New Approach of Intracytoplasmic Sperm Injection With Epididymal Sperm by Retrograde Epididymal Sperm Aspiration for Multiple Failures in ART

Abstract

Male factor infertility has undergone significant changes in the last few years. The treatment for severe oligozoospermia, and obstructive azoospermia, however, are still difficult. The introduction of intracytoplasmic sperm injection (ICSI) has resulted in better fertilization and pregnancy rates in cases with severe male factor infertility. Several techniques exist to obtain the sperm of severe oligozoospermia and obstructive azoospermia. However the use of a micro-operation scope and fine technique are needed for micro-epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE). There are some risks to be expected such as subcutaneous bleeding in the percutaneous sperm aspiration (PESA). In order to obtain the sperm of severe male factor, the procedure of retrograde sperm aspiration (RESA) was designed and efficacy of RESA was evaluated in this study. RESA was undergone in severe male factor infertility couples who failed pregnant in several ICSI attempts with ejaculated spermatozoa. First, the upper side of the scrotum is opened 1cm and vas deferens is lifted. The G-24 elastic catheter is inserted into the vas toward the epididymis. Then, 0.3∼0.5ml of saline is injected and then aspirated the saline. The small number of epididymal sperms is collected with the saline, twenty -seven patients with severe male factor underwent RESA and ICSI was performed (RESA-ICSI group). Fifty-four patients (as control group), who failed pregnant at least .ve times by ICSI, underwent the ICSI with ejaculated sperm. The mean female age of RESA-ICSI group and control group were 35.1±3.3 years and 35.1±3.4 respectively. The previous cycle of ART in RESA-ICSI group was 10.5±7.5 and in control group was 10.0±6.7. The pregnancy rate per embryo transfer was 18.8% in RESA-ICSI group and 15.7% in control group. The pregnancy rate per cases of RESA-ICSI group (36.0%) tended to be higher than the control group (25.5%, not significantly). To pursue the sperm factors which reflect the efficacy of RESA, Kruger’s strict criteria (s.c.), motility rate, anomaly rate were analyzed. In the group of s.c. below 6%, pregnancy rate showed higher tendency in RESA-ICSI group as compared control group (42.1% vs. 18.2%, respective). In the motility rate patient below 50%, RESA-ICSI group showed the higher pregnancy rate tendency (43.8%) than control group (18.5%). In anomaly rate, patient below 70% showed significant higher pregnancy rate in RESA-ICSI group as compared control group (66.7% vs. 12.5%, P<0.05). RESA is a simple, safe and effective method to obtain the sperm of severe male factor infertility. It was suggested that ICSI with epididymal sperm was an effective treatment for multiple failures in some male factor patients.