Microsurgical Epididymal Sperm Aspiration Research Articles

Desire to have children after vasectomy : Vasectomy reversal or assisted reproductive technology?

The vasectomy is asafe and effective method of contraception for men. Up to 6% of men who underwent vasectomy have arenewed child wish. Microsurgical vasectomy reversal (VR) in men, microsurgical epididymal sperm aspiration (MESA), or testicular sperm extraction (TESE) in men plus assisted reproductive technology (ART) in the female partner as well as the combination of VR and MESA/TESE plus ART represent established therapeutic strategies. Various factors may impact the success of VR, as defined by patency and pregnancy rate following VR, including the female partner's age, the obstructive interval, and the surgical VR technique. There is no difference in the pregnancy and live birth rate following VR or MESA/TESE plus ART. However, following MESA/TESE plus ART, time to pregnancy is shorter compared with VR. Overall, VR is more cost-effective than MESA/TESE plus ART and allows for alower therapeutic burden, especially in the female partner. In addition, VR combined with TESE plus-if necessary-ART is more cost-effective than MESA/TESE plus ART alone, even in female partners with advanced age. For successful counseling regarding the different therapy options for arenewed child wish after vasectomy, it is important to evaluate the underlying individual situation of the couple.

P-541 First live birth report of identical twins from a single low-grade mosaic blastocyst (46,XY/45,XY,-19) transfer: when a small chance becomes a double miracle

Abstract Study question N/A Summary answer First live birth report of identical twins from the transfer of a single low-grade mosaic blastocyst for monosomy on chromosome 19. What is known already The clinical decision-making in cases involving the transfer of low-grade mosaic embryos remains controversial. Recent studies have indicated that low-grade mosaic embryos exhibit pregnancy rates similar to euploid embryos, encouraging their transfer. However, the judgment to proceed in most cases is still challenging. The transfer of a low-grade mosaic embryo for monosomy on chromosome 19 is considered relative safe. The occurrence of human twins resulting from embryo splitting in ART (Assisted Reproductive Technology) cycles is a rare phenomenon. To date, there are no reports of the birth of identical twins from a single low-grade mosaic embryo transfer. Study design, size, duration This is a single-case report detailing an assisted reproduction cycle conducted by a couple. Participants/materials, setting, methods A couple with a nine-year history of infertility, characterized by low ovarian reserve and azoospermia, underwent an ICSI (Intracytoplasmic Sperm Injection) cycle in October 2022. Due to azoospermia, microsurgical epididymal sperm aspiration and subsequent freezing of the retrieved sperm were performed prior to ovum pick-up. PGT-A (Preimplantation Genetic Testing for Aneuploidy) of the resultant blastocysts was conducted, followed by the transfer of a single low-grade mosaic after a modified natural endometrial preparation cycle. Main results and the role of chance Seven mature oocytes were retrieved, and following ICSI with the thawed seminal sample, four blastocysts were developed and biopsied for PGT-A analysis. Out of these four high-quality blastocysts, three were aneuploid, and the remaining one was a low-grade (50%) mosaic for monosomy on chromosome 19. After genetic counselling, the patients decided to proceed with the transfer of a day 5 3AA low-grade mosaic embryo, which led to a successful pregnancy. The transferred embryo split, generating a pregnancy of identical twins. The twins were delivered via cesarean section at 30 weeks and 5 days of gestational age. The premature delivery was necessitated due to the mother developing cardiac insufficiency related to pre-existing valvulopathy and a superimposed venous thromboembolism. Peripheral blood samples from the twins have been collected for a 100-cell karyotype analysis (results will be available by February 9th). This case marks the first reported instance of twins born from the transfer of a single low-grade mosaic blastocyst (46,XY/45,XY,-19). Limitations, reasons for caution This is a retrospective case-report from one couple, describing a rare event. Wider implications of the findings This case-report could elucidate the physician’s decision and slightly encourage the transfer of low-grade mosaic embryos when there are no full euploids available. Trial registration number Not pllicable

(332) A Head-to-head Ergonomic Risk Assessment of the 4K-3D Exoscope vs. Standard Operating Microscope for Male Fertility Microsurgery

