Factors affecting outcome after ICSI with spermatozoa retrieved from cryopreserved testicular tissue in non-obstructive azoospermia

Abstract

There is a lack of data regarding variables affecting the treatment outcome for non-obstructive azoospermia when spermatozoa from cryopreserved testicular specimens are utilized for ICSI. The objective of the present retrospective analysis was to investigate the effect of various parameters on treatment outcome in such cases. One hundred and sixty-five couples with non-obstructive azoospermic males undergoing a total of 297 cycles were included. In all cases the testicular tissue retrieved by multiple open-biopsy testicular sperm extraction was stored in liquid nitrogen and, after thawing, only mature spermatozoa were used for ICSI. When no motile spermatozoa were recovered, immotile spermatozoa were used. In 159 cycles, motile spermatozoa were utilized for ICSI, while in 138 cycles immotile spermatozoa were utilized. Higher normal fertilization rate (60.4 +/- 3.1 versus 51.3 +/- 1.6%, P < 0.05), number of embryos transferred (2.8 +/- 0.06 versus 2.6 +/- 0.04, P < 0.05), modified cumulative embryo score (31.2 +/- 1.6 versus 23.9 +/- 0.8, P < 0.001), and proportion of motile spermatozoa injected (67.8 versus 49.8%, P < 0.05) were observed in cycles that resulted in clinical pregnancies. Binary logistic regression analysis showed that sperm motility (odds ratio 2.06, 95% CI 1.1-3.9, P < 0.05), but not woman's age, number of treatment cycle, type of GnRH-analogue used for pituitary suppression, number of oocytes retrieved or number of embryos transferred was a significant determinant of the likelihood of clinical pregnancy. In conclusion, sperm motility after freeze/thawing of testicular tissue is the major determinant of the success of ICSI in non-obstructive azoospermia.

Effect of testicular spermatozoa on embryo quality and pregnancy in patients with non-obstructive azoospermia

“…In a study by Dafopoulos et al [2005] spermatozoa were not extracted before freezing, and tissue pieces the size of rice grains were frozen. The fertilization rates achieved with fresh vs. frozen-thawed testicular spermatozoa were 69% vs. 61.7%, the pregnancy rates per embryo transfer were 29.1% vs. 25.0%, and the delivery rates were 85.7% vs. 80.0%, respectively [Rhouma et al 2003].…”

Processing and selection of surgically-retrieved sperm for ICSI: a review

“…The causes and treatment options for complete immotility are reviewed by Ortega et al [39]. Regarding testicular sperm, fertilization, pregnancy and implantation rates were negatively affected when only immotile sperm were available for ICSI in NOA patients [40, 41]. A number of methods for real-time selection of vital immotile sperm have been tested and introduced into clinical practice.…”

A new method to process testicular sperm: combining enzymatic digestion, accumulation of spermatozoa, and stimulation of motility

“…Particular expertise is needed in cases of non-obstructive azoospermia [7,8] which are of bad prognosis in terms of successful sperm retrieval. In such patients, routine TESE is less promising and modified TESE approaches (e.g.…”