建立一個新的預測指標以評估非阻塞性無精蟲症患者之睪丸取精結果

Establishment of new predictive factors to evaluate the spermatogenesis in men with non-obstructive azoospermia

林微敏(Lin Wei Min)

指導教授 ： 李婉若

臺北醫學大學/醫學院/醫學科學研究所/碩士(2000年)

摘要

中文摘要 對於男性不孕症中非阻塞性無精蟲症患者的治療，目前以手術取出睪丸精子並配合單一精子顯微注射為最有效的解決方法。在本實驗中，我們嘗試找出新的預測指標以評估這些睪丸造精功能受損患者的造精作用，共有37位非阻塞性無精蟲症患者參與這項實驗。目前臨床上用來評估此類患者造精功能的指標包括：（1）血液中濾泡刺激激素濃度（2）睪丸體積大小（3）睪丸組織切片之病理診斷。實驗結果顯示：應用螢光原位雜交法辨識睪丸組織切片上的精細胞進而評估睪丸的造精功能與這三個傳統的指標間具有高相關性，而且還可以更直接的檢視切片上每一條細精小管內的造精功能。而藉由測量細精小管，我們得知造精功能受損患者的細精小管管徑明顯地較具正常造精功能的細精小管細，原因為造精作用活躍的細精小管內生殖細胞較多，因而造成有精子生成的細精小管管徑明顯的較沒有精子生成的細精小管粗。在本篇的研究中，我們証實了除傳統評估指標外，應用螢光原位雜交法偵測睪丸切片上之精細胞並配合外科手術取出管徑較粗的細精小管，可以提高非阻塞性無精蟲症患者找到睪丸精子的機率。 關鍵字：非阻塞性無精蟲症，造精作用，螢光原位雜交法

關鍵字

非阻塞性無精蟲症 ； 造精作用 ； 螢光原位雜交法

並列摘要

Abstract Testicular spermatozoa extraction from non-obstructive azoospermic (NOA) patients followed by microinjection is an effective method in the treatment of male infertility. In this study, we tried to find new parameters to predict the spermatogenesis in men with defective spermatogenesis. We conducted a prospective study of a set of variables in 37 NOA patients. The most frequently available parameters for current clinical decision-making in azoospermic patients: (i) testis size; (ii) serum concentration of follicle stimulating hormone (FSH); and (iii) presence of spermatids in the testicular biopsy histology. Applying fluorescence in situ hybridization (FISH) on testis sections to identify testicular spermatids shows higher relation to these three current predictive factors. The spermatogenesis in individual seminiferous tubule also can be examined directly. There is a significantly difference between the tubular widthes of obstructive and non-obstructive azoospermic patients. The large number of intratubular germ cells within those tubules with active spermatogenesis cause those tubules to be larger than tubules without sperm production. Our study shows that besides those conventional parameters, the combination of both applying FISH on testicular sections and microdissecting ‘fat’ seminiferous tubules can improve the probability of successful testicular sperm extraction from patients with NOA. Key words : non-obstructive azoospermia, spermatogenesis, fluorescence in situ hybridization.

並列關鍵字

Non-obstructive azoospermia ； spermatogenesis ； FISH

參考文獻

Antinori, S., Versaci, C., Dani, G. et al. (1997a) Fertilization with human testicular spermatids: four successful pregnancies. Hum. Reprod., 12, 286-291.

Antinori, S., Versaci, C., Dani, G. et al. (1997b) Successful fertilization and pregnancy after injection of frozen-thawed round spermatids into human oocytes. Hum. Reprod., 12, 554-556.

Aslam, I., Fishel, S., Green, S. et al. (1998) Can we justify spermatid microinjection for severe male factor infertility? Hum. Reprod. Update, 4, 213-222.

Aslam, I., Robins, A., Dowell, K. et al. (1998) Isolation, purification and assessment of viability of spermatogenic cells from testicular biopsies of azoospermic men. Hum. Reprod., 13, 639-645.

Barak, Y., Kogosowski, A,. Goldman, S., et al. (1998) Pregnancy and birth after transfer of embryos that developed from single-nucleated zygotes obtained by injection of round spermatids into oocytes. Fertil. Steril., 70, 67-70.