Abstract Introduction Surgery for male fertility is ergonomically demanding secondary to the tedious and lengthy nature of surgeries performed. The standard operating microscope places surgeons in uncomfortable positions including a “heads down” posture which has been demonstrated to predispose microsurgeons to cervical strain and chronic pain. The 4K-3D exoscope eliminates the need for eyepieces allowing for a “heads up” posture. Additionally, given the standing position of surgeons using the 4K-3D exoscope, it is thought that surgeons may be able to maintain a more “neutral” upper arm position therefore reducing upper body stress. Objective This study aims to stratify ergonomic risk amongst infertility surgeons using the 4K-3D exoscope versus the operating microscope with wearable technology. Secondary objectives included surveying for optical differences and teaching utility between surgical modalities during infertility microsurgery. Methods The participating right-handed surgeon was fitted and calibrated with three wearable sensor inertial measurement units (IMUs) on the head and upper arms in the neutral position. Each IMU is comprised of an accelerometer, magnetometer, and gyroscope. This allows for measurement of the surgeon’s joint angle change throughout 4K-3D and operating microscope use. Microscopic surgical procedures which were considered for inclusion were: vasovasostomy, vasoepididymostomy, varicocelectomy, testicular sperm extraction (mTESE), and microsurgical epididymal sperm aspiration (MESA). The previously validated rapid upper limb assessment (RULA) was used to determine the proportion of time spent in ranges of risk. Categories 1-4 were assigned for the head and upper extremities (4= highest ergonomic risk). Finally, a 5-point Likert scale questionnaire related to ergonomic, optical, and teaching metrics was administered to six microsurgeons. Chi-squared analysis was used to test for differences in proportions. Results A total of 500 and 479 microsurgical minutes from 4K-3D exoscope and operating microscope guided surgeries respectively were analyzed. Examination of the bilateral upper extremities showed that the 4K-3D exoscope significantly favored score 1 positioning compared to the operating microscope indicating a lower level of ergonomic stress with 4K-3D exoscope usage (75.3% vs. 51.5%; p < 0.0001). Finally, the operating microscope exposed the surgeon to a higher level 3 flexion (5.5% vs. 1.9%; p <0.0001). When examining the head and neck, significantly more time was spent in the “extension” position (any degree of neck extension past neutral) using the 4K-3D exoscope compared to the operating microscope (51.8% vs. 19.5%; p < 0.0001). During 4K-3D exoscope use, 67% of neck extension time was between 0-10 degrees. Additionally, 0-10 degrees of flexion (score 1) were maintained 33.6% vs. 7.7% of the time in operating microscope vs. 4K-3D exoscope respectively (p < 0.0001). Assessment of the 5-point Likert scale survey demonstrated that most surgeons favored the 4K-3D exoscope in questionnaire topics of ergonomics, optics/clarity, lighting, and teaching. Conclusions The 4K-3D exoscope offers the surgeon favorable ergonomic positioning for the upper extremities which may reduce upper body work stress related injury. Similarly, a greater proportion of operative time was spent with the neck in mild extension with 4K-3D exoscope utilization which may place the patient in a “low risk” position (less than 20 degrees of extension) according to contemporary studies. Disclosure Yes, this is sponsored by industry/sponsor: Investigator Initiated Grant from Olympus. Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific.

Effects of epididymal sperm recovery methods on fresh and frozen-thawed sperm characteristics in dogs.

The cauda epididymis holds a collectible source of fertile spermatozoa in cases of obstructive azoospermia, sudden death, and after elective or emergency castration. The current study was conducted to compare three different epidydimal sperm collection methods (Percutaneous epididymal sperm aspiration (PESA), microsurgical epididymal sperm aspiration (MESA) and retrograde epididymal wash (EW)) in the dog. Fifteen large-breed adult dogs were applied for comparing the PESA (left testicles) with MESA (right testicles) techniques, while five dogs were used for evaluation of MESA (left testicles) versus EW (right testicles). The recovered sperm cells from MESA and EW were subjected to cryopreservation. Total sperm recovery, level of blood contamination and sperm quality markers (viability, morphology, plasma and acrosome membrane integrity, DNA fragmentation, and metabolic activity) were evaluated for fresh and frozen-thawed spermatozoa. We showed that the collection of epididymal sperm cells through the PESA method resulted in lower total sperm recovery and significantly reduced fresh sperm kinematic and quality measures. While, both MESA and EW procedures resulted in a high number of intact epididymal spermatozoa with appropriate cryo-tolerance potential. In conclusion, EW and MESA methods provide high-quality epidydimal spermatozoa with high cryopreservation potential in domestic dogs.

