Abstract
ObjectiveTo study the efficacy of percutaneous epididymal sperm aspiration (PESA) in combination with short time insemination to treat infertile men with obstructive azoospermia (OA).DesignPaired randomized controlled trial in which each couple’s cohort of oocytes was divided into two equal groups.SettingCenter for reproductive care.PatientsTwenty men with OA.InterventionsMotile spermatozoa were collected using PESA. Half of the oocytes were used for intracytoplasmic sperm injection (ICSI). The rest were inseminated briefly with PESA sperm in vitro fertilization (IVF). After 4–5 h, the remaining cumulus cells were removed mechanically for second polar body observation to decide whether to apply “rescue” ICSI (RE-ICSI).Main outcome measuresRates of oocyte maturation, fertilization, cleavage, and good quality embryos. Numbers of available embryos and good quality embryos were compared between PESA-IVF (using a short incubation protocol + rescue ICSI) group and PESA-ICSI group.ResultsIn the short time insemination group, cumulus cells were dispersed by PESA spermatozoa. No second polar bodies were found, so RE-ICSI was done. PESA-IVF + RE-ICSI and PESA-ICSI outcomes were comparable in terms of fertilization rates, 2PN cleavage rate and good quality embryo rates with no statistically significant differences.ConclusionsPESA sperm without centrifugation could disperse the cumulus cells but were infertile and therefore could substitute for synthetic hyaluronidase. The outcomes of PESA-IVF with rescue ICSI were equivalent to PESA-ICSI. Using spermatozoa obtained by PESA and IVF before RE-ICIS is a viable treatment for men with OA.
Highlights
Obstructive azoospermia (OA) is characterized by an occlusion or partial absence of the male reproductive tract with the presence of normal spermatogenesis [1]
In the short time insemination group, cumulus cells were dispersed by percutaneous epididymal sperm aspiration (PESA) spermatozoa
PESA-in vitro fertilization (IVF) + RE-intracytoplasmic sperm injection (ICSI) and PESA-ICSI outcomes were comparable in terms of fertilization rates, 2PN cleavage rate and good quality embryo rates with no statistically significant differences
Summary
The patients’ mean age was 25.6±5.3 years, the female partners ranged in age from 22 to 32 years with a mean duration of primary infertility of 4.1±4.7 years. The cumulus cells had been dispersed by the PESA spermatozoa and were easy to remove after 4 h in the IVF short time insemination group. Spermatozoa obtained by PESA plus short time insemination and RE-ICSI is a valid treatment for men with OA. PESA-derived spermatozoa can disperse the cumulus cells instead of hyaluronidase, so we can use them for PESA-IVF (using a short incubation protocol+rescue ICSI). Unique features of our study include using motility spermatozoa acquired from PESA without centrifugation, a short period insemination to disperse the cumulus cells and simulate physiological conditions, and RE-ICSI performed as early as possible when no second polar body was found. Compared with PESA-ICSI, the procedure of PESA-IVF plus RE-ICSI can disperse the cumulus cells but needs enough motile sperm. The PESA-IVF plus RE-ICSI procedure is more “complicated” than using ICSI directly but can offer a feasible method for the treatment of men with OA
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