Biol Endocrinol 2009;7:142.
18. Aboulghar MA, Mansour RT, Serour GI, Fahmy I, Kamal A, Tawab
NA, et al. Fertilization and pregnancy rates after intracytoplasmic
sperm injection using ejaculate semen and surgically retrieved
sperm. Fertil Steril 1997;68(1):108-11.
19. Tsai CC, Huang FJ, Wang LJ, Lin YJ, Kung FT, Hsieh CH, et al.
Clinical outcomes and development of children born after intracyto-
plasmic sperm injection (ICSI) using extracted testicular sperm or
ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a
comparative study. Fertil Steril 2011;96(3):567-71.
20. Naru T, Sulaiman MN, Kidwai A, Ather MH, Waqar S, Virk S, et al.
Intracytoplasmic sperm injection outcome using ejaculated sperm
and retrieved sperm in azoospermic men. Urol J 2008;5(2):106-10.
Intracytoplasmic sperm injection outcome in oligo and azoospermic men

234
،ناﺮﻬﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭘ هﺪﻜﺸﻧاد ﻪﻠﺠﻣﺮﻴﺗ 1393 هرود ،72 هرﺎﻤﺷ ،4 ،229 ﺎﺗ 234
Comparison of intracytoplasmic sperm injection outcome of
oligoasthenoteratozoospermic and azoospermic men
Marzieh Mehrafza M.D.1*
Azadeh Raoufi M.Sc.1
Talieh Rahimian M.D.1
Parvaneh Abdollahian M.D.1
Zahra Nikpouri M.D.1
Rahim Tavakkolnia M.D.1
Abolfazl Golmohammadi M.D.1
Ahmad Hosseini P.hD.1,2
1- Infertility Research Center, Mehr
Medical Institute, Rasht, Iran.
2- Cellular and Molecular Biology
Research Center, Shahid Beheshti
University of Medical Sciences, Te-
hran, Iran.
*Corresponding author: Infertility Re-
search Center, Mehr Medical Center, Er-
shad St., Shahid Ansari Blvd., Rasht,
Iran.
Tel: +98- 131-7764270
E-mail: dr.mehrafza@yahoo.com
Background: With introduction of intracytoplasmic sperm injection with testicular
sperm extraction or precutaneouse epididymal sperm aspiration, effective treatment was
provided for azoospermic men. The aim of present study was to compare clinical out-
come following intracytoplasmic sperm injection using extracted testicular/epididymal
sperm or ejaculated severe oligoasthenoteratozoospermic sperm.
Methods: After retrospective evaluation of more than four hundred medical records of
patients undergoing intracytoplasmic sperm injection Mehr medical institute (between
2011-2012), 45 cycles with severe eligoasthenoteratozoospermia and 34 cycles with
azoospermia were included. Patients were treated with gonadotropin releasing hormone
agonist. The clinical characteristics and intracytoplasmic sperm injection outcome such
as the rate of fertilization, implantation and clinical pregnancy were compared between
the two groups. Results were presented as mean±standard deviation and number (per-
cent). Differences between variables were analyzed using student's t test and the chi-
square test was used to examine differences between categorical variables. P value less
than 0.05 were considered as statistically significant.
Results: Mean of female age (29±4.9 vs. 30.2±5.8), body mass index (26.9±5.3 vs.
26.9±3.8), estradiol level on human chorionic gonadotropin administration day
(1375.6±843.9 vs. 1181.8±673.1), total number of retrieved oocytes (9.7±5.3 vs.
9.2±5.9) and metaphase II oocytes (7.7±5.1 vs. 7.5±5.4) were similar between the two
groups. Of 436 and 313 retrieved oocytes, respectively 232 and 163 oocytes were fertil-
ized in oligoasthenoteratozoospermic and azoospermic groups (53.2% vs. 52.1%,
P=0.214). There were not statistical differences between groups in number of trans-
ferred top quality embryos (1.5±1.2 vs. 1±1.2, P=0.09), implantation rate (22.7% vs.
16.9%, P=0.238) and clinical pregnancy rate (21 (47.7%) vs. 11 (35.4%), P=0.199).
Conclusion: Intracytoplasmic sperm injection with precutaneouse epididymal sperm
aspiration and testicular sperm extraction are effective methods to treat azoospermic
men and its clinical outcome were comparable to ejaculated sever oligoasthenoterato-
zoospermic cycles. It can be concluded that the influence of sperm quality and origin on
intracytoplasmic sperm injection outcome are the same.
Keywords: azoospermia, intracytoplasmic, pregnancy, sperm injections.
Abstract Received: 17 Nov. 2013 Accepted: 10 Mar. 2014 Available online: 05 Jun. 2014
Original Article
Tehran University Medical Journal, July 2014; Vol. 72, No. 4: 229-234