Testicular versus epididymal spermatozoa in intracytoplasmic sperm injection treatment cycles.
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Normal fertilization and ongoing pregnancy can be achieved using intracytoplasmic sperm injection (ICSI), even with severely immature spermatozoa. However, the published literature documents conflicting results as to the outcome of ICSI.Surgical extraction of spermatozoa in 111 ICSI treatment cycles performed over five years at the Assisted Conception Unit (ACU), University College Hospital (UCH), was retrospectively evaluated to compare the outcome of ICSI treatment using either testicular or epididymal spermatozoa.A higher normal fertilization rate and lower abnormal fertilization rate was observed in the epididymal spermatozoa group than in the testicular spermatozoa group. Embryo development on day 3 after fertilization and implantation was significantly better in the epididymal spermatozoa group. Clinical and ongoing pregnancy rates were higher and the spontaneous miscarriage rate lower in the epididymal spermatozoa group, but only the clinical pregnancy rate reached statistical significance.The origin of surgically extracted spermatozoa has an effect on the success of assisted reproduction using ICSI, and the immaturity of testicular spermatozoa may affect fertilization, embryo development, implantation and pregnancy.Keywords:
Testicular sperm extraction
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Sperm Retrieval
Testicular sperm extraction
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Normal fertilization and ongoing pregnancy can be achieved using intracytoplasmic sperm injection (ICSI), even with severely immature spermatozoa. However, the published literature documents conflicting results as to the outcome of ICSI.Surgical extraction of spermatozoa in 111 ICSI treatment cycles performed over five years at the Assisted Conception Unit (ACU), University College Hospital (UCH), was retrospectively evaluated to compare the outcome of ICSI treatment using either testicular or epididymal spermatozoa.A higher normal fertilization rate and lower abnormal fertilization rate was observed in the epididymal spermatozoa group than in the testicular spermatozoa group. Embryo development on day 3 after fertilization and implantation was significantly better in the epididymal spermatozoa group. Clinical and ongoing pregnancy rates were higher and the spontaneous miscarriage rate lower in the epididymal spermatozoa group, but only the clinical pregnancy rate reached statistical significance.The origin of surgically extracted spermatozoa has an effect on the success of assisted reproduction using ICSI, and the immaturity of testicular spermatozoa may affect fertilization, embryo development, implantation and pregnancy.
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For men with uncorrectable obstructive azoospermia, their only hope of fathering a child is microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilization (IVF). In 1988, proximal epididymal sperm were demonstrated to have better motility than senescent sperm in the distal epididymis, and it was thought that retrieval of motile sperm from the proximal epididymis would yield reliable fertilization and pregnancy rates after conventional IVF. However, the results to date have been poor, and although a minority of patients achieved good fertilization rates with IVF, the vast majority (81%) had consistently poor or no fertilization and the pregnancy rate averaged only 9%. Recently, intracytoplasmic sperm injection (ICSI) has been successfully used to achieve fertilization and pregnancies for patients with extreme oligoasthenozoospermia. ICSI has therefore been applied to cases of obstructive azoospermia and, in this report, 67 MESA-IVF cases are compared with 72 MESA-ICSI cases. The principle that motile sperm from the proximal segments of the epididymis should be used for ICSI was followed, although in the most severe cases in which there was an absence of the epididymis (or absence of sperm in the epididymis), testicular sperm were obtained from macerated testicular biopsies. These sperm only exhibited a weak, twitching motion. In 72 consecutive MESA cases, ICSI resulted in fertilization and normal embryos for transfer in 90% of the cases, with an overall fertilization rate of 46%, a cleavage rate of 68%, and ongoing or delivered pregnancy rates of 46% per transfer and 42% per cycle. The pregnancy and take-home baby rates increased from 9% and 4.5% with IVF to 53% and 42% with ICSI. There were no differences between the results for fresh epididymal, frozen epididymal or testicular sperm, and the number of eggs collected did not affect the outcome. The results were also unaffected by the aetiology of the obstruction such as congenital absence of the vas deferens or failed vasoepididymostomy. The only significant factor which affected the pregnancy rate was female age. It is concluded that although complex mechanisms involving epididymal transport may be beneficial for conventional fertilization of human oocytes (in vivo or in vitro), none of these mechanisms are required for fertilization after ICSI. Given the excellent results with epididymal and testicular sperm, ICSI is obligatory for all future MESA patients. Finally, the use of ICSI with testicular sperm from men with non-obstructive azoospermia is also discussed.
