Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility

Abstract

We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia (100%; adjusted odds ratio: 0.033; 95% CI: 0.007–0.164; P < 0.001). Live birth rates after sperm injections were lower in men with testicular failure (19.9%) compared with donor sperm (37.5%; adjusted OR: 0.377 (95% CI: 0.233–0.609, P < 0.001)) and obstructive azoospermia (34.2%; adjusted OR: 0.403 (95% CI: 0.241–0.676, P = 0.001). Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection (ICSI) are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.

Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm

“…In our study, fertilization rates after sperm injections with testicular sperm were lower than those with ejaculated sperm. Similar results have been observed when azoospermic (nonobstructive) and nonazoospermic men were compared (43)(44)(45)(46). An impaired fertilization potential in the group of men with nonobstructive azoospermia might be explained by the inherent defective spermatogenesis (26).…”

Engaging Practicing Gynecologists in the Management of Infertile Men

“…ICSI is associated with lower fertilization rates per injected oocyte as well as clinical pregnancy and delivery rates when testicular spermatozoa from men with NOA are used in comparison to epididymal/testicular sperm from men with OA [113][114][115]. Once a live birth is achieved, newborn parameters of infants conceived were not significantly different among the groups, and no major differences are noted in the offspring's neonatal profile [113].…”

“…Once a live birth is achieved, newborn parameters of infants conceived were not significantly different among the groups, and no major differences are noted in the offspring's neonatal profile [113]. If there is no worthy sperm for fertilization, then the couple must consider adoption or donor insemination.…”

“…Among the SR methods, microsurgical testicular sperm extraction (micro-TESE) is considered to be the best option for SR in men with NOA (retrieval rates ranging from 40 to 60 %). Micro-TESE also provides the opportunity for both preserving testicular vasculature and minimizing the amount of extracted parenchyma [112,113].…”

Fresh Versus Frozen Testicular Sperm Samples in Microdissection Testicular Sperm Extraction Intracytoplasmic Sperm Injection Treatment

“…It has been reported that sperm retrieval rates change between 35% and 77% for MD TESE procedures, and more importantly, MD TESE procedures have significantly better clinical outcomes than conventional TESE procedures or percutaneous aspirations (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”