Clinical outcomes and development of children born to couples with obstructive and nonobstructive azoospermia undergoing testicular sperm extraction-intracytoplasmic sperm injection: A comparative study.

To evaluate and compare the clinical outcomes and development of children born between obstructive azoospermia (OA) couples and nonobstructive azoospermia couples (NOA) after testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). Data were collected from infertile couples suffering from azoospermia who underwent TESE and ICSI from January 2001 to December 2009 at Chang Gung Memorial Hospital, Taiwan. A total of 154 ICSI cycles were performed using extracted testicular sperm from men with obstructive azoospermia (67 ICSI cycles) and men with nonobstructive azoospermia (87 ICSI cycles). Retrospective analysis of clinical outcomes and development of children born after TESE-ICSE between obstructive azoospermia couples and nonobstructive azoospermia couples. The assisted reproductive technology (ART) result between OA and NOA groups, including age, E2 level on hCG day, number of oocytes retrieved, normal fertilization rate, zygote Grade 1 score distribution, number of top-quality embryos transferred, clinical pregnancy rate per transfer, chemical pregnancy rate per transfer, implantation rate, live birth rate per transfer, and abortion rate per transfer, were all similar. Thirty-one live births resulted from 67 ICSE cycles in the OA group and 33 live births from 87 ICSE cycles in the NOA group. The obstetric and perinatal outcomes were similar between the groups, and children conceived by using ICSI were generally healthy without raised tendency of major birth defect and development impairment. In our study, there were no differences in the fertility rate and clinic pregnancy rate between the OA and NOA groups using TESE-ICSI. Also, the clinical outcomes and development of children were similar between the OA and the NOA groups using TESE-ICSI.

Tsai YR ，Huang FJ ，Lin PY ，Kung FT ，Lin YJ ，Lan KC ... -  《-》

Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study.

To evaluate the clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) with extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia (OAT) sperm. Retrospective study. Infertility clinic at Chang Gung Memorial Hospital. A total of 126 ICSI cycles were performed using extracted testicular sperm from men with azoospermia and 65 ICSI cycles using fresh ejaculated sperm from men with extreme severe OAT. Retrospective analysis of clinical outcomes and development of children born after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm. Fertilization rates, number of grade 1 zygotes and number of embryos produced, implantation rate, clinical pregnancy rate, abortion and live birth rate per transfer, perinatal outcomes, and birth defects. The demographic and clinical factors, including age, E(2) level on hCG day, number of oocytes retrieved, normal fertilization rate, zygote grade 1 score distribution, number of top-quality embryos transferred, clinical pregnancy rate per transfer, chemical pregnancy rate per transfer, implantation rate, live birth rate per transfer, and abortion rate per transfer, were similar between the groups. Sixty live births resulted from 48 extracted testicular sperm cycles and 21 live births from 19 extreme severe OAT. The obstetric and perinatal outcomes were similar between the groups, and children conceived by using ICSI were healthy and without major psychomotor or intellectual development retardation. One case of tetralogy of Fallot occurred in each group. There is no evidence of differences in the clinical outcomes and development of children result after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm.

Tsai CC ，Huang FJ ，Wang LJ ，Lin YJ ，Kung FT ，Hsieh CH ，Lan KC ... -  《-》

Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients.

Kanto S ，Sugawara J ，Masuda H ，Sasano H ，Arai Y ，Kyono K ... -  《-》

Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference?

How do live birth rates compare after intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia when using sperm derived from testicular sperm extraction (TESE) versus microsurgical epididymal sperm aspiration (MESA)? Our study suggests that proximal epididymal sperm (from MESA) result in higher live birth rates as compared with testicular sperm (from TESE) in couples where the man has obstructive azoospermia due to congenital bilateral absence of the vas deferens (CBAVD) or vasectomy. For couples with obstructive azoospermia, MESA (epididymal sperm) and TESE (testicular sperm) have generally been assumed to be equivalent for use in ICSI. But this assumption has never been confirmed, and this view has important clinical and basic scientific consequences. This was a retrospective study of a consecutive cohort of 374 men with obstructive azoospermia and normal spermatogenesis, who underwent IVF and ICSI using either epididymal sperm or testicular sperm in the period 2000-2009. The study included men undergoing MESA or TESE at St. Luke's Hospital for obstructive azoospermia due to CBAVD or vasectomy. A total of 280 couples underwent MESA and 94 underwent TESE with ICSI. The live birth rate was 39% after MESA-ICSI and 24% after TESE-ICSI. The MESA-ICSI cycles also resulted in a significantly higher implantation rate and significantly higher clinical and ongoing pregnancy rates than the TESE-ICSI cycles. There was no significant difference in results between fresh or frozen sperm for both MESA and TESE. When adjusted for the available confounders, the odds ratio for live birth was significantly in favour of MESA-ICSI versus TESE-ICSI (OR 1.82; 95% CI 1.05-3.67). The only significant confounders were female age and ovarian reserve. This is a retrospective cohort study and not a randomized clinical trial. Our study suggests that some aspect of sperm maturation after the sperm leaves the testicle to enter the epididymis is required for the most optimal results, even when ICSI is used for fertilization. No funding was used and there are no competing interests.

van Wely M ，Barbey N ，Meissner A ，Repping S ，Silber SJ ... -  《-》

The effect of advanced paternal age on the outcomes of assisted reproductive techniques among patients with azoospermia using cryopreserved testicular spermatozoa.

To determine whether advanced male age influences the outcome of intracytoplasmic sperm injection (ICSI) following the cryopreservation of spermatozoa obtained through testicular sperm extraction (TESE). Data were collected from infertile couples suffering from azoospermia who underwent TESE and ICSI from January 1998 to August 2010. There were 212 ICSI cycles using extracted testicular sperm after cryopreservation in this retrospective clinical analysis. The participating men all underwent testicular biopsy and subsequent tissue cryopreservation in a single academic tertiary care medical center. Those cryopreserved sperm were used during consecutive intracytoplasmic sperm injection treatment cycles. Female partners underwent individualized controlled ovarian hyperstimulation programs. A total of 184 ICSI cycles were divided into the following two evaluation designs: (1) total cycles irrespective maternal age; (2) ICSI cycles with maternal age <34 years. Male partners were stratified into age categories at 5-year intervals (31-35 years, 36-40 years, and 41-51 years) in these two designs. In the first design, most outcomes of assisted reproductive techniques were similar during the three groups, but the maternal age is much lower in the first group, and the mean number of retried oocytes and estradiol level on the day of human chorionic gonadotropin injection was significantly higher in the first group. In the second design, the outcome of intracytoplasmic sperm injection and clinical factors including the estradiol level on the day of human chorionic gonadotropin injection, the number of retrieved oocytes, the rate of cleaved oocytes, the number of transferred embryos, the numbers of transferred good embryos, the clinical pregnancy rate per transfer cycle and the implantation rate were similar among the three groups of women aged <34 years after adjusting for female age. There is insufficient evidence to demonstrate an unfavorable effect of advanced paternal age on the fertility outcome for TESE-ICSI. The thawed testicular spermatozoa from males aged ≤ 40 years did not have an adverse impact on ICSI outcomes.

Tsai YR ，Lan KC ，Kung FT ，Lin PY ，Chiang HJ ，Lin YJ ，Huang FJ ... -  《-》