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PubMed2000

Probability to retrieve testicular spermatozoa in azoospermic patients.

AIM: The degree of probability to retrieve spermatozoa from testicular tissue for intracytoplasmic sperm injection into oocytes is of interest for counselling of infertility patients. We investigated the relation of sperm retrieval to clinical data and histological pattern in testicular biopsies from azoospermic patients. METHODS: In 264 testicular biopsies from 142 azoospermic patients, the testicular tissue was shredded to separate the spermatozoa, histological semi-thin sections of which were then evaluated using Johnsen score. RESULTS: The retrieval of spermatozoa correlated significantly ( P < 0.001) with the testicular volume ( r = 0.49), the FSH concentration ( r = -0.66), the maximum score (r = 0.85) and the mean Johnsen score (r = 0.81). In the multivariate regression analysis the successful testicular sperm extraction showed the closest relationship to the maximum score. The testicular volume correlated significantly with the mean Johnsen score ( r = 0. 64, P < 0. 001), and the basal serum FSH concentration mainly with the maximum score ( r = - 0.77; P < 0.001). Patients with a history cryptorchidism showed a significantly lower Johnsen score compared to the patients who did not have any testicular disease in the past (3.7 +/- 2.4 vs. 5.9 +/- 2.5; P < 0. 01). CONCLUSION: In a limited range, the testicular volume and the FSH concentration in serum were related to the Johnsen score which correlated significantly with the sperm retrieval. The successful sperm retrieval can be expected in all azoospermic patients irrespective of the results of clinical examination. However, the probability of retrieval of spermatozoa decreased significantly in patients with a FSH level > 18 U/L, testicular volume < 5 mL, mean Johnsen score <5, and maximum Johnsen score <7.

Adult↗
PubMed2000

[Epididymal sperm aspiration for obstructive azoospermia].

Epididymal sperm aspiration technique combined with assisted reproductive technology (ART) including intracytoplasmic sperm injection (ICSI) has provided new frontiers for the treatment of unreconstructable obstructive azoospermia, including congenital bilateral absence of the vas deferens and failed surgical intervention. Epididymal sperm is obtained by several procedures, including microsurgical epididymal sperm aspiration (MESA), mini-MESA (Modified MESA), macroscopic epididymal sperm aspiration (MaESA) and percutaneous epididymal sperm aspiration (PESA). Since 1991 in our department, epididymal sperm aspiration combined with ART was performed by MESA (26 cases, 41 times) and PESA (3 cases, 4 times). Motile sperm retrieval using MESA and PESA was obtained in 34 out of 36 times (94.4%) and 2 out of 4 times (50%), respectively. MESA-ICSI resulted in a 47.3% 2PN (metaphase II) fertilization rate per eggs and a 28.8% pregnancy rate per transfer. With advancement of ICSI technique in which frozen sperm can be used, elective sperm retrieval can be planned at our convenience. PESA is a convenient, inexpensive and effective outpatient clinic procedure for retrieving sperm assisted with ICSI. In summary, infertile couples need to be given realistic options regarding treatment outcome. The fertility potential and age of the female partner need to be considered when addressing male treatment options.

Epididymis↗
PubMed1996

Intracytoplasmic sperm injection using microsurgically retrieved epididymal and testicular sperm.

OBJECTIVE: To evaluate treatment of couples who are infertile due to unreconstructable obstructive azoospermia with microsurgical epididymal sperm aspiration or testicular sperm and intracytoplasmic sperm injection (ICSI). DESIGN: Prospective. SETTING: The Egyptian IVF-ET Center in association with Cairo University. PATIENTS: Twenty-three couples who are infertile due to obstructive azoospermia in which reconstructive microsurgery failed or was not possible. INTERVENTIONS: Microsurgical epididymal or testicular sperm retrieval and ICSI in 24 cycles. MAIN OUTCOME MEASURES: Fertilization and pregnancies. RESULTS: All 24 cycles had successful fertilization and reached the ET stage. In microsurgical epididymal sperm aspiration cases, fertilization rate per metaphase II oocyte was 63% (109/ 172). Six patients became pregnant, including one set of twins and one set of triplets. One pregnancy resulted from the use of cryothawed epididymal sperm. In testicular sperm aspiration cases, the fertilization rate was 59% (32/54) and four clinical pregnancies resulted. CONCLUSION: The use of microepididymal sperm aspiration or testicular sperm aspiration in conjunction with ICSI provide a highly precise and efficient procedure for achieving pregnancy in cases of unreconstuctable obstructive azoospermia.

