Resultados da ICSI-TESE em azoospermia: influência da etiologia e criopreservação

Abstract

IntroductionAzoospermia can have an obstructive (AO) or non-obstructive (ANO) aetiology. Although in both cases testicular sperm can be used to treat male infertility, it is not well established whether success rates following intracytoplasmatic sperm injection (ICSI) are comparable. Various factors may influence the outcome of ICSI in azoospermic patients: aetiology, origin (epidimis or testicle) and sperm status (fresh or freezethawed), among others. Materials and methodsA retrospective analysis of fertilization, pregnancy and embryo implantation rates was performed following 136 ICSI cycles with motile testicular sperm in 81 couples with male factor only (azoospermia). The first part of the study analysed the effect of the azoospermia aetiology, comparing the outcome of 99 AO and 37 ANO cycles of ICSI-TESE. The second part focused on the effect of sperm cryopreservation by analyzing the outcome of 86 ICSI cycles realized with fresh and 50 cycles realized with freezethawed testicular sperm. ResultsPart I: fertilization, implantation and pregnancy outcome were lower using sperm from men with NOA, but this did not reach statistical significance. Part II: our data demonstrated similar outcome between the use of fresh or freezethawed testicular sperm in men with AO. The use of frozen-thawed testicular sperm did demonstrate a lower fertilization, implantation and pregnancy rates in men with ANO. ConclusionsThe realization of ICSI-TESE cycles in men with AO has better success prognosis than in men with ANO. The use of frozen-thawed testicular sperm does not affect ICSI outcome both in men with AO and ANO. The use of such data on which to base clinical decisions needs to be supported by meta-analyses of several reports.