Sperm Recovery and IVF after Testicular Sperm Extraction (TESE): Effect of Male Diagnosis and Use of Off-Site Surgical Centers on Sperm Recovery and IVF

Abstract

ObjectiveDetermine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation.PatientsOne hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm.Outcome MeasuresSuccessful sperm recovery defined as 1–2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n = 60), non-obstructive azoospermia (n = 39), cancer (n = 14), paralysis (n = 7) and other (n = 10). Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n = 22), vasectomy or failed vasectomy reversal (n = 37) and “other”(n = 1). Sperm recovery was also evaluated by surgical site including infertility clinic (n = 54), hospital operating room (n = 67) and physician’s office (n = 11). Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm.ResultsTesticular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p = <0.0001) compared to other male diagnoses (66%, p = <0.0001, 59% p = 0.015). No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p = 0.0371) compared to diagnoses of cancer, paralysis or other (16.7%). Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p = 0.007) compared to those with other diagnoses (44%).ConclusionTesticular sperm extraction is a safe and effective option regardless of the etiology of the azoospermia. The type of surgical center and/or its distance from the laboratory was not related to success. Men with non-obstructive azoospermia have a lower chance of successful sperm retrieval and fertilization.

Embryo Grading and Pregnancy Outcome in Women of Patients with Azoospermia Following ICSI

“…The present study showed that Sperms were successfully isolated from 30 patients (50%) and that the isolation rate was significantly higher in the obstructive azoospermia group than in the non-obstructive azoospermia group, 100% versus 33.3% (P<0.01); these results were comparable to the finding of other studies in which sperm retrieval rate was higher in obstructive azoospermia in comparison with non-obstructive type (61%) (6) . It was also, similar to the present study finding, stated by some authors that testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) (7) . In the current study, sperm isolation rate was not affected by age of the patient, but it was significantly related to lower FSH, LH and prolactin and higher testosterone level and also it was significantly determined by higher histological and MCL 1 scores.…”

“…Several studies showed that there is no statistically significant difference in clinical pregnancy rates between the two (13) and this result solidify the finding of the present study which also found no significant difference in clinical pregnancy rate between obstructive and non-obstructive azoospermia rate. In accordance with the result of the present study it was found that there was no differences were noted in clinical pregnancy rate between obstructive azoospermia and non-obstructive azoospermia groups (7) . In contradiction to the finding of the current study, rate of fertilization was significantly lower with non-obstructive azoospermia (7) .It has also been recorded that fertilization and clinical pregnancy rates was lower in non-obstructive azoospermia (14) ; However a metaanalysis of surgical sperm retrieved in azoospermic patients concluded that…”

Immuno-Histochemical Expression of McL-1 in Testicular Biopsy of Patients With Azoospermia.

“…The present study showed that Sperms were successfully isolated from 30 patients (50%) and that the isolation rate was significantly higher in the obstructive azoospermia group than in the non-obstructive azoospermia group, 100% versus 33.3% (P<0.01); these results were comparable to the finding of other studies in which sperm retrieval rate was higher in obstructive azoospermia in comparison with non-obstructive type (61%) (Moeinet al, 2015) (10) . It was also, similar to the present study finding, stated by some authors that testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) (Omurtaget al, 2013) (11) . In the current study, sperm isolation rate was not affected by age of the patient, but it was significantly related to lower FSH, LH and prolactin and higher testosterone level and also it was significantly determined by higher histological and MCL 1 scores.…”

Sperm retrieval by microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in nonobstructive azoospermic patients with Klinefelter syndrome

“…The simultaneous TESE and ICSI attempts carry the risk of cancellation of ICSI cycle and associated pointless ovarian stimulation with its complications, emotional stress and financial burden (Vicdan et al., ). In addition, studies have indicated similar pregnancy rates with fresh TESE spermatozoa versus frozen‐thawed TESE spermatozoa (Omurtag et al., ; Vicdan et al., ).…”