Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: A comparative study

Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan
Fertility and sterility (Impact Factor: 4.59). 09/2011; 96(3):567-71. DOI: 10.1016/j.fertnstert.2011.06.080
Source: PubMed


To evaluate the clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) with extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia (OAT) sperm.
Retrospective study.
Infertility clinic at Chang Gung Memorial Hospital.
A total of 126 ICSI cycles were performed using extracted testicular sperm from men with azoospermia and 65 ICSI cycles using fresh ejaculated sperm from men with extreme severe OAT.
Retrospective analysis of clinical outcomes and development of children born after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm.
Fertilization rates, number of grade 1 zygotes and number of embryos produced, implantation rate, clinical pregnancy rate, abortion and live birth rate per transfer, perinatal outcomes, and birth defects.
The demographic and clinical factors, including age, E(2) level on hCG day, number of oocytes retrieved, normal fertilization rate, zygote grade 1 score distribution, number of top-quality embryos transferred, clinical pregnancy rate per transfer, chemical pregnancy rate per transfer, implantation rate, live birth rate per transfer, and abortion rate per transfer, were similar between the groups. Sixty live births resulted from 48 extracted testicular sperm cycles and 21 live births from 19 extreme severe OAT. The obstetric and perinatal outcomes were similar between the groups, and children conceived by using ICSI were healthy and without major psychomotor or intellectual development retardation. One case of tetralogy of Fallot occurred in each group.
There is no evidence of differences in the clinical outcomes and development of children result after ICSI with extracted testicular sperm or ejaculated extreme severe OAT sperm.

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    • "However, if fertilisation as such occurs, the final clinical success seems to be equal in all groups. And studies analysing the health of these children show no impairment regardless of the origin of the spermatozoa (Tsai et al., 2011; Oldereid et al., 2014). Lower fertilisation rates with TESE have been reported in the literature (Hourvitz et al., 1998). "
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    ABSTRACT: Intracytoplasmic sperm injection (ICSI) using spermatozoa from patients with severe oligoasthenoteratozoospermia is still a challenge. Although spermatozoa are available, lower fertilisation rates as well as compromised pregnancy rates are observed after ICSI. We aimed at identifying respective parameters in the pre-values of ejaculate samples used for couple counselling. The clinical pre-values of 121 patients and their corresponding 228 ICSI cycles performed between 2002 and 2010 were retrospectively analysed. Patients were divided into three groups: (i) group 1 (G1, n = 51) where all patients showed at least once <0.1 million/mL (…) and ICSI was performed using ejaculate alone; (ii) group 2 (G2, n = 14) patients had once <0.1 Mill/mL or azoospermia and a testicular biopsy before start of ICSI; (iii) group 3 (G3, n = 56) patients were azoospermic and directed immediately to testicular sperm extraction (TESE). The pre-values of G2 differed significantly from G1 in terms of volume and motility. Lutenizing hormone (LH) and follicle-stimulating hormone (FSH) values were equal in G1 and G2, but showed significant differences in comparison to G3. Testis volume was significantly higher in G3. In the corresponding ICSI cycles, the percentage of cancelled embryo transfers was highest in G3. We did not find any correlations of hormonal markers or sperm pre-values with the success rates of ICSI. In our patient cohort, spermatozoa retrieved either from ejaculate or testicular biopsies have nearly identical chances in achieving pregnancies. Patients in need of TESE before ICSI have significantly lower sperm counts. However, it is not possible to calculate threshold values as indicator for TESE. © 2015 American Society of Andrology and European Academy of Andrology.
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    • "In previous studies, the embryonic development and clinical outcomes of infertile men who suffered from AZF microdeletion were controversial after ICSI treatment. Some studies have demonstrated comparable outcomes in patients with or without AZF microdeletion (Choi et al., 2004; Tsai et al., 2011). Other studies, however, showed different outcomes, especially for the fertilization rate and high-grade embryo quality between two groups (Yu et al., 2006; van Golde et al., 2001). "
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    ABSTRACT: Summary This study aimed to explore whether the presence of a Y chromosome azoospermia factor (AZF) microdeletion confers any adverse effect on embryonic development and clinical outcomes after intracytoplasmic sperm injection (ICSI) treatment. Fifty-seven patients with AZF microdeletion were included in the present study and 114 oligozoospermia and azoospermia patients without AZF microdeletion were recruited as controls. Both AZF and control groups were further divided into subgroups based upon the methods of semen collection: the AZF-testicular sperm extraction subgroup (AZF-TESE, n = 14), the AZF-ejaculation subgroup (AZF-EJA, n = 43), the control-TESE subgroup (n = 28) and the control-EJA subgroup (n = 86). Clinical data were analyzed in the two groups and four subgroups respectively. A retrospective case-control study was performed. A significantly lower fertilization rate (69.27 versus 75.70%, P = 0.000) and cleavage rate (89.55 versus 94.39%, P = 0.000) was found in AZF group compared with the control group. Furthermore, in AZF-TESE subgroup, the fertilization rate (67.54 versus 74.25%, P = 0.037) and cleavage rate (88.96 versus 94.79%, P = 0.022) were significantly lower than in the control-TESE subgroup; similarly, the fertilization rate (69.85 versus 75.85%, P = 0.004) and cleavage rate (89.36 versus 94.26%, P = 0.002) in AZF-EJA subgroup were significantly lower than in the control-EJA subgroup; however, the fertilization rate and cleavage rate in AZF-TESE (control-TESE) subgroup was similar to that in the AZF-EJA (control-EJA) subgroup. The other clinical outcomes were comparable between four subgroups (P > 0.05). Therefore, sperm from patients with AZF microdeletion, obtained either by ejaculation or TESE, may have lower fertilization and cleavage rates, but seem to have comparable clinical outcomes to those from patients without AZF microdeletion.
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    ABSTRACT: The true impact of the current sperm DNA fragmentation testing needs further scrutiny to assess whether clinically meaningful information is conveyed. Various studies have suggested different or no threshold values with assorted tests for the percentage of DNA fragmentation in the ejaculated sperm above which natural conception, fertilization or embryo development and/or clinical pregnancy rates are compromised. Current DNA fragmentation assessment methods provide very little specific information on the nature and severity of the DNA damage detected. Although sperm DNA fragmentation is associated with lower pregnancy rates through natural conception or intrauterine insemination, it does not seem to affect intracytoplasmic sperm injection outcome. Although animal studies demonstrated adverse reproductive effects of sperm DNA fragmentation, any conclusive evidence in humans is yet to be demonstrated. It is not clear whether interventions aimed at enrichment of sperm with decreased DNA fragmentation are effective in preventing the potential adverse effects of sperm DNA fragmentation in humans. Major concern about the use of sperm DNA integrity tests as prognostic parameters is that the direct evaluation of DNA fragmentation in individual sperm fertilizing the oocyte is not possible. The lack of consensus in defining a clinically relevant standard DNA fragmentation test with a meaningful cut-off level brings challenges in implementing the routine use of sperm DNA integrity assessment in daily practice.
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