The impact of the origin of surgical sperm retrieval on placental and embryonic development: The Rotterdam Periconception cohort.

BackgroundIn patients with azoospermia, pregnancy can be achieved after surgical techniques using sperm retrieved from the testis or epididymis, which can impact on DNA integrity and epigenetics. DNA of the fetus and placenta is equally derived from both parents; however, genes important for placental development are expressed from the paternal alleles. Therefore, the origin of sperm may affect fetal and placental development.ObjectivesTo investigate whether first‐trimester trajectories of embryonic and placental development of pregnancies conceived after intracytoplasmic sperm injection (ICSI) with testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA), are different from pregnancies after ICSI with ejaculated sperm or natural conceptions.Materials and methodsA total of 147 singleton ICSI pregnancies, including pregnancies conceived after TESE (n = 23), MESA (n = 25) and ejaculated sperm (n = 99), and 380 naturally conceived and 140 after IVF treatment without ICSI were selected from the prospective Rotterdam periconception cohort. Crown‐rump length (CRL), embryonic volume (EV), Carnegie stages, and placental volume (PV) at 7, 9, and 11 weeks of gestation were measured using 3D ultrasound and virtual reality technology.ResultsLinear mixed model analysis showed no differences in trajectories of CRL, EV, and Carnegie stages between pregnancies conceived after ICSI with testicular, epididymal, and ejaculated sperm. A significantly positive association was demonstrated for PV between pregnancies conceived after TESE‐ICSI (adjusted beta: 0.28(95%CI: 0.05‐0.50)) versus ICSI with ejaculated sperm. Retransformation to original values showed that the PV of pregnancies after TESE‐ICSI is 14.6% (95%CI: 1.4%‐25.5%) larger at 11 weeks of gestation compared to ICSI pregnancies conceived with ejaculated sperm.Discussion and ConclusionHere we demonstrate that the first‐trimester growth trajectory of the placenta is increased in pregnancies conceived after TESE‐ICSI compared to those conceived after ICSI with ejaculated sperm. Findings are discussed in the light of known differences in sperm DNA integrity, epigenetics, and placental gene expression.

COMPARING EUPLOIDY IN TESE, MESA, AND EJACULATE FROM PATIENTS WITH AND WITHOUT MALE FACTOR INFERTILITY

Sperm retrieval via testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA) have been used to treat men with obstructive and non-obstructive azoospermia. Here we compare fertilization rates, blastocyst formation, euploidy, and euploidy rates, in IVF cycles with intracytoplasmic sperm injection (ICSI) and preimplantation genetic testing for aneuploidy (PGT-A), with sperm obtained via TESE, MESA and ejaculation.

The Simple Solution for Infertile Patients with Aspermia in the Modern Era of Assisted Reproductive Technique

Purpose: The purpose is to investigate the feasibility and outcomes of loupe-assisted vasostomy for sperm retrieval in male infertility due to anejaculation or retrograde ejaculation. Materials and Methods: We retrospectively reviewed the vasal sperm aspirations of 9 patients with anejaculation or retrograde ejaculation from 2015 to 2017. We collected preoperative serum hormone data (testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin) and comorbidities of each patient. The patients underwent standard loupe-assisted modified vasostomy by a single surgeon with immediate specimen interpretation, with follow-up at the clinic. Results: Of the 9 patients, 4 had retrograde ejaculation, and 5 had anejaculation. Seven patients had controlled diabetes mellitus; of them, one had an ejaculating duct stone, and only one had no comorbidity. Aspirations were performed for sequential assisted reproductive techniques in 7 patients and cryopreservation in another two. The average total sperm count was 213 × 106, with motility between 9% and 67% and normal sperm morphology between 4.5% and 50.0%. One patient had undergone microsurgical epididymal sperm aspiration before vasal aspiration, but the semen analysis indicated poor sperm quality and could not be used for in vitro fertilization. In total, 7 of the 8 aspirations (87.5%) resulted in pregnancy. No complications have been observed to date. Conclusion: Vasal sperm aspiration is a simple and effective alternative method for sperm retrieval, with the advantage of a high success rate and less invasiveness and destruction of the reproductive system. It may be performed before sperm retrieval from the epididymis or testis in infertile men with aspermia.

