MP43-02 COMBINATION OF MICROSCOPIC TESTICULAR SPERM EXTRACTION (MTESE) AND DENSITY GRADIENT PROCESSING TO OPTIMIZE SPERM RETRIEVAL AND PREGNANCY OUTCOMES IN MEN WITH NONOBSTRUCTIVE AZOOSPERMIA (NOA)

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP43-02 COMBINATION OF MICROSCOPIC TESTICULAR SPERM EXTRACTION (MTESE) AND DENSITY GRADIENT PROCESSING TO OPTIMIZE SPERM RETRIEVAL AND PREGNANCY OUTCOMES IN MEN WITH NONOBSTRUCTIVE AZOOSPERMIA (NOA) Nicholas Deebel, Banafsheh Nikmehr, Janmejay Hingu, Collette O'Connor, Rachel Ruble, Yueqiang Song, Ayse Vuruskan, Anuradha Devineni, Cihan Halicigil, Stuart Howards, Tamer Yalcinkaya, and Hooman Sadri-Ardekani Nicholas DeebelNicholas Deebel More articles by this author , Banafsheh NikmehrBanafsheh Nikmehr More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Collette O'ConnorCollette O'Connor More articles by this author , Rachel RubleRachel Ruble More articles by this author , Yueqiang SongYueqiang Song More articles by this author , Ayse VuruskanAyse Vuruskan More articles by this author , Anuradha DevineniAnuradha Devineni More articles by this author , Cihan HalicigilCihan Halicigil More articles by this author , Stuart HowardsStuart Howards More articles by this author , Tamer YalcinkayaTamer Yalcinkaya More articles by this author , and Hooman Sadri-ArdekaniHooman Sadri-Ardekani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: mTESE with Intracytoplasmic sperm injection (ICSI) is the gold standard for treating infertile couples when NOA in the male is present. However, using conventional tissue processing techniques, many patients will remain negative for sperm on mTESE. Standard practice in assisted reproduction technology (ART) does not utilize the density gradient centrifugation process following mTESE. We hypothesize that gradient utilization can enrich sperm retrieval following mTESE. METHODS: Men with NOA underwent mTESE from 2019-2022 by a single surgeon. The biopsy specimens underwent mechanical dissection. Subsequent tissue processing and gradient wash were carried out through a gradient column including 90% and 50% gradient solution diluted in standard sperm wash medium. Upon verification of sperm, the post-gradient sperm and remaining un-dissociated tissue were cryopreserved separately. On the day of ICSI, the frozen gradient sperm were thawed to recover viable sperm. If needed, frozen tissue was thawed, subjected to mechanical dissociation, and a subsequent gradient to obtain enough viable sperm. Fertilization and embryo development were assessed morphologically with the Embryoscope and genetically with preimplantation genetic testing for aneuploidy (PGT-A). Following embryo transfer, biochemical (ß-HCG) and clinical (gestational sac) pregnancy were assessed. RESULTS: Overall, 24 male patients (36±1.5 years old) with NOA underwent mTESE for an average operating time of 110.6±6.9 minutes (range: 37-177). The primary sperm identification rate after mechanical dissociation of tissue was 37.5% (n=9). The use of the density gradient led to an overall sperm retrieval rate of 70.8% (n=17) (p<0.05) and secondary sperm retrieval rate (sperm identification in initially negative patients) of 53.3% (n=8). Retrieved sperm were cryopreserved to be used for ICSI. Thirteen couples (average female age and AMH 32.1±1.6 and 3.2±0.8 ng/ml respectively) underwent ICSI using extracted sperm. The overall fertilization, per-cycle pregnancy, and per-transfer pregnancy rates were 66%, 76%, and 100% respectively. Amongst these couples, 6 underwent PGT-A, and 70.0% of tested blastocysts were euploid. CONCLUSIONS: Utilization of mTESE with subsequent gradient technology may serve as a highly sensitive sperm detection and enrichment method for NOA patients in order to obtain superior ART outcomes. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e601 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Deebel More articles by this author Banafsheh Nikmehr More articles by this author Janmejay Hingu More articles by this author Collette O'Connor More articles by this author Rachel Ruble More articles by this author Yueqiang Song More articles by this author Ayse Vuruskan More articles by this author Anuradha Devineni More articles by this author Cihan Halicigil More articles by this author Stuart Howards More articles by this author Tamer Yalcinkaya More articles by this author Hooman Sadri-Ardekani More articles by this author Expand All Advertisement PDF downloadLoading ...