Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review

Abstract

We compared pregnancy outcomes following intracytoplasmic sperm injection for the treatment of male infertility according to the type of azoospermia. First, we analyzed our data from 370 couples who underwent intracytoplasmic sperm injection using sperm from men with obstructive azoospermia and nonobstructive azoospermia, and the outcomes were compared to a group of 465 non-azoospermic infertile males. Then, we performed a systematic review of the published data on pregnancy and neonatal outcomes of children born after sperm injection using sperm from men with obstructive and nonobstructive azoospermia. Live birth rates were significantly lower in the nonobstructive azoospermia group (21.4%) compared with the obstructive azoospermia (37.5%) and ejaculated sperm (32.3%) groups. A total of 326 live births resulted in 427 babies born. Differences were not observed between the groups in gestational age, preterm birth, birth weight and low birth weight, although we noted a tendency towards poorer neonatal outcomes in the azoospermia categories. The overall perinatal death and malformation rates were 2.8% and 1.6%, respectively, and the results did not differ between the groups. We identified 20 published studies that directly compared pregnancy outcomes between obstructive azoospermia and nonobstructive azoospermia. Most of these studies were not designed to detect differences in live birth rates and had lower power to detect differences in less frequent outcomes, and the reporting of neonatal outcomes was unusual. The included studies reported either a decrease or no difference in pregnancy outcomes with intracytoplasmic sperm injection in cases of nonobstructive azoospermia and obstructive azoospermia. In general, no major differences were noted in short-term neonatal outcomes and congenital malformation rates between children from fathers with nonobstructive azoospermia and obstructive azoospermia.

Comparison of reproductive outcome in oligozoospermic men with high sperm DNA fragmentation undergoing intracytoplasmic sperm injection with ejaculated and testicular sperm

“…In our study, fertilization rates after sperm injections with testicular sperm were lower than those with ejaculated sperm. Similar results have been observed when azoospermic (nonobstructive) and nonazoospermic men were compared (43)(44)(45)(46). An impaired fertilization potential in the group of men with nonobstructive azoospermia might be explained by the inherent defective spermatogenesis (26).…”

“…While defective spermatozoa passing the testicular barrier can be eventually deselected via natural apoptoticlike processes (54), it is possible that testicular sperm originating from a subpopulation that would be blocked in its ontogeny during the maturation process is selected for TESTI-ICSI and carries putative deficiencies (55). Importantly, current evidence indicates that the neonatal profiles of babies born after ICSI using surgically retrieved gametes are reassuring (43,44), but these data exclusively concern the subset of patients with azoospermia. The limited evidence favoring ICSI outcomes with the use of testicular sperm in men with high SDF calls for continuous monitoring until the safety of this strategy is confirmed.…”

Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility

“…However, reports comparing both SR and ICSI results by making a clear distinction between the types of azoospermia are minimum 1011. Still, ICSI data comparing the reproductive potential of the non-ejaculated gametes from men with testicular failure with the ejaculated sperm from fertile donors are lacking.…”

The role of modern technologies in the management of azoospermia using micro-TESE in the framework of the ECF/ICSI program. A literature review. Part II.

“…Esteves и соавт. [45] сравнили результаты ис-пользования сперматозоидов 370 мужчин с азоо-спермией (НОА и ОА) и 465 бесплодных мужчин с тяжелой формой патозооспермии (для ИКСИ ис-пользовали эякуляторные сперматозоиды). Кроме того, был проведен обзор 20 публикаций, касаю-щихся беременностей и детей, родившихся после ИКСИ с использованием сперматозоидов мужчин с ОА и НОА.…”