Sperm retrieval predictive factors and testicular histology in nonobstructive azoospermia patients

Purpose: The purpose of this study was to investigate the potential factors for sperm retrieval prediction. Materials and Methods: This is a retrospective and single-operator study at National Taiwan University Hospital. Between January 2009 and December 2017, 66 nonobstructive azoospermia (NOA) patients were collected. They received testicular biopsy and sperm retrieval including microsurgical epididymal sperm aspiration or microdissection testicular sperm extraction. Results: Eleven patients had normal spermatogenesis, with successful sperm retrieval (SSR) 90.9%; 21 patients hypospermatogenesis, with SSR 47.6%; 13 patients maturation arrest, with SSR 30.8%; and 21 patients Sertoli cell-only syndrome, with SSR 0%. SSR declined significantly when follicle-stimulating hormone (FSH) values rise: FSH 20 mIU/ml with SSR 6.7% (P = 0.003). Receiver operating characteristic curve to predict SSR by FSH achieved the area under the curve 0.792, with the best cutoff point of FSH being at 6.8 mIU/ml. Conclusion: We concluded that a higher sperm retrieval rate was statistically significantly related to lower FSH, lower luteinizing hormone, and better histology types among the NOA men. In the absence of testicular histopathology before surgery, preoperative FSH can be used for prediction and counseling. FSH ≤6.8 mIU/ml predicts SSR with a sensitivity of 63.2% and specificity of 88.2%.

Evaluation of the morphokinetic parameters and development of pre-implantation embryos obtained by testicular, epididymal and ejaculate spermatozoa using time-lapse imaging system.

Low sperm quality has negative effects on fertilisation and embryo development. The males with azoospermia apply for testicular sperm extraction (TESE) or microsurgical epididymal sperm aspiration (MESA) in order to retrieve sperm. To date, there have not been any reports investigating morphokinetic parameters of pre-implantation embryos using testicular and epididymal spermatozoa. Therefore, we aimed to correlate embryo development and assess morphogenetic parameters in embryos obtained by TESE and MESA using time-lapse imaging. A total of 60 patients undergoing IVF treatments were included in this study. Twenty men with normal semen parameters were selected as control group. Twenty men undergoing TESE and 20 men undergoing MESA were also included in this study. The morphokinetic parameters of time intervals between the second polar body (PB2) extrusion, pronuclei formation and disappearance and cleavage divisions showed significant variations in TESE, MESA and control groups. Furthermore, the pregnancy rates (positive beta-hCG) were shown to be similar in both TESE and the control group (55% in each group), whereas for the MESA group, this rate was significantly lower (39%, p=0.049). Further extrapolation of these results may implicate that the obstructive azoospermia patients should undergo TESE instead of MESA for better blastocyst development and higher pregnancy rates.

The role of surgical sperm retrieval techniques in patients with azoospermia in assisted reproductive technology programs (literature review)

This literature review is dedicated to surgical sperm retrieval techniques, such as percutaneous and microsurgical epididymal sperm aspiration, testicular sperm aspiration, testicular sperm extraction (standard, microdissection, multifocal). Those methods allow men with azoospermia to achieve biological parenthood, because gametes retrieved from testis or epididymis are usable for assisted reproduction. After laboratory processing of surgical specimen the sperm may be used for intracytoplasmic injection and/or cryopreservation. In this article we discuss historical and technical aspects of such procedures and provide critical analysis of their advantages, disadvantages and limitations. Existing laboratory techniques for processing of surgically retrieved sperm are mentioned. We discuss possible future directions for development of testicular biopsy technique aimed at improving sperm retrieval outcomes.

