Day surgery sperm retrieval using pesa or tese with elective freezing: a retrospective review of 6 years experience and 292 cases

Abstract

OBJECTIVE: To review our experience of surgical sperm retrieval with elective sperm freezing with a particular focus on sperm retrieval success, sample utilisation, pregnancy outcomes and post-operative experience. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: All day surgery percutaneous epididymal sperm aspiration (PESA) and multiple percutaneous-multiple biopsy (TESE) sperm retrieval cases with elective freezing at a large infertility centre were reviewed for a 6-year period. Azoospermic patients were referred to a single clinician (RB) who performed all cases under local anaesthetic +/− intravenous sedation. Patients with obstructive azoospermia (OA) were treated with PESA. If no sperm was retrieved or in cases of non-obstructive azoospermia (NOA), TESE was performed and 10-15 samples/testis taken with a 14 G Cook Core biopsy needle. Patients were discharged from the clinic within 2 hours post-procedure and given a post-operative questionnaire. RESULTS: 274 patients underwent 292 procedures (129 were NOA, 99 were OA (55 failed vasectomy with or without reversal, 14 bilateral congenital absence of vas deferens, 22 other obstructive origin) and 2 had anejaculation. Sperm was retrieved in 97/99 (98%) OA, 25/64 (39%) NOA cases and in 4 cases when previous open biopsies were negative. 143 cycles of ICSI led to 140 (98%) oocyte collections and 130 (91%) embryo transfer (ET) procedures. Overall, clinical pregnancy rates/ET and implantation rates were 32.3 % and 19.7 % respectively. To date, 44.7% couples have clinical pregnancies with five miscarriages, one ectopic pregnancy and 34 babies born with no major abnormalities. 7 pregnancies are ongoing. TESE sperm was used in 53 cycles and PESA sperm in 85 cycles. Pregnancy rates/ET or per couple were significantly different depending on sperm origin (PESA 36.47 %; 53.44 % vs TESE 20.75%; 28.9%). 13 patients with successful sperm retrieval await IVF and 10 with frozen sperm have not yet contacted the clinic to initiate IVF treatment. 46/274 (17%) post-operative forms were received and 6 (13%) patients experienced severe pain, 12 (26%) complained of swelling and bruising but all patients were able to resume normal activity within 5 days. Only one patient experienced a haematoma, which required no further surgical treatment. CONCLUSIONS: Percutaneous sperm retrieval is safe, simple, well accepted by patients, and gives acceptable results in terms of sperm yield. Elective sperm freezing simplifies patient management and avoids unnecessary ovarian stimulation.