Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration

Hibi, Hatsuki; Sumitomo, Makoto; Fukunaga, Noritaka; Sonohara, Megumi; Asada, Yoshimasa

doi:10.1002/rmb2.12069

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…In obstructive azoospermia, epididymal sperm have been reported to have higher SDF than testicular sperm 6 . Although we have not evaluated SDF, we believe that SDF does not significantly affect ART outcomes because ICSI using epididymal sperm is associated with high clinical pregnancy and delivery rates 16 …”

Section: Discussionmentioning

confidence: 85%

“…6 Although we have not evaluated SDF, we believe that SDF does not significantly affect ART outcomes because ICSI using epididymal sperm is associated with high clinical pregnancy and delivery rates. 16 Micro-TESE has been employed widely used as sperm retrieval does not require precise microsurgical skills. However, there have been reports of postoperative lower testosterone levels with TESE.…”

Section: Discussionmentioning

confidence: 99%

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Cryptozoospermia: Should we use ejaculated sperm or surgically retrieved sperm for assisted reproductive technology?

Hibi,

Tokoro,

Sonohara

et al. 2023

Reprod Medicine & Biology

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PurposeIn cryptozoospermic subjects, it may often may be difficult to secure motile sperm for assisted reproductive technology (ART). We examined the results of ART with frozen thawed ejaculated sperm in cryptozoospermic subjects and evaluated whether sperm retrieval surgery is necessary for such patients in our clinic.MethodsBetween 2013 and 2021, we evaluated 197 cryptozoospermic patients. Age, endocrine panel at the time of the initial semen analysis, and anti‐müllerian hormone levels at the time of the spouse's first egg retrieval were examined. Cryopreservation of ejaculated motile sperm collected essentially weekly over a 3‐month period was carried out. ART data recorded was the number of egg retrieval cycles, normal fertilization rate, and clinical pregnancy rate.ResultsART using frozen sperm as well as sperm ejaculated on the day of egg retrieval was possible in all cases. The normal fertilization rate was 70.4%, the clinical pregnancy rate per embryo transferred was achieved in 31.5% (870 cycles), and the live birth rate per case was 73.8%.ConclusionsIntracytoplasmic sperm injection (ICSI) was possible without sperm retrieval surgery in cryptozoospermia, resulting in 73.8% of live births per patient. Sperm identification, sperm processing, and ICSI technique are especially important in cryptozoospermia. Sperm retrieval surgery can be avoided in cryptozoospermic patients.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Cryptozoospermia: Should we use ejaculated sperm or surgically retrieved sperm for assisted reproductive technology?

Hibi,

Tokoro,

Sonohara

et al. 2023

Reprod Medicine & Biology

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“…Contrary to expectations following TESE, this indicated it would be necessary to turn to a sperm donor or adoption. As suggested, microepididymal sperm aspiration (MESA) enhances the chances of pregnancy and clinical deliveries after ICSI without testicular surgical damage [ 205 ].…”

Section: Discussionmentioning

confidence: 99%

A Narrative Review Discussing Vasectomy-Related Impact upon the Status of Oxidative Stress and Inflammation Biomarkers and Semen Microbiota

Doroftei

Ilie

Maftei

et al. 2023

JCM

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Background: Male contraceptive approaches besides tubal sterilization involve vasectomy and represent the method of choice among midlife men in developing countries thanks to many advantages. However, the subsidiary consequences of this intervention are insufficiently explored since the involved mechanisms may offer insight into a much more complex picture. Methods: Thus, in this manuscript, we aimed to reunite all available data by searching three separate academic database(s) (PubMed, Web of Knowledge, and Scopus) published in the past two decades by covering the interval 2000–2023 and using a predefined set of keywords and strings involving “oxidative stress” (OS), “inflammation”, and “semen microbiota” in combination with “humans”, “rats”, and “mice”. Results: By following all evidence that fits in the pre-, post-, and vasectomy reversal (VR) stages, we identified a total of n = 210 studies from which only n = 21 were finally included following two procedures of eligibility evaluation. Conclusions: The topic surrounding this intricate landscape has created debate since the current evidence is contradictory, limited, or does not exist. Starting from this consideration, we argue that further research is mandatory to decipher how a vasectomy might disturb homeostasis.

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“…Uncontaminated sperm such as blood can be retrieved only by MESA, and there is no need for special procedures before cryopreservation. Previously we reported that MESA completed using the micropuncture technique resulted in higher fertilization and pregnancy rates [ 14 ]. The advantage of MESA is that a large quantity of sperm can be cryopreserved in a single procedure for future attempts at ICSI and that a clinical pregnancy rate of 42%-60% can be achieved [ 15 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

Microscopic Epididymal Sperm Aspiration (MESA) Should be Employed Over Testicular Sperm Extraction (TESE) Sperm Retrieval Surgery for Obstructive Azoospermia (OA)

Hibi¹,

Sonohara²,

Sugie³

et al. 2023

Cureus

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Introduction: Testicular sperm extraction (TESE) has been widely used as a sperm extraction surgery for azoospermia even for obstructive azoospermia (OA) because it does not require surgical skill. However, there are postoperative pain issues, and subsequent testicular atrophy and decreased testosterone levels may occur with TESE. This study examines the usefulness of microscopic epididymal sperm aspiration (MESA) for OA. Methods: We studied 108 patients diagnosed with OA and treated with MESA at our institute between April 2004 and December 2021. The MESA was performed using a micropipette with a micropuncture technique under an operative microscope. When no sperm were present or motility was not observed, additional punctures to the epididymal tubule were performed. Results: Motile sperm were recovered in all cases (108 cases). Of these, intracytoplasmic sperm injection (ICSI) using frozen-thawed sperm was performed in 101 cases and the normal fertilization rate was 76.2%. A total of 436 embryo transfer (ET) cycles were performed. The implantation rate per transfer cycle was 47.9%, the clinical pregnancy rate was 41.0%, and the live birth rate was 23.7%. The per-case live birth rate was 84.8%. Conclusions: MESA-ICSI has a very good fertilization rate, clinical pregnancy rate, and delivery rate. Furthermore, the patient's postoperative pain is less, the number of sperm collected is larger, the burden on the embryologist who processes the collected sperm is less, and ICSI can be easily attempted after frozen-thawed sperm. MESA rather than TESE should be employed for the OA subjects.

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Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration

Cited by 10 publications

References 17 publications

Cryptozoospermia: Should we use ejaculated sperm or surgically retrieved sperm for assisted reproductive technology?

Cryptozoospermia: Should we use ejaculated sperm or surgically retrieved sperm for assisted reproductive technology?

A Narrative Review Discussing Vasectomy-Related Impact upon the Status of Oxidative Stress and Inflammation Biomarkers and Semen Microbiota

Microscopic Epididymal Sperm Aspiration (MESA) Should be Employed Over Testicular Sperm Extraction (TESE) Sperm Retrieval Surgery for Obstructive Azoospermia (OA)

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