Adult↗
PubMed2002

Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction.

The purpose of this review is to present the current understanding of penile vibratory stimulation (PVS) and electroejaculation (EEJ) procedures and its clinical use in men with ejaculatory dysfunction. Unfortunately, the record of treating such individuals has been quite poor, but within recent years development and refinement of PVS and EEJ in men with spinal cord injury (SCI) has significantly enhanced the prospects for treatment of ejaculatory dysfunction. The majority of spinal cord injured men are not able to produce antegrade ejaculation by masturbation or sexual stimulation. However, approximately 80% of all spinal cord injured men with an intact ejaculatory reflex arc (above T10) can obtain antegrade ejaculation with PVS. Electroejaculation may be successful in obtaining ejaculate from men with all types of SCI, including men who do not have major components of the ejaculatory reflex arc. Because vibratory stimulation is very simple in use, non-invasive, it does not require anaesthesia and is preferred by the patients when compared with EEJ, PVS is recommended to be the first choice of treatment in spinal cord injured men. Furthermore, EEJ has been successfully used to induce ejaculation in men with multiple sclerosis and diabetic neuropathy. Any other conditions which affect the ejaculatory mechanism of the central and/or peripheral nervous system including surgical nerve injury may be treated successfully with EEJ. Finally, for sperm retrieval and sperm cryopreservation before intensive anticancer therapy in pubertal boys, PVS and EEJ have been successfully performed in patients who failed to obtain ejaculation by masturbation. Nearly all data concerning semen characteristics in men with ejaculatory dysfuntion originate from spinal cord injured men. Semen analyses demonstrate low sperm motility rates in the majority of spinal cord injured men. The data give evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCI. Furthermore, it is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCI. Home insemination with semen obtained by penile vibratory and introduced intravaginally in order to achieve successful pregnancies may be an option for some spinal cord injured men and their partners. The majority of men will further enhance their fertility potential when using either penile vibratory or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization with or without intracytoplasmic sperm injection.

Ejaculation↗
PubMed1996

Natural spermatoceles in irreversible obstructive azoospermia--reservoirs of viable spermatozoa for assisted conception.

Fine needle aspiration of asymptomatic spermatoceles detected in five men with obstructive azoospermia was evaluated as a minimally invasive method of sperm retrieval for assisted conception. Sperm preparations adequate for in-vitro fertilization were initially obtained from three men, but there was failure of fertilization in all three cycles. However, intracytoplasmic sperm injection (ICSI) in three couples resulted in fertilization of 58% of metaphase II oocytes, with embryo transfers in five of six cycles. A successful pregnancy and delivery resulted from spermatozoa from a man with an irreversible vasectomy, for whom previous epididymal microaspiration and ICSI had been unsuccessful. Spermatoceles were found in 4% of men with irreversible obstructive azoospermia referred for assisted conception. These patients should therefore be examined very carefully for small cysts near the epididymis, because fine needle aspiration, usually without anaesthesia, can instantly locate a ready source of viable spermatozoa for ICSI. This is less invasive than the alternative sperm retrieval procedures, which are more traumatic and require local or general anaesthesia.

Adult↗
PubMedDate not supplied

[Predictive factor for TESE (testicular sperm extraction)--ICSI (intracytoplasmic sperm injection) for non-obstructive azoospermia].

