Abstract
Objective. To optimise the use of freeze/thaw testicular immotile spermatozoa from nonobstructive azoospermia patients and to analyse the outcome of intracytoplasmic sperm injection (ICSI) of such spermatozoa. Methods. Testicular specimens were retrieved and cryopreserved from forty patients with nonobstructive azoospermia and underwent one cycle with thawed spermatozoa (Group I) that led to pregnancy in sixteen cases. Twenty-four patients of group I underwent treatment with the same batch of thawed spermatozoa (Group II). For the first ICSI attempt, injection was performed when motile spermatozoa were found. In group II, injection was performed when maximum motility was reached. We compared mean of fertilization rate, embryo quality, clinical pregnancy rate and embryo implantation rate. Results. The mean percentage of motility was significantly higher in the group II than in the group I (18, 6 versus 8, 2). Group I showed a significant decrease in fertilization rates when compared with cryopreserved testicular spermatozoa in group II (54% versus 72%, P < 0.05). No difference was noted between the cleavage rate, embryo quality, clinical pregnancy rates and implantation rates among group II and I. Conclusion. Fecundation rate can be significantly improved after in-vitro culture and sperm selection of frozen-thawed immotile testicular spermatozoa in patients with nonobstructive azoospermia.
Highlights
It has been shown that the combination of human testicular sperm biopsy and intracytoplasmatic sperm injection (ICSI) is an efficient method for the treatment of male-factor infertility caused by azoospermia [1,2,3,4]
We studied forty couples in which the husband was diagnosed as having nonobstructive azoospermia (NOA) and only immotile testicular sperm cells were isolated by testicular sperm extraction (TESE)
Several authors have demonstrated that performing intracytoplasmic sperm injection (ICSI) with fresh or frozen spermatozoa produces similar results [7, 8, 18, 19], and that freezing does not affect the spermatozoa [20]
Summary
It has been shown that the combination of human testicular sperm biopsy and intracytoplasmatic sperm injection (ICSI) is an efficient method for the treatment of male-factor infertility caused by azoospermia [1,2,3,4]. The addition of sperm cryopreservation is valuable as it may reduce the number of procedures required for pregnancy success, and repeated testicular biopsies can be avoided [5]. It seems that comparable success may be achieved with frozen-thawed and from testis spermatozoa [6,7,8]. It has been reported that the motility of testicular spermatozoa can be improved after “in vitro” culture [7, 9, 10], it is not known whether implantation and pregnancy rates are affected from such a practice [11]. Only limited data available connected with the efficacy of ICSI carried out with frozen nonmotile testicular spermatozoa
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