MP31-02 MICROTESE AND CRYOPRESERVED SPERM - A DECISION-MAKING DILEMMA FOR PATIENTS AND PROVIDERS

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-02 MICROTESE AND CRYOPRESERVED SPERM - A DECISION-MAKING DILEMMA FOR PATIENTS AND PROVIDERS Johnathan Doolittle, Darren Bryk, Scott Lundy, and Sarah Vij Johnathan DoolittleJohnathan Doolittle More articles by this author , Darren BrykDarren Bryk More articles by this author , Scott LundyScott Lundy More articles by this author , and Sarah VijSarah Vij More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A known disadvantage of frozen microdissection testicular sperm extraction (mTESE) is the negative impact of cryopreservation and subsequent thawing of any sperm that are obtained. A post thaw (PT) sample provides insight in to how the sample withstands this stress and the predicts likelihood of sperm available for intracytoplasmic sperm injection (ICSI). If a PT cannot be performed due to such low numbers of sperm identified or no pre-freeze motility, providers and couples arrive at a challenging decision in their fertility pathway - pay for an additional sperm retrieval procedure or proceed with a sample that may not be sufficient for ICSI, requiring a back-up plan. Our study sought to characterize the ICSI outcomes after retrieval of motile sperm during frozen mTESE at our institution. METHODS: A retrospective chart review was conducted from 2012 through 2020 to identify all men that underwent frozen mTESE with successful retrieval of motile sperm. Prior sperm extraction or biopsy, testis size, hormone levels, genetics and prior semen analyses were recorded. A PT and recommendations regarding ISCI were made by the lead embryologist at our institution. When available, ISCI outcomes were recorded. RESULTS: Of the 88 men who underwent frozen mTESE, motile sperm were identified in 26.1% (23/88). 16 of these samples were assessed with a PT, of which 12/16 had PT motility. Of these 12, 10 specimens were deemed sufficient to proceed to ISCI by the embryologist whereas the remaining 2 couples were advised to consider fresh mTESE. ICSI records were available for 7 of the 12 patients with PT motility. All 7 cycles led to embryos for transfer, resulting in 6 pregnancies and 5 live births. Of the 11 men without PT motility, ICSI records were available for 6 couples. 3 underwent subsequent fresh mTESE all leading to embryos for transfer but no pregnancies, and 3 proceeded straight to ICSI, 2 of which created an embryo for transfer, with 1 resulting in an ongoing pregnancy. CONCLUSIONS: Of those men who have successful frozen mTESE, as defined as recovery of motile sperm, some may be advised to pursue fresh mTESE based on poor PT parameters or absence of PT due to poor pre-freeze parameters. This creates a very difficult decision for couples. Although frozen mTESE potentially spares the female partner an unnecessary IVF cycle, we often place couples in a difficult position to make a decision about whether to proceed to ICSI absent PT or in the setting of poor PT motility. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e555-e555 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Doolittle More articles by this author Darren Bryk More articles by this author Scott Lundy More articles by this author Sarah Vij More articles by this author Expand All Advertisement Loading ...