BACKGROUND: TESE-ICSI has been used very successfully in the treatment of the patients with non-obstructive azoospermia but its indication is still controversial. We performed retrospective study concerning parameters to predict successful recovery of testicular sperm from the patients and outcomes of ICSI. PATIENTS AND METHODS: 44 patients with non-obstructive azoospermia who underwent TESE-ICSI from July, 1997 to September 1999 were studied retrospectively. RESULTS: 1) Testicular sperm were retrieved from 32 patients (72.7%). ICSI was performed in 29 patients and the partner of 15 patients (46.9%) got pregnant. From 10 patients with histology of Sertoli-cell-only, we could retrieve sperm in 3 patients (30%). 2) Testicular volume, Johnsen's score count (JSC), and FSH were significant parameter to predict the recovery of testicular sperm from the patients, but if we see only the patients with JSC less than 7, there were no significant parameter. Chromosomal abnormality was not a significant parameter. 3) The partner's age, motility of recovered sperm and testicular volume correlated with fertilization rate. Chromosomal abnormality was not significant parameter to predict fertilization. CONCLUSIONS: There was no absolute parameter to predict the recovery of testicular sperm from the patients with non-obstructive azoospermia. All patients with non-obstructive azoospermia can be the indication of TESE-ICSI.

Adult↗
PubMed1999

Fertilization capability of frozen epididymal sperm for intracytoplasmic sperm injection.

Both microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) are great advances in assisted reproductive techniques. By using the ICSI technique, frozen sperm from the epididymis can result in successful fertilization. The epididymal sperm retrieved via MESA can be cryopreserved for an in-vitro fertilization (IVF) procedure, thus, making repeat surgical retrieval of sperm unnecessary. We report a retrospective analysis of 24 ICSI cycles in 16 patients with obstructive or nonreconstructable azoospermia. Fresh epididymal sperm was used in 13 ICSI cycles and frozen-thawed epididymal sperm was used in the other 11. We compared the fertilization capability of ICSI using frozen-thawed epididymal sperm with fresh epididymal sperm. Eleven patients became pregnant and five of these pregnancies resulted from frozen epididymal sperm. The fertilization rate per oocyte was 58% with fresh sperm, and 66% with frozen-thawed sperm. The rate of clinical pregnancy for one embryo transfer was 46% with fresh sperm, and 45% with frozen-thawed sperm. There were no significant differences between fresh and frozen-thawed spermatozoa in the fertilization rate of oocytes or the clinical pregnancy rate. Our results suggest that we should cryopreserve supernumerary spermatozoa during a MESA/ICSI procedure in order to avoid repeated scrotal surgery.

Adult↗
PubMed2006

Association of spermatogenic failure with decreased CDC25A expression in infertile men.

BACKGROUND: DAZ gene family is crucial for human spermatogenesis that requires the precise co-ordination of cell cycle events. CDC25A is recognized as the downstream substrate of DAZ gene family and is thought to function on the M-phase regulation of cell cycles. We investigated the expression profiles of CDC25A in the testes of infertile men and evaluated the relationship between CDC25A levels and testicular phenotype, clinical hormonal parameters and sperm retrieval results. METHODS: The protein and mRNA transcript levels of CDC25A in the testes of 40 azoospermic men were determined by immunohistochemistry and quantitative real-time-PCR. CDC25A in human spermatozoa was investigated by western blotting and immunofluorescence staining. RESULTS: The CDC25A protein was expressed mainly in spermatocyte, spermatid and spermatozoa. CDC25A transcript levels were significantly decreased (P = 0.0009) in patients with spermatogenic failure, especially in men with meiotic arrest and Sertoli cell-only syndrome. Significantly higher CDC25A transcript levels were detected in patients with successful sperm retrieval than in patients with failed sperm retrieval (P = 0.005). CONCLUSIONS: Decreased CDC25A is associated with spermatogenic failure and failed sperm retrieval in infertile men. Further studies are necessary to explore the functional roles of CDC25A in human spermatozoa.

Adult↗
PubMed2004

Successful testicular sperm extraction in Korean Klinefelter syndrome.

