Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids

Department of Medical Genetics, Faculty of Medicine, University of Porto, Portugal.
Human Reproduction (Impact Factor: 4.57). 08/2002; 17(7):1800-10. DOI: 10.1093/humrep/17.7.1800
Source: PubMed


A retrospective study was carried out on 159 treatment cycles in 148 secretory azoospermic patients to determine whether histopathological secretory azoospermic subgroups were predictive for gamete retrieval, and to evaluate outcome of microinjection using fresh or frozen-thawed testicular sperm and spermatids.
Sperm and spermatids were recovered by open testicular biopsy and microinjected into oocytes. Fertilization and pregnancy rates were assessed.
In hypoplasia, 97.7% of the 44 patients had late spermatids/sperm recovered. In maturation-arrest (MA; 47 patients), 31.9% had complete MA, and 68.1% incomplete MA due to a focus of early (36.2%) or late (31.9%) spermiogenesis. Gamete retrieval was achieved in 53.3, 41.2 and 93.3% of the cases respectively. In Sertoli cell-only syndrome (SCOS; 57 patients), 61.4% were complete SCOS, whereas incomplete SCOS cases showed one focus of MA (5.3%), or of early (29.8%) and late (3.5%) spermiogenesis. Only 29.8% of the patients had a successful gamete retrieval, 2.9% in complete and 77.3% in incomplete SCOS cases. In total, there were 87 ICSI, 39 elongated spermatid injection (ELSI) and 33 round spermatid injection (ROSI) treatment cycles, with mean values of fertilization rate of 71.4, 53.6 and 17%, and clinical pregnancy rates of 31.7, 26.3 and 0% respectively.
Histopathological subgroups were positively correlated with successful gamete retrieval. No major outcome differences were observed between testicular sperm and elongated spermatids, either fresh or frozen-thawed. However, injection of intact round-spermatids showed very low rates of fertilization and no pregnancies.

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    • "Human experiments, however, have revealed that oocyte degeneration after ROSI is not adversely affected by the use of a larger microinjection pipette nor by the presence of a cytoplasmic layer surrounding the spermatid nucleus; the rupture of the cytoplasmic membrane and the nuclear envelope is rapidly achieved after microinjection (14). Sousa reported a low oocyte degeneration rate (9%) in 33 ROSI cycles following the injection of 200 oocytes (14). "
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    • "Oocytes were denuded enzymatically (Synvitro Hyadase, Medicult) and mechanically (SweMed, Frolunda, Sweden). After culture in IVF medium (Medicult) for 2 h, they were microinjected as described in SPM [34]. They were then cultured in ISM1 medium (Medicult) for 2 days and then changed to ISM2 (Medicult). "
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    • "An additional problem in these early publications is the definition of testicular failure (NOA), which was not always clearly described and/or not always based on testicular histology. Nevertheless, acceptable results of ICSI with frozen –thawed testicular sperm of NOA patients have been described (Friedler et al., 1997; Oates et al., 1997; Ben- Yosef et al., 1999; Habermann et al., 2000; Kupker et al., 2000; Sousa et al., 2002). "
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