Comparative Clinical Study of Percutaneous Epididymal Sperm Aspiration and Testicular Biopsy in the Outcome of ICSI-Assisted Fertility Treatment in Patients with Obstructive Azoospermia

Abstract

ObjectiveTo compare and contrast the effects of percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) on the outcome of intracytoplasmic sperm injection (ICSI)-assisted fertility treatment in patients with obstructive azoospermia.MethodsPatients with obstructive azoospermia with an age distribution of 20–36 years admitted to the male department of the Reproductive Center of the Second Affiliated Hospital of South China University (Hengyang Nanhua Xing Hui Reproductive Health Hospital) from December 2018 to December 2020 were used in this study. One group was set up as the PESA group to perform PESA, and the other group was set up as the TESA group to perform percutaneous testicular biopsy for sperm extraction. Patients who were unsuccessful in PESA continued to undergo TESA, and if sperm were retrieved, they were classified as the TESA group. General information on male patients and their partners was collected and compared in patients from different sperm source groups. Embryo development (normal fertilization rate, high-quality embryo rate, and high-quality blastocyst rate) and pregnancy outcome (clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate) were compared between the two groups.ResultsFinally, there were 26 patients in the PESA group and 31 patients in the TESA group. There were no significant differences in terms of age, years of infertility, testosterone level, (FSH) follicle-stimulating hormone level, and testicular volume between the male patients in the PESA and TESA groups of two different sperm sources, and no significant differences were found in the general conditions of the female patients in terms of age, number of eggs obtained, number of sinus follicles, basal FSH value, and basal E2 value (p > 0.05). The rate of high-quality blastocysts in the TESA group was significantly higher than that in the PESA group (p < 0.05); the differences in clinical normal fertilization rate, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate between the two groups were not statistically significant (p > 0.05).ConclusionICSI with different sources of sperm in patients with male factor infertility alone, which had no significant effect on embryo development, embryo implantation rate, clinical pregnancy rate, and miscarriage rate, resulting in better clinical outcomes.

Effects of different sperm sources on the clinical outcomes of in vitro oocyte maturation cycles combined with intracytoplasmic sperm injection

“…We have come to the same conclusion since sperm recovered by PESA and TESA had similar clinical pregnancy rates and birth rates, and there was no significant difference compared to the ejaculation group. Another study found that the rate of high-quality blastocysts in the TESA group (82.56%) was significantly higher than that in the PESA group (71.82%), but the embryo implantation rate, pregnancy rate, and miscarriage rate of spermatozoa from the PESA and TESA groups were similar during the ICSI cycle ( 1 ).…”

“…Azoospermia refers to the absence of sperm in semen after three consecutive semen examinations and accounts for 15% of cases of male infertility ( 1 ). Sperm is initially generated in the seminiferous tubules of the testis, collected through these tubules, and temporarily stored in the epididymis.…”

“…Intracytoplasmic sperm injection (ICSI) can assist fertility by directly injecting sperm into an oocyte. This method has been the mainstream technique to help azoospermia patients produce genetic offspring ( 1 ). Percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) are common surgical methods for azoospermia patients to retrieve sperm for further ICSI ( 1 ).…”

“…This method has been the mainstream technique to help azoospermia patients produce genetic offspring ( 1 ). Percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) are common surgical methods for azoospermia patients to retrieve sperm for further ICSI ( 1 ). Recent research shows that sperm may carry genetic information that affects the development of offspring and control the early development of embryos ( 2 ).…”

“…There is limited research on TESA–IVM and PESA–IVM cycles, and only a limited number of studies have reported on IVM oocytes fertilized by sperm from male patients with azoospermia in the ICSI cycle ( 6 , 7 ). It is still debatable whether the source of sperm affects outcomes in the ICSI cycle or the IVM–ICSI cycle ( 1 , 8 ). Therefore, we used different sperm sources (percutaneous epididymal sperm aspiration, testicular sperm aspiration, and ejaculated sperm) to analyze outcomes after ICSI in IVM cycles.…”