Impact of sperm cell source on the results of intracytoplasmic sperm injection

Gnoth, Christian; Markhinin, Vitaly; Maxrath, Beatrice; Skonieczny, T.; Friol, K.; Roos, J; Rahimi, Gohar; Godehardt, Erhard

doi:10.1007/s00404-014-3448-5

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…Lu et al found a slight advantage of ejaculated sperm in terms of fertilization rates and embryo quality within one center’s large experience [4]. Similarly, Gnoth and colleagues analyzed 337 IVF-ICSI cycles and found no difference in clinical outcomes between ejaculated and testicular sperm for men with cryptozoospermia [6]. Both studies were limited by a retrospective design with significant potential for selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…However, this tenet is increasingly being challenged as IVF-ICSI outcomes correlate poorly with traditional sperm quality parameters [4, 5]. Studies involving large cohorts have now shown near equivalence with samples retrieved from the epididymis or testis [6–8], and even with sperm characterized by poor motility and morphology [5]. In the extreme scenario of substantial necrospermia, testicular sperm may even outperform viable ejaculated samples [9].…”

Section: Introductionmentioning

confidence: 99%

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Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series

Hayden

Wright²,

Toth

et al. 2016

Fertil Res and Pract

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BackgroundSperm quality may degrade during transit through the male reproductive tract in some individuals. In this setting surgically retrieved testicular sperm may outperform ejaculated samples for use with in vitro fertilization (IVF) and intracytoplasmic sperm injection (IVF-ICSI). We sought to describe one center’s experience with the use of fresh testicular sperm after prior failed IVF-ICSI with ejaculated samples.ResultsA retrospective review was conducted evaluating IVF-ICSI cycles performed at a tertiary IVF unit between 2009 and 2014. Couples who were managed with percutaneous testis biopsy to obtain sperm, despite availability of ejaculated sperm, were included. Four couples who underwent a total of 6 percutaneous testis biopsy/IVF-ICSI cycles were identified. Collectively, the couples had undergone 9 prior IVF-ICSI cycles using fresh ejaculated sperm without successful pregnancy. From the six cycles that used fresh testicular sperm four live births resulted (1 twin gestation, 3 singletons). Only 1 of the 4 couples remained childless.ConclusionsFor patients who have had prior failed IVF-ICSI attempts, this small case series demonstrates a possible therapeutic benefit when freshly procured testicular sperm are used in lieu of ejaculated samples.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series

Hayden

Wright²,

Toth

et al. 2016

Fertil Res and Pract

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“…Although intracytoplasmic sperm injection (ICSI) is a remarkably effective technique in allowing fatherhood in men previously considered sterile, sperm retrieval from the epididymis or testis should be the last option to be given to men. Gnoth et al showed that the source of spermatozoa has not relevant impact on the results of ICSI cycles as long as fresh motile, morphologically normal spermatozoa are used, proposing, in case of cryptozoospermia, to preferentially use ejaculated spermatozoa to prevent those men from an unnecessary testicular biopsy avoiding risks and costs implied ( 12 ). In addition, the use of a single sperm found in ejaculate in ICSI resulting in successful pregnancy was demonstrated by Desai et al ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Owed to its complex nature, we have advocated that semen analysis should be ideally carried out in Andrology Laboratories equipped with experienced technicians and validated systems, and enrolled in internal and external quality control programs ( 3 , 8 , 9 , 12 ). In this current issue of Int Braz J Urol, Monteiro and colleagues shed light on this very same issue ( 1 ).…”

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confidence: 99%

An easy, reproducible and cost-effective method for andrologists to improve the laboratory diagnosis of non-obstructive azoospermia: a novel microcentrifugation technique

Hallak

2016

Int. braz j urol.

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This study describes a new method of microcentrifugation as an improved, viable, cost-effective option to the classical Cytospin apparatus to confirm azoospermia. Azoospermic semen samples were evaluated for cryptozoospermia by a centrifugation method similar to that of World Health Organization guidelines (2010; entire specimen centrifuged at 3000g for 15 min, and aliquots of the pellet examined). Then, if no sperm were detected, the pellet from that procedure was resuspended in culture medium, centrifuged (2000g for 15 min), and the entire pellet spread on a 4 X 6mm area of a slide and stained using the Christmas tree method (Nuclear-Fast solution and picric acid). The entire stained area was examined for the presence or absence of sperm. A total of 148 azoospermic samples (after standard WHO diagnosis) were included in the study and 21 samples (14.2%) were identified as sperm-positive. In all microcentrifugation slides, intact spermatozoa could be easily visualized against a clear background, with no cellular debris. This novel microcentrifugation technique is clearly a simple and effective method, with lower cost, increasing both sensitivity and specificity in confirming the absence or presence of spermatozoa in the ejaculate. It may represent a step forward of prognostic value to be introduced by andrology laboratories in the routine evaluation of patients with azoospermia in the initial semen analysis.

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“…However, testicular sperm retrieval does carry risk for the male patient—it is an invasive surgical procedure with potential complications including but not limited to bleeding, infection, and irreversible testicular tissue damage (Gnoth et al ., ). We therefore need to be cautious when recommending this procedure to patients to ensure the potential benefits outweigh the risks.…”

Section: Introductionmentioning

confidence: 97%

Does using testicular sperm retrieval rather than ejaculated spermatozoa improve reproductive outcomes in couples with previous ART failure and poor ovarian response? A case‐controlled study

Gilman¹,

Younes²,

Tannus³

et al. 2017

Andrology

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The objective of this study was to assess whether testicular-retrieved spermatozoa improve reproductive outcomes compared to fresh ejaculate in women with poor ovarian response and a history of previous ART failure. The study was performed as a retrospective case-control study at a university-based reproductive center in Montreal, Quebec, Canada. Eighteen poor-responder patients were matched 3 : 1 with 54 controls. Poor responders were defined as those with ≤3 oocytes retrieved at oocyte pickup. Cases were identified as poor responders, and only those with previous IVF failure(s) as an indication for testicular-retrieved spermatozoa were included. Controls were age and cycle attempt number matched. All patients were included only once. From January 1, 2009 to December 31, 2015, all patients and controls underwent an IVF cycle using ICSI with either testicular spermatozoa or ejaculated spermatozoa, respectively. Outcomes included live birth rate, pregnancy rate, miscarriage rate, oocyte number, and embryo transfer (ET) day. The results showed live birth rates, pregnancy rates, and miscarriage rates were similar. There were fewer day 2 ETs (8.5% vs. 48.6%, p = 0.01) and more day 5 blastocyst transfers (25.0% vs. 5.4%, p = 0.05) in the testicular sperm retrieval group compared to controls and thus an overall suggestion of better embryo quality in the testicular sperm group. Overall, however, the use of testicular sperm retrieval appears to add little. Women with poor ovarian response typically have a poor prognosis with respect to live birth rates, and this is further supported in this study. The suggestion of better embryo quality in the testicular-retrieved sperm group would need to be further assessed in a larger multicentered study.

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Impact of sperm cell source on the results of intracytoplasmic sperm injection

Cited by 11 publications

References 24 publications

Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series

Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series

An easy, reproducible and cost-effective method for andrologists to improve the laboratory diagnosis of non-obstructive azoospermia: a novel microcentrifugation technique

Does using testicular sperm retrieval rather than ejaculated spermatozoa improve reproductive outcomes in couples with previous ART failure and poor ovarian response? A case‐controlled study

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