Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection

Abstract

Objective: To evaluate the impact of sperm defect severity and the type of azoospermia on the outcomes of intracytoplasmic sperm injection (ICSI). Materials and Methods:This study included 313 ICSI cycles that were divided into two major groups according to the source of spermatozoa used for ICSI: 1) Ejaculated (group 1; n = 220) and 2) Testicular/Epididymal (group 2; n = 93). Group 1 was subdivided into four subgroups according to the results of the semen analysis:, n = 41), 2) double defect (a combination of two single defects, n = 45), 3) triple defect (OAT, n = 48), and 4) control (no sperm defects; n = 86). Group 2 was subdivided according to the type of azoospermia: 1) obstructive (OA: n = 39) and 2) non-obstructive (NOA: n = 54). Fertilization (2PN), cleavage, embryo quality, clinical pregnancy and miscarriage rates were statistically compared using one-way ANOVA and Chi-square analyses. Results: Significantly lower fertilization rates were obtained when either ejaculated sperm with triple defect or testicular sperm from NOA patients (63.4 ± 25.9% and 52.2 ± 29.3%, respectively) were used for ICSI as compared to other groups (~73%; P < 0.05). Epididymal and testicular spermatozoa from OA patients fertilized as well as normal or mild/moderate deficient ejaculated sperm. Cleavage, embryo quality, pregnancy and miscarriage rates did not differ statistically between ejaculated and obstructive azoospermia groups. However, fertilization, cleavage and pregnancy rates were significantly lower for NOA patients. Conclusion: Lower fertilization rates are achieved when ICSI is performed with sperm from men with oligoasthenoteratozoospermic and non-obstructive azoospermic, and embryo development and pregnancy rates are significantly lower when testicular spermatozoa from NOA men are used.

A Critical Appraisal on the Role of Varicocele in Male Infertility

“…Although infertile men presenting with NOA are the most difficult to treat, the recent advances in ART coupled with surgical methods of testicular sperm extraction (TESE) made it possible for approximately 20%–40% of men with NOA to father children of their own [82]. …”

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

“…[39] Clinical pregnancy and live birth rates are also lower in NOA than other male infertility scenarios. [395253] In one report comparing the reproductive potential of azoospermic men undergoing SR and ICSI, the likelihood of obtaining a live birth was 1.8-fold higher (odds ratio [OR] = 1.86; 95% CI: 1.03-2.89) in men with OA compared with men with NOA. [52] These findings indicate that men with NOA undergoing ART have decreased reproductive potential, which may be explained by a higher tendency of their testicular sperm to carry deficiencies related to the centrioles and genetic material.…”

“…As a result, the ability of the male gamete to activate the egg and trigger formation and development of a normal zygote and a viable embryo is impaired. [53] Nevertheless, the neonatal profile of babies born seems not to be affected by the type of azoospermia or the source of sperm used for ICSI. Malformation and perinatal death rates in NOA range from 1.3% to 5.2% in large cohorts.…”

In vitro fertilization/intracytoplasmic sperm injection for male infertility

“…IVF with ICSI yields good clinical results in couples with severe male factor infertility. [139] Because of the consistently good results with MESA/TESE-ICSI when compared with conventional IVF, ICSI is mandatory for all future MESA patients. [31]…”

“…[1] Since the first US report of a successful delivery from in vitro fertilization (IVF) in 1982, progress in the field of assisted reproduction and micromanipulation has been truly dramatic, particularly in the area of male factor infertility, offering couples considered irreversibly infertile and eligible for donor insemination or adoption, the option of parenting a genetically related child despite severe impairments in sperm quantity and quality. [2] Assisted reproductive techniques that aim to overcome natural barriers to fertilization include intra-uterine insemination (IUI), in vitro fertilization and embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), subzonal sperm insemination (SUZI), partial zona dissection (PZD), and intracytoplasmic sperm injection (ICSI).…”