Obstructive azoospermia
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Objective:To study the association of sperm DNA integrity with sperm parameters and pregnancy outcomes of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods:Sperm chromatin structure assay(SCSA)was performed to test sperm chromatin integrity(SCI)in 148 ART cycles,and the results were expressed as DNA fragmentation index(DFI).According to the level of DFI,the 148 cycles were allocated to a high DFI group(DFI≥30%)and a low DFI group(DFI30%),each of which was again divided into an IVF and an ICSI subgroup.The semen parameters and the outcomes of IVF/ICSI were compared between groups.Results:DFI was negatively correlated with the sperm concentration,progressive motility(a+b)and morphology(P0.01).Fertilization rate(P0.05)and optimal embryo rate(P0.05)in IVF treatment with DFI30% was significantly higher than those with DFI≥30%.No statistically significant differences were seen between fertilization rate,cleavage rate and optimal embryo ratein other groups.The clinical pregnancy rate and implantation rate showed no significant differences between each group.However,clinical pregnancy rate and implantation rate in ICSI group with DFI≥30% seemed to be higher than in any other subgroup.Conclusion:The integrity of sperm DNA is negatively correlated with the sperm parameters and has an adverse effect on fertilization rate and optimal embryo rate,while has no effect on clinical pregnancy rate and implantation rate.But ICSI should be suggested as the preferred method when DFI exceeds 30% and the sperm DNA integrity should be detected before IVF/ICSI.
Assisted Reproductive Technology
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Testicular sperm extraction
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Obstructive azoospermia
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This new procedure principally aims to avoid a second or possibly multiple surgical procedures for sperm extraction from the male partner in cases of limited amounts of sperm cells, where normal freeze-thaw protocols would fail. Patients (n = 34) diagnosed as azoospermic, extreme oligozoospermic, or oligoasthenozoospermic underwent the process of sperm cryopreservation within evacuated egg zonae. Other samples were allocated to conventional sperm freezing. Sperm samples were acquired using testicular sperm extraction (TESE), microepididymal sperm aspiration (MESA), or fresh ejaculate. Subsequently, five of these 34 couples have undergone in-vitro fertilization (IVF) and achieved normal fertilization using post-thawed spermatozoa frozen under zonae pellucidae in conjunction with intracytoplasmic sperm injection (ICSI). The average fertilization rate for the post-thaw injected spermatozoa was 65%. This is comparable with the regular fertilization rate of 65% for combined MESA and TESE using fresh spermatozoa. All patients underwent embryo transfer. The average implantation rate per embryo was 31%; nearly the same for regular MESA/TESE ICSI cycles (32%). The first pregnancy associated with this procedure concluded with the full term delivery of healthy twin girls on July 18, 1997. The remaining four thaw procedures resulted in another twin delivery, an ongoing singleton gestation, a negative pregnancy test and a biochemical pregnancy respectively.
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A retrospective analysis in 50 couples of 53 cycles of intracytoplasmic sperm injection (ICSI) with immotile spermatozoa from testicular-retrieved spermatozoa was performed to evaluate whether total immotile spermatozoa achieved after testicular sperm extraction could fertilize ova and result in pregnancies. We assessed the efficacy of ICSI with totally immotile testicular spermatozoa extracted from the testes of azoospermic patients with severe spermatogenic failure (group 1) and compared these results with those from spermatozoa which were recovered after several hours of incubation and were motile (group 2) at the time of injection. In 19 cycles, only totally immotile spermatozoa were injected at the time of ICSI. For the remaining 34 cycles, at least one motile spermatozoon was found for injection. The oocyte fertilization rates were 51% for group 1 and 62% for group 2 (P < 0.02). Eighteen of 19 cycles in group 1 (90%) and all 34 (100%) cycles in group 2 had embryos for replacement. The mean number of embryos per cycle was 5.2 ± 0.8 and 7.5 ± 0.9 in groups 1 and 2 respectively; this and the embryo quality (cumulative embryo scoring = 40 ± 8 for group 1 and 50 ± 7 for group 2), and clinical pregnancy rates (15.8% per oocyte retrieval in group 1 and 23.5% in group 2) were not significantly different between groups. Fertilization, cleavage and pregnancy can be achieved with intracytoplasmic testicular sperm injection from patients with immotile spermatozoa, at levels comparable with those of ICSI using motile spermatozoa.
Testicular sperm extraction
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Testicular sperm extraction
Vas deferens
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