Extensive sperm search is still a valuable approach to treat secretory azoospermia

Abstract

OBJECTIVE: The availability of micromanipulation procedures to treat male infertility has allowed the development of enhanced sperm identification procedures attempting at differentiating absolute versus virtual azoospermia.DESIGN: Retrospective analysis of ART cycles in men diagnosed with azoospermia and subsequently treated with ICSI following extensive sperm search.MATERIALS AND METHODS: From January 2002 to February 2009, 8,147 men were screened for infertility and 211 were diagnosed with azoospermia. Men were scheduled for TESE and on the day of surgical retrieval, spermatozoa in the ejaculate were screened first. The extensive semen analysis performed included centrifugation up to 3000g as well as suspension of the germ cells in droplets under oil and observed under an inverted microscope by several embryologists.RESULTS: A total of 134 azoospermic men that underwent 156 ICSI cycles were evaluated. The average age of the men that used ejaculated was 38.8 ± 7yrs and their partners were 35.5 ± 9 yrs. All men were scheduled for TESE, however, at the time of ICSI, spermatozoa were found in 13 (8.3%) ejaculates while 111 (71.2%) men continued to undergo testicular biopsies. From these men, spermatozoa were recovered in 87 (78.4%) cycles while none in 24 (21.6%) either in their immediate TESE sampling or even after an extended search. Therefore, 11 of them chose to use donor sperm. Another 21 men opted to use donor spermatozoa immediately. The fertilization rate was 50.0% (64/128) in ejaculated group and 53.0% (626/1,181) in TESE while the clinical pregnancy rate was 41.7% (5/12) and 37.6% (35/93), respectively. In the patients that utilized donor spermatozoa (n = 32), the fertilization rate was 75.3% (250/332) with a clinical pregnancy of 50.0% (16/32).CONCLUSIONS: Extensive screening ejaculates prior to a TESE procedure is advisable in patients with secretory azoospermia. When absolutely no sperm cells are indentified in the ejaculate, TESE or ultimately, donor gametes remain the most valuable option. OBJECTIVE: The availability of micromanipulation procedures to treat male infertility has allowed the development of enhanced sperm identification procedures attempting at differentiating absolute versus virtual azoospermia. DESIGN: Retrospective analysis of ART cycles in men diagnosed with azoospermia and subsequently treated with ICSI following extensive sperm search. MATERIALS AND METHODS: From January 2002 to February 2009, 8,147 men were screened for infertility and 211 were diagnosed with azoospermia. Men were scheduled for TESE and on the day of surgical retrieval, spermatozoa in the ejaculate were screened first. The extensive semen analysis performed included centrifugation up to 3000g as well as suspension of the germ cells in droplets under oil and observed under an inverted microscope by several embryologists. RESULTS: A total of 134 azoospermic men that underwent 156 ICSI cycles were evaluated. The average age of the men that used ejaculated was 38.8 ± 7yrs and their partners were 35.5 ± 9 yrs. All men were scheduled for TESE, however, at the time of ICSI, spermatozoa were found in 13 (8.3%) ejaculates while 111 (71.2%) men continued to undergo testicular biopsies. From these men, spermatozoa were recovered in 87 (78.4%) cycles while none in 24 (21.6%) either in their immediate TESE sampling or even after an extended search. Therefore, 11 of them chose to use donor sperm. Another 21 men opted to use donor spermatozoa immediately. The fertilization rate was 50.0% (64/128) in ejaculated group and 53.0% (626/1,181) in TESE while the clinical pregnancy rate was 41.7% (5/12) and 37.6% (35/93), respectively. In the patients that utilized donor spermatozoa (n = 32), the fertilization rate was 75.3% (250/332) with a clinical pregnancy of 50.0% (16/32). CONCLUSIONS: Extensive screening ejaculates prior to a TESE procedure is advisable in patients with secretory azoospermia. When absolutely no sperm cells are indentified in the ejaculate, TESE or ultimately, donor gametes remain the most valuable option.