Abstract
To determine whether there are differences in IVF outcome in patients with sperm obtained via testicular biopsy versus epididymal aspiration. Retrospective data analysis from a large private IVF center. The study included data from 98 women undergoing IVF during 2000–2002. Patients were grouped according to method of sperm collection for their IVF cycles. Thirty-six cycles utilized sperm obtained via epididymal aspiration (EA) and 62 cycles utilized sperm obtained via testicular biopsy (TB). All patients were downregulated with a standard long leuprolide acetate protocol, and underwent controlled ovarian stimulation (COH) using recombinant FSH (rFSH). Final follicular maturation was achieved with urinary hCG when the lead follicle reached at least 17 mm in diameter. Embryos were transferred on day 3. Demographic and cycle data were analyzed via the Mann-Whitney Rank Sum test. Implantation and pregnancy rates were analyzed via the chi-square test. Data are presented as medians (25%-75% range). There were no significant differences noted between the two groups in terms of demographic, stimulation or laboratory data. The EA group had a significantly higher (p=0.005) implantation rate (IR) when compared to the TB group. Clinical pregnancy and live birth rates are reported per cycle start. There was also a trend (p=0.060) towards higher clinical pregnancy rate in the EA group. Live birth rate also tended to be higher in the EA group. All data are summarized below: The group of patients with sperm obtained via epididymal aspiration had a higher implantation rate compared to the testicular biopsy group. The higher IR and trend towards higher clinical pregnancy and birth rate did not appear to be explained by differences in stimulation, follicular or oocyte data. Whether or not these differences were due primarily to variations in sperm quality between obstructive versus non-obstructive azoospermia, or due to other unrelated causes remains to be determined. Unfortunately, detailed embryo data was not available for this analysis and we are currently assessing embryo quality. Patients with EA as the source of their sperm trended towards higher IVF success than patients with TB as their sperm source, though this trend did not reach statistical significance.
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