OBJECTIVES: To evaluate the clinical features of Korean Klinefelter syndrome (KS) and the outcome of intracytoplasmic sperm injection using fresh testicular spermatozoa obtained by testicular sperm extraction from these infertile men. Most patients with KS have a nonmosaic 47,XXY karyotype, and about 3% of males with KS are mosaic (46,XY/47,XXY). Great variability is present in the clinical findings. Testicular sperm extraction in conjunction with intracytoplasmic sperm injection has been performed in men with KS in the hope of finding spermatozoa, and some men with KS have had sperm retrieved successfully and achieved pregnancy. METHODS: From January 2000 to January 2002, 42 azoospermic patients were diagnosed with KS after cytogenic evaluation. The karyotypes for all patients were determined by cytologic analysis, including the evaluation of more than 30 peripheral blood lymphocyte metaphases. The patients underwent history and physical examination. The testicular volume was measured using an orchidometer. Semen analysis was performed twice according to the methods recommended by the World Health Organization. Their hormonal profile was also assessed. RESULTS: Our study groups consisted of 36 patients with KS, 11 with mosaic and 25 with nonmosaic KS. Testicular sperm extraction was performed in all 36 patients. In 10 patients (27%), mature sperm were found in the wet preparation and were used for intracytoplasmic sperm injection. No statistically significant correlation was found between sperm extraction and age, serum follicle-stimulating hormone, serum testosterone, or testicular volume. The sperm retrieval rate of the patients with mosaic and nonmosaic KS was 54.5% and 16%, respectively. Intracytoplasmic sperm injection using fresh testicular spermatozoa resulted in a total fertilization rate of 50%. CONCLUSIONS: In our study, patients with mosaic KS had a greater rate of successful sperm retrieval than did those with nonmosaic KS. However, age, serum follicle-stimulating hormone, testosterone level, and testicular volume had no statistically significant relationship with successful sperm retrieval. Testicular sperm obtained from patients with KS induced fertilization and delivery of chromosomally normal children.

Adult↗
PubMed2004

Can biological or clinical parameters predict testicular sperm recovery in 47,XXY Klinefelter's syndrome patients?

BACKGROUND: Contradictory results are available regarding prediction of testicular sperm extraction in 47,XXY patients. This study, therefore, aimed at assessing the availability of testicular sperm and evaluates clinical parameters predicting successful sperm retrieval in azoospermic 47,XXY Klinefelter's syndrome patients. METHODS: Sperm recovery procedures were performed in 50 non-mosaic azoospermic Klinefelter patients. The facial hair pattern and the presence of gynaecomastia in men with successful and unsuccessful sperm recovery were compared using Fisher's exact test. The predictive value of clinical parameters such as age, testicular volume, FSH, FSH:LH ratio, testosterone and androgen sensitivity index (LH x testosterone) for successful testicular sperm retrieval was evaluated using the receiver operating characteristics (ROC) curve analysis. RESULTS: In 24 patients (48%) testicular sperm were recovered. Ninety-four per cent of the men in whom sperm was found had a normal facial hair pattern compared to 93% in whom no sperm was recovered (not significant, NS). Seventeen percent of the men with successful testicular sperm extraction had gynaecomastia compared to 31% of the men with failed testicular sperm extraction (NS). The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml compared to 3.6 ml in patients with no sperm found (NS). The mean FSH and testosterone values in patients with sperm recovered were 31.2 IU/l and 3.1 ng/ml versus 40.4 IU/l (P = 0.04) and 3.2 ng/ml (NS) in patients without sperm recovered. All examined clinical and biological parameters failed to predict the outcome of the testicular sperm extraction using ROC curve analysis. CONCLUSION: As in the general population of men with non-obstructive azoospermia, there are currently no clinical parameters predicting successful sperm retrieval in the subpopulation of patients with non-mosaic Klinefelter syndrome.

Gynecomastia↗
PubMed1999

Quality of cryopreserved testicular sperm in patients with obstructive and nonobstructive azoospermia.

