ICSI results with and without Y chromosomal deletions in men with severe oligospermia and azoospermia.

Abstract

Objective: 13% of azoospermic and 7% of severely oligospermic (<2 × 106) infertile men in our IVF program have Y chromosomal deletions. It has been suggested that these patients might experience poorer results with ICSI than similarly infertile men without Y deletions (van Golde et al., 2001). The purpose of this study is to evaluate the effect of Y deletions in such men and the results of ICSI in Y-deleted men compared to similar men who are not Y-deleted. Design: Retrospective collaborative study in a community hospital and major teaching and research university setting. Materials/Methods: 28 azoospermic or severely oligospermic men with Y chromosomal microdeletions and 205 similar men without Y chromosomal deletions underwent TESE-ICSI (or ICSI) with their wives. Fertilization rate, cleavage rate, pregnancy rate and deliveries were compared. Results: For couples with less than 2 × 106 sperm undergoing ICSI or TESE-ICSI, 2PN fertilization was 57% for Y-deleted and 56% for non Y-deleted men. The pregnancy rate was 38% for Y-deleted and 36% for non Y-deleted men. The delivered pregnancy rate was 29% for Y-deleted and 26% for non Y-deleted men. There were 18 babies from Y-deleted men (10 boys and 8 girls) and 99 babies from non Y-deleted men (43 boys and 56 girls). Our data does not support any difference in ICSI outcome in Y-deleted men from non Y-deleted men with equivalent spermatogenic deficiency. A comparison to previous publications suggests that small numbers are responsible for the contrary impression. Conclusions: 1) Azoospermia or severe oligospermia associated with a discernible Y chromosomal defect did not influence fertilization, or pregnancy rates with ICSI or TESE-ICSI, so long as sperm was present. 2) However, Y chromosomal defects beyond the AZFc region were associated with failure to find sperm, and Y chromosomal deletions limited to AZFc were associated with a good prognosis for finding sperm. 3) There were roughly equivalent numbers of boys and girls delivered from ICSI in both Y-deleted and non Y-deleted groups.