Factors influencing the outcome of in-vitro fertilization with percutaneous aspirated epididymal spermatozoa and intracytoplasmic sperm injection in azoospermic men

Abstract

In-vitro fertilization (IVF) by intracytoplasmic sperm injection (ICSI) with spermatozoa retrieved by percutaneous epididymal sperm aspiration (PESA) is a novel, simple and effective treatment for azoospermic men. In all, 38 azoospermic men had an IVF/PESA/ICSI cycle. A total of 42 cycles were performed. The aetiology of azoospermia was classified as failed vasectomy reversal (12 patients/16 cycles), inflammatory obstruction (five patients/five cycles), partial testicular failure (five patients/five cycles) and bilateral congenital absence of vas (16 patients/16 cycles). Adequate sperm preparations for ICSI were obtained from 38 of the 42 treatment cycles (90%). The mean fertilization rate was 32.7%, and fertilization occurred in 35 cycles (92.0%). Embryo transfer was performed in 13 out of 14 cycles (93%) in men with a failed vasectomy reversal, four out of five cycles in men with an inflammatory obstruction (80%), four out of four cycles in men with a partial testicular failure (100%), and 14 out of 15 cycles in men with a bilateral congenital absence of vas (93%). The overall pregnancy rate per two or three embryos transferred was 28.6 and 26.3% per treatment cycle respectively. The sperm parameters of the final pooled sperm aspirate preparations varied widely among the four aetiological groups. These parameters were of no value in predicting the fertilization or pregnancy rates (P > 0.05), and neither was the embryo cleavage rate.

Sperm retrieval for obstructive azoospermia

“…When reconstruction is impossible (as in CBAVD), unlikely to succeed, or has already failed (as in previous attempts at vasovasostomy or vasoepididymostomy), sperm may be retrieved directly from the epididymis or testis and used for ART. In case series reporting the results of sperm retrieval and intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia, pregnancy rates per retrieval attempt have ranged between 24% and 64% (8,9), comparable or better than those achieved for similar couples at the same centers using ejaculated sperm.…”

“…The results achieved with retrieved sperm and ICSI are far superior. Contemporary pregnancy rates of 24% to 64% (comparable to that achieved with ejaculated sperm at individual centers) have been achieved using sperm retrieved from azoospermic men (8,9). Maternal factors (maternal age, oocyte number, and oocyte quality) alone now are considered the principal determinants of outcomes achieved with ART and ICSI for couples with infertility related to obstructive azoospermia (19,20).…”

Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia

“…The simplicity of PESA associated to the efficacy of ICSI, allows that many infertile couples have their own children, as in the case of men with obstructive azoospermia (6). Many authors are confirming the efficiency of PESA (3,7,10).…”

“…Initially, spermatozoa obtained from the epididymis were used in in-vitro fertilization (FIV), but rates of fertilization and pregnancy by transference were low, as for instance with values of 11% for fertilization rate and 8% for pregnancy rate (2,5,6). With the development of ICSI, results obtained became to be better, showing that the 2 techniques (PESA and ICSI) can be used together and successfully (4).…”

Development of a new and efficient laboratory method for processing testicular sperm.

“…Testicular and epididymal sperm have been used successfully for treating men with azoospermia (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). For males with normal spermatogenesis, testicular sperm extraction (TESE) requires less surgical expertise to obtain good quality specimens as compared with microepididymal sperm aspiration (MESA) (4,7,9).…”