PURPOSE: Sperm retrieved by testicular sperm extraction is routinely used to attempt pregnancy by in vitro fertilization-intracytoplasmic sperm injection. We evaluated the efficacy of cryopreserving testicular sperm collected by testicular sperm extraction at diagnostic biopsy. MATERIALS AND METHODS: A total of 73 men with obstructive and 42 with nonobstructive azoospermia underwent testicular sperm extraction at diagnostic biopsy. Sperm was retrieved and cryopreserved in all cases of obstruction and in 15 of nonobstructive azoospermia cases. Before freezing we determined sperm count, motility, morphology and viability, and after thawing we assessed sperm motility and viability. In 17 couples a total of 20 cycles of in vitro fertilization-intracytoplasmic sperm injection were performed and fertilization, cleavage and pregnancy rates were determined in cases of obstruction and nonobstruction. RESULTS: Sperm count and morphology were lower in the testicular biopsies of men with nonobstructive versus obstructive azoospermia. Motility was low or absent in all testicular sperm extraction specimens. Importantly, pre-freeze (63%) and post-thaw (31%) viability was the same in both patient groups. After in vitro fertilization-intracytoplasmic sperm injection using frozen and thawed testicular sperm the fertilization, cleavage, implantation and clinical pregnancy rates were 60, 86, 16 and 50%, respectively. Using cryopreserved sperm we observed no differences in outcome of any in vitro fertilization-intracytoplasmic sperm injection procedure in patients with obstructive versus nonobstructive azoospermia. CONCLUSIONS: Cryopreservation of testicular sperm provides enough good quality sperm after thawing to result in excellent in vitro fertilization-intracytoplasmic sperm injection outcomes. Cryopreservation does not adversely affect intracytoplasmic sperm injection outcomes, including pregnancy rate. Therefore, we recommend routine testicular sperm extraction and cryopreservation of sperm at testicular biopsy.

Cryopreservation↗
PubMed2004

Outcome of testicular sperm recovery and ICSI in patients with non-obstructive azoospermia with a history of orchidopexy.

BACKGROUND: Little is known about sperm recovery and ICSI using testicular sperm from men with non-obstructive azoospermia who had a previous orchidopexy. We therefore studied the sperm recovery in this subgroup and evaluated clinical parameters predicting successful sperm retrieval and the outcome of ICSI. METHODS: A total of 79 non-obstructive azoospermic men with a history of orchidopexy underwent a sperm recovery procedure. The predictive value of clinical parameters such as age at sperm retrieval, age at orchidopexy, testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index (LH x testosterone) for successful testicular sperm retrieval was evaluated using receiver operating characteristics (ROC) curve analysis. A comparison between 64 ICSI cycles performed in these couples and 92 cycles performed in couples in which the men had an unexplained non-obstructive azoospermia was carried out. RESULTS: Testicular spermatozoa were recovered in 41 patients (52%). The mean age at orchidopexy of the patients with a positive sperm recovery was 10.6 years [95% confidence interval (CI) 7.3-13.8] versus 15.5 years (95% CI 11.3-19.8) for those where no spermatozoa were found. The mean testicular volume of the largest testis of patients with spermatozoa found was 10 ml (95% CI 8.3-11.9) versus 8.5 ml (95% CI 5.8-11.1) in patients with no spermatozoa found. The mean FSH and testosterone value for patients with successful and unsuccessful sperm recovery, respectively, was 24.1 IU/l (95% CI 17.9-30.3) and 4.4 ng/ml (95% CI 3.7-5.1) versus 28.8 IU/l (95% CI 19.4-38.2) and 3.4 ng/ml (95% CI 2.2-4.5). All clinical and biological parameters examined failed to predict the outcome of the testicular sperm extraction. No differences were observed between the orchidopexy and unexplained group for the number of oocytes retrieved, fertilization rate, embryo quality, pregnancy rate and implantation rate. CONCLUSIONS: As in the population of men with non-obstructive azoospermia, the sperm recovery rate for patients with a history of orchidopexy is approximately 50% and there are currently no clinical parameters predicting successful sperm retrieval in this subpopulation of patients. The outcome of the ICSI cycles is comparable with that in the population of men with non-obstructive azoospermia.

Adult↗
PubMed2003

Feasibility of microsurgical reconstruction of the male reproductive tract after percutaneous epididymal sperm aspiration (PESA).

For obstructive azoospermia, surgical sperm retrieval from the epididymis for IVF/ICSI is an established management. However, various recent studies have established that surgical reconstruction with vasovasostomy or vasoepididymostomy remains a more cost-effective treatment option than upfront assisted reproduction. After epididymal sperm retrieval, fibrosis and scarring of the punctured epididymal tubule can lead to complete epididymal obstruction. The feasibility of surgical reconstruction after surgical epididymal sperm retrieval has not been established. We describe two cases of bilateral microsurgical vasoepididymostomy, using a new 2-suture longitudinal intussusception technique we previously described, after previous successful bilateral percutaneous epididymal sperm aspiration (PESA). In both cases, motile sperm were found in ejaculate in the first post-operative semen analysis at 6 weeks and 2 months. We conclude that even in men with previous epididymal sperm retrieval, surgical reconstruction remains a feasible management option for fertility.

