Outcome of intracytoplasmic sperm injection (ICSI) using epididymal and testicular sperm from azoospermic men: the cleveland clinic experience

Abstract

Objective: Sperm retrieval from testis and epididymis, combined with ICSI, has significantly enhanced the chances of azoospermic men to father their own genetic offspring. The impact of the sperm origin (epididymal versus testicular) and status (fresh versus frozen-thawed), and the etiology of azoospermia <obstructive versus non-obstructive azoospermia (NOA)>on sperm reproductive capacity is not well established. In this retrospective analysis, we examined the outcome of ICSI with use of epididymal versus testicular spermatozoa in patients with OA and NOA. Design: Retrospective study Materials/Methods: We collected data of 32 infertile men (26 with OA and 6 with NOA) treated with ICSI. Out of the 26 obstructive cases, 10 were diagnosed with congenital absence of vas deferens, 9 with failed vasectomy reversal, 2 with congenital bilateral ejaculatory duct obstruction and 5 with post-inflammatory obstruction. Female partners underwent a standard protocol of controlled ovarian stimulation. Techniques of MESA and TESE were used for sperm retrieval in OA, whereas TESE was used in NOA cases. Data were collected on normal fertilization and embryo development rates and on pregnancy rates (per patient and per cycle). Results: A total of 52 ICSI cycles were performed including 42 cycles from patients with OA and 10 cycles from NOA. Epididymal sperm was used in 32 cycles (12 cycles with fresh and 20 with frozen-thawed sperm), whereas testicular sperm was used in the remaining 20 cycles (11 cycles with fresh and 9 with frozen sperm). Study parameters are shown in the table. Normal fertilization and pregnancy rates per cycle did not differ significantly (p >0.05) in relation to etiology (obstructive versus non-obstructive), origin (epididymal versus testicular) or type of sperm (fresh versus frozen-thawed). However, normal embryo development rates were significantly lower in NOA versus OA cases (0.0004). Normal embryo development rates and pregnancy rates per patient were significantly lower with frozen testicular sperm compared to frozen epididymal sperm (p = 0.004 & 0.03, respectively). Abortion was noted in 1/12 (8%) cycles with fresh epididymal sperm, 1/20 (5%) cycles with frozen-thawed epididymal sperm and 1/9 (11%) cycles with of frozen-thawed testicular sperm. Tabled 1ParametersICSI with Fresh Epididymal Sperm (n = 12)ICSI with Frozen- thawed epididymal Sperm (n = 20)ICSI with Fresh Testicular Sperm (n = 11)ICSI with Frozen- thawed Testicular Sperm (n = 9)Female Partner’s Age (mean ± SD)33 ± 332 ± 432 ± 233 ± 3Number of Oocytes Retrieved (mean ± SD)15 ± 615 ± 614 ± 914 ± 6Normal Fertilization Rate (%)62565350Normal Embryo Development Rate (%)69756962Pregnancy Rate Per Cycle (%)28363633Pregnancy Rate Per Patient (%)60676337 Open table in a new tab Conclusions: Our study showed no significant difference in fertilization, embryo development or pregnancy rates with fresh epididymal versus fresh testicular sperm. Also, fertilization and pregnancy rates were comparable for OA versus NOA cases, and for fresh versus frozen-thawed sperm both from epididymis and testis. However, frozen testicular sperm resulted in a lower embryo development rate and a relative increase of abortion rate than frozen epididymal sperm. Simultaneous retrieval of fresh sperm from testis combined with ICSI may help improve the outcome in NOA. Supported by: None.