Clinical outcome is associated with diagnosis and sperm preparation method in azoospermic males

Abstract

Objective: Obstructive and nonobstructive azoospermia accounts for a relatively high incidence of male factor infertility. These patients require epididymal aspirations and/or testicular biopsies performed either the day of egg retrieval or prior to cycle start. This study investigated impact of sperm preparation conditions, source, and diagnosis on IVF outcome. Design: Retrospective analysis of patients undergoing ICSI with fresh or frozen testicular or epididymal sperm at Brigham and Women’s Hospital, Boston, MA from 1998–2002. Materials and Methods: 141 ICSI cycles from 84 patients were identified that had utilized fresh or frozen testicular or epididymal sperm. Embryo quality (i.e. % ≥ 8 cells with <10 fragments), implantation, and ongoing pregnancy rates were assessed with respect to time of sperm harvest (fresh or frozen), sperm origin, and azoospermia diagnosis (obstructive or nonobstructive). Results were analyzed using Chi-square and Mann-Whitney U tests as appropriate with p< 0.05 considered statistically significant. Results: No statistical difference was found in the ongoing pregnancy rates (50.0% vs 39.5%) or overall embryo quality (21.7% vs 21.3%) between epididymal or testicular sperm regardless of whether it was fresh or frozen. However, there was a significantly increased implantation rate with all fresh sources versus all frozen sources ( 26.1% vs 16.8%, p=0.014). Comparison of obstructive versus non-obstructive azoospermia using testicular specimens showed a significant increase in pregnancy rate, implantation rate, and embryo quality in the obstructive versus non-obstructive patients. Tabled 1 Tabled 1 Conclusion: The use of fresh rather than frozen specimens for ICSI from azoospermic males results in an increased implantation rate but with no concordant increase in pregnancy rates. In addition, testicular specimens from non-obstructed males are associated with poor clinical outcome, reduced implantation rate and poorer embryo quality. Pregnancy rates using ejaculated, epididymal, or obstructive testicular sperm should not be used to counsel patients with non-obstructive azoospermia in terms of their ultimate probability of success.