Epididymal sperm retrieval by modified open fine needle aspiration

To develop a method with maximally minimized injury and sufficient sperm yield on the basis of the above methods. For obstructive azoospermia (OA), percutaneous epididymis sperm aspiration (PESA), microsurgical epididymal sperm aspiration (MESA), minimally invasive epididymal sperm aspiration (MIESA), mini-micro-epididymal sperm aspiration (mini-MESA), macrosurgical epididymal sperm imprint collection (MESIC) and open fine needle aspiration (OFEN) have been employed to retrieve sperm. In this study, PESA, MESA, MIESA, mini-MESA , MESIC and OFEN were performed for more than 10 cases each method in OA patients. On the basis of comparing the above methods, we developed a modified method of OFEN (MOFEN). MOFEN was performed under local anesthesia with 2% lidocaine in 20 OA patients. A small incision less than 1 cm in length was cut at the position corresponding to epididymis. After epididymis was exposed, the needle tip of tuberculin syringe preloaded with about 0.1 ml of sperm washing medium was pierced through tunica into the epididymal tubule which was seen faintly beneath epididymal tunic under operating microscope at 25X magnification. To minimize injury to epididymal tubule, attention was paid to inserting the needle carefully with the rear of the needle bevel just passed the tunica. Then the tubule fluid was aspitrated. If no cloudy material entered into syringe, the needle was withdrawn a little and inserted again with direction adjusted. After aspiration, the content of the syringe was expelled into a culture plate. Then, the epididymis was squeezed, and the fluid milked out from the needle hole was suctioned with the nipple of the same syringe preloaded with about 0.1 ml of sperm washing medium. If no sperm was found in the aspiration, the needle hole on the epididymal tunic was enlarged as small as possible that just 2 or 3 tubules were exposed. Then, the tubule was pierced and aspirated, and the contents milked out from the needle hole of the tubule was suctioned with the same manoeuvre as described above. The severity of injury ranked from MIESA, MESA to Mini-MESA in microsurgical procedure; MESIC to OFNA in macrosurgical procedure. In PESA, the epididymal tubules were punctured blindly and generally repeatedly, many tubules were injured. Considering the size of the incision and only one tubule was punctured in most condition, MOFNA injuried the least in the study. As to efficiency of sperm retrieval, PESA and MIESA harvested the least and the most, respectively. In MOFNA, sperm retrieval was 100% successful and 20.8X106 sperm were harvested on average. MOFNA is an efficient and safer method for epididymal sperm aspiration.

Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration.

PurposeTo assess normal fertilization, clinical pregnancy, and live birth rates after the use of microscopic epididymal sperm aspiration (MESA).MethodsOne‐hundred‐and‐sixty azoospermic participants who underwent MESA were evaluated. The MESA was performed by using a micropuncture method with a micropipette. In cases in which motile sperm were not obtained after the MESA, conventional or micro‐testicular sperm extraction (TESE) was completed.ResultsAdequate motile sperm were retrieved in 71 participants by using MESA and in 59 out of 89 participants by using TESE. Of the total number of patients, 123 underwent intracytoplasmic sperm injection. After MESA, the normal fertilization rate was 73.5% and the clinical pregnancy rate per case was 95.7%. Healthy deliveries resulted after MESA in 65 (92.9%) cases and after TESE in 38 (71.7%) cases.ConclusionThe MESA specimen collection does not have any special requirements, such as mincing tissue disposition. The MESA also can reduce the amount of laboratory work that is needed for cryopreservation. In the authors' experience, MESA is a beneficial procedure and should be given priority over TESE.

A step-by-step guide to office-based sperm retrieval for obstructive azoospermia.

A variety of surgical options exists for sperm retrieval in the setting of obstructive azoospermia (OA). With appropriate preparation, the majority of these techniques can safely be performed in the office with local anesthesia and with or without monitored anesthesia care (MAC). The available techniques include percutaneous options such as percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA), as well as open techniques that include testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA). In addition to providing a step-by-step description of each available approach, we introduce and describe a new technique for sperm retrieval for OA called minimally invasive epididymal sperm aspiration (MIESA). The MIESA utilizes a tiny keyhole incision, and the epididymis is exposed without testicular delivery. Epididymal aspiration is performed in the style of MESA, except using loupe magnification rather than an operating microscope. MIESA is a safe, office-based procedure in which millions of motile sperm can be retrieved for cryopreservation. While we prefer the MIESA technique for OA, there remain distinct advantages of each open and percutaneous approach. In the current era of assisted reproductive technology, sperm retrieval rates for OA should approach 100% regardless of the technique. This reference provides a roadmap for both advanced and novice male reproductive surgeons to guide them through every stage of sperm retrieval for OA, including preoperative evaluation, patient selection, procedural techniques, and complications. With the incredible advances in in vitro fertilization (IVF), combined with innovative surgical treatment for male factor infertility in recent years, OA is no longer a barrier for men to become biologic fathers.

Successful treatments for Kartagener syndrome with completely immotile sperm or azoospermia

Kartagener triad syndrome consists of dextrocardia, bronchoectasia and chronic bronchitis. It is often associated with completely immotile sperm with structurally abnormal tails. However, we observed that about half of Kartagener syndrome cases show obstructive azoospermia with normal epididymal spermatozoa with structurally normal flagellum collected easily with MESA (Microsurgical Epididymal Sperm Aspiration). We report successful cases of Kartagener syndrome with completely immotile sperm or obstructive azoospermia.

