Abstract
Intracytoplasmic sperm injection (ICSI) is well established and provides patients with severely impaired sperm quality with an opportunity to father a child. However, previous studies do not clearly indicate whether male with cryptozoospermia should use testicular sperm or ejaculated sperm for ICSI. The newest systematic review of this topic also gave a controversial conclusion that was based on incorrect pooling result. Moreover, two clinical studies published after the systematic review. In the present update systematic review and meta-analysis, a comprehensive citation search for relevant studies was performed using the Cochrane library databases, Embase, Ovid MEDLINE, PubMed, ScienceDirect, Scopus, and Web of Science up to September 2017. The search returned 313 records, in which six studies were included in quantitative synthesis. These studies involved 578 male infertility patients who had undergone 761 ICSI cycles. The risk ratios favour fresh testicular sperm for good quality embryo rate (1.17, 95% CI 1.05–1.30, P = 0.005), implantation rate (95% CI 1.02–2.26, P = 0.04), and pregnancy rate (RR = 1.74, 95% CI 1.20–2.52, P = 0.004). In conclusion, the existing evidence suggests that testicular sperm is better than ejaculated sperm for ICSI in male with cryptozoospermia.
Highlights
Intracytoplasmic sperm injection (ICSI) is well established and provides hope for patients with extremely poor sperm quality, as in cryptozoospermia, to father children[1]
The present systemic review and meta-analysis showed that among patients with cryptozoospermia undergoing ICSI, the use of testicular sperm leads to higher good-quality embryo rate, implantation rate, and pregnancy rate in compared with ejaculated sperm
The epididymis plays a crucial role in the final steps of spermatogenesis, including epigenetic modification of genes[13,14], changes in the surface proteins of spermatozoa[15], and maturation of sperm cells[16]
Summary
Intracytoplasmic sperm injection (ICSI) is well established and provides hope for patients with extremely poor sperm quality, as in cryptozoospermia, to father children[1]. The ejaculate collected from the patients with cryptozoospermia containing very few sperm cells, and these sperm cells commonly exhibit low motility. This kind of sperm may reduce ICSI success rate. Testicular sperm obtained through surgical retrieval for ICSI may be suggested[6,7,8] In these decades, whether testicular or ejaculated sperm produces better outcomes of ICSI, assessed as fertilisation rate, embryo quality, implantation rate, and pregnancy rate still remain controversial[6,7,8,9,10,11]. The purpose of this study was to perform a further examination on this issue
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