Adult↗
PubMed1999

Advanced surgical sperm recovery is a viable option for intracytoplasmic sperm injection in patients with obstructive or nonobstructive azoospermia.

OBJECTIVE: To determine whether advanced sperm retrieval is appropriate in cases of obstructive and nonobstructive azoospermia. DESIGN: Prospective controlled study. SETTING: Tertiary care center. PATIENT(S): Men with obstructive and nonobstructive azoospermia, and their partners. INTERVENTION(S): Surgical sperm retrieval followed by intracytoplasmic sperm injection (ICSI) after 4 or 48 hours. MAIN OUTCOME MEASURE(S): Fertilization and pregnancy rates. RESULT(S): Advanced and fresh surgical sperm recoveries for ICSI were performed in 54 and 230 cycles, respectively. Patient demographics and cycle parameters were comparable. Two hundred forty-one (56.3%) of 428 injected eggs in the advanced retrieval group were fertilized, compared with 955 (56.6%) of 1,686 eggs in the fresh retrieved group (P=.94). There was no statistically significant difference in the pregnancy rates per ET between groups: 38.2% (18 of 47) in the advanced retrieval group and 39.9% (73 of 183) in the fresh sperm recovery group (P=.97). CONCLUSION(S): Testicular and epididymal sperm recovery can be safely performed 48 hours before ICSI. This facilitates planning, and, in cases of failure to retrieve sperm, hCG administration and ovum pick-up can be canceled, thereby reducing costs and eliminating the risk of ovarian hyperstimulation.

Biopsy↗
PubMed1995

Micropuncture retrieval of epididymal sperm with in vitro fertilization: importance of in vitro micromanipulation techniques.

OBJECTIVES: To evaluate the importance of in vitro micromanipulation techniques, specifically intracytoplasmic sperm injection (ICSI), for the fertility treatment of men with congenital absence of the vas deferens (CAV) or other unreconstructable male reproductive tract obstruction. METHODS: Results using ICSI during in vitro fertilization (IVF) were compared to previously published results of IVF alone and IVF with other micromanipulation techniques at the same infertility center. Main outcome parameters evaluated were: fertilization rate per oocyte, clinical pregnancy rate, and ongoing pregnancies and deliveries. RESULTS: IVF with ICSI yielded a fertilization rate per oocyte of 140 of 312 (45%) and a clinical pregnancy rate of 14 of 27 (52%) per cycle of sperm and egg retrieval. Ongoing pregnancies or deliveries have occurred for 13 of 27 (48%) cycles with ICSI. These results were better than our previously published results of IVF alone or in conjunction with the micromanipulation techniques of subzonal insertion (SuZI) or partial zona dissection (PZD) that yielded a 119 of 631 (19%; P < 0.0001) fertilization rate, clinical pregnancy rate of 14 of 51 (27%; P < 0.001) and ongoing pregnancy or delivery for 12 of 51 cycles (24%; P < 0.001). CONCLUSIONS: Epididymal sperm retrieval should be performed only when micromanipulation is available in conjunction with IVF to maximize chances of fertilization and subsequent pregnancies. The use of ICSI for epididymal sperm appears to maximize chances of pregnancy for couples with surgically unreconstructable obstructive male infertility.

Cytoplasm↗
PubMed2006

Current trends in the treatment of infertility in men with spinal cord injury.