EFFICACY OF SURGICAL SPERM RETRIEVAL IN AZOOSPERMIC PATIENT AND ITS CONTRIBUTION TO IN VITRO RERTILIZATION PROGRAM

Objective: This study was made to evaluate efficacy and success rate of Percutaneous Epididymal Sperm Aspiration (PESA), Microsurgical Epididymal Sperm Aspiration (MESA), or Testicular Sperm Extraction (TESE) in azoopsermic patients, and evaluate IVF program’s pregnancy rate by comparing methods of sperm retrieval. Material & method: A descriptive retrospective study to azoospermic patients undergone PESA, MESA or TESE and IVF program in Bunda Hospital Jakarta and Cipto Mangunkusumo Hospital Jakarta in 2011–2012. The data were collected from patients’ medical records and IVF program’s database. Results: There were 146 azoospermic patients with mean age 38.97 ± 7.35 years. Viable sperm was found in 46 patients (31.5%) by PESA and 47 patients (32.2%) by MESA and TESE. The IVF program was followed by 72 patients. Sperm was retrieved by PESA in 43 patients (59.7%) and TESE in 29 patients (40.3%). Pregnancy was achieved in 18 patients in PESA group (25%) and 15 patients (20.8%) in TESE group. Conclusion: Sperm can be retrieved from azoospermic patients by PESA, MESA or TESE, and there was good success rate in pregnancy rate of IVF program by using surgically retrieved sperm.

Seminal vesicle sperm aspiration from wounded warriors: a case series

There has been an increase in blast injuries from dismounted Improvised Explosive Devices (IEDs) encountered on the battlefield (i.e. ambulatory soldiers not within the protection of a vehicle). Associated injuries involve the lower extremities, pelvis, and perineum. Thus, options to retrieve sperm may be limited due to type and extent of injury. An alternative technique to the standard Testicular Sperm Extraction or Microsurgical Epididymal Sperm Aspiration is seminal vesicle sperm aspiration (SVSA), described in cases of ejaculatory duct obstructions or primary anorgasmy.

Congenital bilateral absence of the vas deferens: the impact of spermatogenesis quality on intracytoplasmic sperm injection outcomes in 108 men.

In azoospermic men with congenital bilateral absence of the vas deferens (CBAVD), it is not known whether the outcomes of intracytoplasmic sperm injection (ICSI) depend on the quality of testicular spermatogenesis (as determined histopathologically). We retrospectively studied the impact of spermatogenesis quality on ICSI outcomes in 108 azoospermic men with CBAVD consulting in a university hospital's department of andrology and reproductive biology. As part of an ICSI program, sperm samples were obtained from the epididymis [by microsurgical epididymal sperm aspiration (MESA); n = 47] or the testis [by testicular sperm extraction (TESE); n = 14] or both (MESA + TESE, n = 47). In the TESE group (i.e., TESE-only and MESA + TESE), spermatogenesis was normal in 21 of the 108 men (19.4%) and hypospermatogenesis occurred in 33 (30.5%). The fertilization rate was significantly lower in the hypospermatogenic group than in the normospermatogenesis group (65.6 and 72.9%, respectively; p = 0.02); this was also true for the embryo cleavage rate (88.6 and 92.1%, respectively; p = 0.007), and the proportion of embryos with fewer than 30% of enucleate fragments (79.5 and 86.9%, respectively; p = 0.02). Our study results showed that impaired spermatogenesis had a negative impact on certain early-stage biological outcomes of ICSI. In CBAVD, male factors are likely to exert a harmful effect on the early stages of embryo development.

Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference?

