臨床泌尿器科62巻8号

2008年07月発行

特集 男性不妊症に対するマイクロサージェリー

顕微鏡下精巣内精子採取術

著者： 宮川康¹ 辻村晃¹ 高尾徹也¹ 岡本吉夫² 奥山明彦¹

所属機関： ¹大阪大学医学部泌尿器科 ²岡本クリニック

ページ範囲：P.575 - P.580

文献概要

要旨　非閉塞性無精子症に対する顕微鏡下精巣内精子採取術（MD-TESE）は，従来法に比べて精子採取率が比較的高く，手術による精巣障害を可及的に回避できる最も理想的な術式である。しかし，セルトリセルオンリー症候群などの重度の造精機能障害例では，手術用顕微鏡による精細管の観察や採取組織からの精子検索は長時間を要し，手術時間および精子採取率には学習曲線効果を認める。また，得られた非閉塞性無精子症患者の精子は，閉塞性無精子症患者の精子と比較して受精率・妊娠率が劣るうえ，実際には術後テストステロン低下が生じることも明らかとなってきた。本術式選択にあたっては，不妊カップルへの十分なインフォームド・コンセントが必要である。

参考文献

1）Willott GM：Frequency of azoospermia. Forensic Sci Int 20：9-10, 1982

2）Devroey P, Liu J, Nagy Z, et al：Pregnancies alter testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 10：1457-1460, 1995

3）Amer M, El Haggar S, Moustafa T, et al：Testicular sperm extraction：impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition. Hum Reprod 14：3030-3034, 1999

4）Turek P, Givens CR, Schriock ED, et al：Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine-needle aspiration mapping in patients with nonobstructive azoospermia. Fertil Steril 71：552-557, 1999

5）Har-Toov J, Eytan O, Hauser R, et al：A new power Doppler ultrasound guiding technique for improved testicular sperm extraction. Fertil Steril 81：430, 2004

6）Schlegel PN：Testicular sperm extraction：microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14：131-135, 1999

7）Amer M, Ateyah A, Hany R, et al：Prospective comparative study between microsurgical and conventional sperm extraction in non-obstructive azoospermia：follow-up by serial ultrasound examinations. Hum Reprod 15：653-656, 2000

8）Tsujimura A, Matsumiya K, Miyagawa Y, et al：Conventional multiple or microdissection testicular sperm extraction：a comparative study. Hum Reprod 17：2924-2929, 2002

9）Okada H, Dobashi M, Yamazaki T, et al：Conventional versus microdissection testicular sperm extraction for non obstructive azoospermia. J Urol 168：1063-1067, 2002

10）Ramasamy R, Yagan N, Schlegel PN：Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 65：1190-1194, 2005

11）Koga M, Tsujimura A, Takeyama M, et al：Clinical comparison of successful and failed microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome. Urology 70：341, 2007

12）宮川　康：精巣内精子抽出術のコツ．生殖医療のコツと落とし穴．中山書店，東京，pp82-83，2004

13）Donoso P, Tournaye H and Devroey P：Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 13：539, 2007

14）Ramasamy R and Schlegel PN：Microdissection testicular sperm extraction：effect of prior biopsy on success of sperm retrieval. J Urol 177：1447-1449, 2007

15）Tsujimura A, Miyagawa Y, Takao T, et al：Salvage microdissection testicular sperm extraction after failed conventional testicular sperm extraction in patients with nonobstructive azoospermia. J Urol 175：1446-1449, 2006

16）Okada H, Goda K, Yamamoto Y, et al：Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter's syndrome. Fertil Steril 84：1662-1664, 2005

17）Schiff JD, Palermo GD, Veeck LL, et al：Success of testicular sperm injection and intracytoplasmic sperm injection in men with Klinefelter syndrome. J Clin Endocrinol Metab 90：6263-6267, 2005

18）Nicopoullos J, Gilling-Smith C, Almeida P, et al：Use of surgical sperm retrieval in azoospermic men：a meta-analysis. Fertil Steril 82：691-700, 2004

19）Mercan R, Urman B, Alatas C, et al：Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia：percutaneous aspiration versus open biopsy. Hum Reprod 15：1548-1551, 2000

20）Nassar ZA, Lakkis D, Sasy M, et al：Fine needle testicular sperm aspiration：an alternative to open testicular biopsy in patients with non-obstructive azoospermia. Fertil Steril 76：S137, 2001

21）Khadra A, Abdulhadi I, Ghunain S, et al：Efficiency of percutaneous sperm aspiration as a mode of sperm collection for intracytoplasmic sperm injection in nonobstructive azoospermia. J Urol 169：603-605, 2003

22）辻村　晃，宮川　康，奥山明彦：ARTにおけるmicrodissection TESE．産婦人科治療 96：400-405，2008

23）Takada S, Tsujimura A, Ueda T, et al：Androgen decline in patients with nonobstructive azoospemia after microdissection testicular sperm extraction. Urology, 2008（Epub ahead of print）

24）Fujita K, Tsujimura A, Takao T, et al：Expression of inhibin alpha, glial cell line-derived neurotrophic factor and stem cell factor in Sertoli cell-only syndrome：relation to successful sperm retrieval by microdissection testicular sperm extraction. Hum Reprod 20：2289, 2005

25）Koscinski I, Wittemer C, Rigot JM, et al：Seminal haploid cell detection by flow cytometry in non-obstructive azoospermia：a good predictive parameter for testicular sperm extraction. Hum Reprod 20：1915-1920, 2005

26）Duvilla E, Lejeune H, Trombert-Paviot B, et al：Significance of inhibin B and anti-Müllerian hormone in seminal plasma：a preliminary study. Fertil Steril 89：444-448, 2008