OBJECTIVE: To determine current use of penile vibratory stimulation (PVS), electroejaculation (EEJ), and intrauterine insemination (IUI) in treatment of infertility in men with spinal cord injury (SCI). DESIGN: Prospective survey, retrospective chart review, and literature review. SETTING: Major university medical center. PATIENT(S): Male SCI patients and female partners. INTERVENTION(S): A survey administered to professionals determined current treatment methods for infertility in couples with SCI male partners. MAIN OUTCOME MEASURE(S): Sperm retrieval methods, ejaculation success rates, total motile sperm (TMS), IUI application, and IUI outcomes. RESULT(S): Twenty-eight percent of surveyed professionals do not retrieve sperm from ejaculates of SCI patients, relying instead on retrieval from reproductive tissues. Reasons for not offering PVS or EEJ were lack of familiarity, training, or equipment. Thirty-four percent do not offer IUI to these couples. Chart review showed that semen could be retrieved by PVS or EEJ in 95% of patients. Fifty-three percent and 43% of trials had TMS >5 and >10 x 10(6), respectively. Of survey respondents performing IUI, 42% lacked enough data to estimate pregnancy rates (PRs) in these couples. Literature review showed IUI PRs between 9% and 18% per cycle and 30% and 60% per couple. CONCLUSION(S): Based on ejaculation success rates, TMS yields, and IUI outcomes, the methods of PVS, EEJ, and IUI warrant consideration in centers not currently offering these options for couples with SCI male partners.

Comorbidity↗
PubMed1999

Testicular sperm extraction: impact of testicular histology on outcome, number of biopsies to be performed and optimal time for repetition.

Testicular sperm extraction (TESE) may not always be successful in patients with non-obstructive azoospermia, as they only have minute foci of active spermatogenesis from which a tiny number of spermatozoa can be extracted. The aim of this study was to find the percentile incidence of successful TESE in non-obstructive azoospermia patients in relation to various histopathological patterns and the number of performed biopsies, and to determine the optimal time needed for repetition. A total of 216 patients underwent bilateral testicular biopsy taking a single piece from each testis for sperm retrieval and pathological evaluation. In another 100 patients, the same procedure was done but taking multiple samples (maximum four samples/testis). Spermatozoa were successfully retrieved from 37.5 and 49% of patients who supplied single and multiple samples respectively. TESE was significantly higher when multiple samples were taken in all histopathological groups except for Sertoli cell-only syndrome, tubular sclerosis and Klinefelter's pattern. Twenty-seven patients underwent repeated TESE for ICSI between 1 and 24 months from the first procedure; all of them had easy sperm retrieval during the first procedure. Although sperm retrieval was successful in 75 and 94.7% of patients who underwent the second attempt, before and after 3 months respectively, a second TESE was usually more difficult and necessitated multiple sampling.

Adult↗
PubMed1998

Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm extracted from patients with obstructive and nonobstructive azoospermia.

OBJECTIVE: To evaluate IVF outcome after epididymal and testicular sperm retrieval in patients with obstructive or nonobstructive azoospermia. DESIGN: Retrospective clinical analysis. SETTING: Public university-affiliated IVF unit. PATIENT(S): One hundred twenty-three azoospermic patients (178 cycles). INTERVENTION(S): Sixty-three patients (103 cycles) with obstructive azoospermia (group 1) underwent either epididymal or testicular sperm retrieval, and 60 patients (75 cycles) with nonobstructive azoospermia (group 2) underwent testicular sperm retrieval combined with IVF treatment. Mature oocytes were fertilized using intracytoplasmic sperm injection. After sperm preparation, supernumerary spermatozoa were cryopreserved. MAIN OUTCOME MEASURE(S): Oocyte fertilization rate and clinical pregnancy rate (PR). RESULT(S): The oocyte fertilization rate was 48.4% (534/1,104) in group 1 and 41.5% (312/751) in group 2 (not significant [NS] difference). A total of 100 cycles (97.1%) and 62 cycles (82.7%) in the obstructive and nonobstructive groups, respectively, had embryos for replacement (NS difference). The clinical PRs per ET cycle were 24% (24/100) and 17.7% (11/62) in the two groups, respectively. Oocyte fertilization rates, when fresh (46.4%) or frozen-thawed (41.8%) spermatozoa were used, were not significantly different in the two groups. The PR when fresh sperm were used was 23.6% (30/127), versus 14.3% (5/35) when frozen sperm were used (NS difference). The PR for women aged < or = 35 years was similar to that for women >35 years of age (20.7% or 29/140 and 18.2% or 4/25, respectively). CONCLUSION(S): Epididymal and testicular sperm obtained in azoospermic patients can fertilize oocytes successfully and may lead to high fertilization rates and PRs. Freezing of these spermatozoa does not reduce the outcome of treatment significantly.

Adult↗