How do live birth rates compare after intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia when using sperm derived from testicular sperm extraction (TESE) versus microsurgical epididymal sperm aspiration (MESA)? Our study suggests that proximal epididymal sperm (from MESA) result in higher live birth rates as compared with testicular sperm (from TESE) in couples where the man has obstructive azoospermia due to congenital bilateral absence of the vas deferens (CBAVD) or vasectomy. For couples with obstructive azoospermia, MESA (epididymal sperm) and TESE (testicular sperm) have generally been assumed to be equivalent for use in ICSI. But this assumption has never been confirmed, and this view has important clinical and basic scientific consequences. This was a retrospective study of a consecutive cohort of 374 men with obstructive azoospermia and normal spermatogenesis, who underwent IVF and ICSI using either epididymal sperm or testicular sperm in the period 2000-2009. The study included men undergoing MESA or TESE at St. Luke's Hospital for obstructive azoospermia due to CBAVD or vasectomy. A total of 280 couples underwent MESA and 94 underwent TESE with ICSI. The live birth rate was 39% after MESA-ICSI and 24% after TESE-ICSI. The MESA-ICSI cycles also resulted in a significantly higher implantation rate and significantly higher clinical and ongoing pregnancy rates than the TESE-ICSI cycles. There was no significant difference in results between fresh or frozen sperm for both MESA and TESE. When adjusted for the available confounders, the odds ratio for live birth was significantly in favour of MESA-ICSI versus TESE-ICSI (OR 1.82; 95% CI 1.05-3.67). The only significant confounders were female age and ovarian reserve. This is a retrospective cohort study and not a randomized clinical trial. Our study suggests that some aspect of sperm maturation after the sperm leaves the testicle to enter the epididymis is required for the most optimal results, even when ICSI is used for fertilization. No funding was used and there are no competing interests.

EVALUATION OF EPIDIDYMAL AND TESTICULAR SPERM ASPIRATION IN AZOOSPERMIC INFERTILE MALES IN BASRAH

This study aimed to evaluate the safety and efficacy of percutaneous epididymal and testicular sperm aspiration as a diagnostic technique to confirm sperm production and as a therapeutic technique to harvest sperms for use in the intracytoplasmic sperm injection and the indications for performing testicular biopsy in azoospermic infertile males. Thirty married patients were included in this prospective study from February 2011 to December 2012 seen in Basrah General Hospital. Their age ranged from 20 to 40 years. All patients underwent full medical examination with laboratory tests which included seminal fluid analysis, serum leutinising hormone (LH), follicular stimulating hormone (FSH), testosterone, and prolactin in addition to color Doppler ultrasonography of the scrotum. Patients with history of undescended testes, varicocele, & testicular pathology were excluded from this study. All patients showed normal physical examination with normal secondary sexual characters. The external genitalia were normal with normal sizes of their testes. The percutaneous epididymal and testicular sperm aspirations were positive in 12 out of 30 patients (40%). The rest had negative aspirations (60%). The testicular biopsy which performed in the patients with negative aspiration showed normal germinal epithelium with mature spermatozoa in only 5 patients out of 18 (28%) while the rest 13 patients had spermatogenic arrest (72%). In conclusion, percutaneous epididymal and testicular sperm aspiration has been found helpful as a diagnostic technique for patients with non-reconstructable azoospermia. It is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive and costly. It is less invasive than testicular biopsy and preferably performed as a first step procedure in an attempt to obtain sperms for both diagnostic and therapeutic purposes.

Chromosome abnormalities in embryos derived from microsurgical epididymal sperm aspiration and testicular sperm extraction

ObjectiveTo evaluate the patterns of chromosome abnormalities in embryos derived from intracytoplasmic sperm injection (ICSI) in microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) in comparison to embryos that are derived from naturally ejaculated (EJAC) patients. Materials and methodsMale partners with azoospermia who required MESA or TESE for ICSI were studied for chromosomal abnormalities. The ICSI patients with EJAC sperm served as the control group. Preimplantation genetic diagnosis (PGD) was performed by fluorescence in situ hybridization (FISH). Chromosome abnormalities were categorized as polyploidy, haploidy, aneuploidy, and complex abnormality (which involves more than two chromosomes). Fertilization, embryo development, and patterns of chromosome abnormalities were accessed and evaluated. ResultsThere was no difference between the MESA, TESE, and EJAC patient groups in the rates of fertilization and pregnancy and the percentages of euploid embryos. In all three groups, less than one-half of the embryos for each group were normal (41 ± 31%, 48 ± 38%, and 48 ± 31% in MESA, TESA, and EJAC, respectively). Complex chromosomal abnormality was significantly more frequent in the MESA group than in the EJAC group (48.3% vs. 26.5%, respectively; p < 0.001). Furthermore, the overall pattern of chromosomal aneuploidy was similar among all three studied groups. ConclusionWe suggest that MESA and TESE, followed by ICSI and PGD, appear to be acceptable approaches for treating men with severe spermatogenesis impairment.