Pregnancies and live births following ICSI with testicular spermatozoa after repeated implantation failure using ejaculated spermatozoa

Abstract

The use of testicular spermatozoa for IVF/intracytoplasmic sperm injection (ICSI) is currently indicated exclusively for patients with azoospermia, since a favourable outcome is expected even when very few spermatozoa are present in the ejaculate. Here, a series of four couples with long-standing male factor infertility and multiple failed IVF/ICSI cycles are described. In all couples, the use of ejaculated spermatozoa for ICSI resulted in poor embryo quality and repeated implantation failure. Testicular sperm aspiration was performed in subsequent cycles, and testicular spermatozoa were used for ICSI. Embryo implantation and ongoing pregnancies/deliveries were achieved in all four couples. It is postulated that spermatozoa are subjected to post-testicular damage during sperm transport between the seminiferous tubules and epididymis, with the injection of damaged spermatozoa being the cause for repetitive IVF/ICSI failures. In selected patients, the use of testicular spermatozoa for IVF/ICSI should be considered, even when motile spermatozoa can be identified in the ejaculate.

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

“…Lastly, Weissman et al showed that testicular spermatozoa was useful to overcome long-standing recurrent implantation failure in a group of four couples who failed to conceive by ICSI using ejaculated sperm (31). A plausible reason for the improved ICSI outcomes in the aforementioned series might be the lower SDF levels in testicular specimens compared with ejaculated counterparts (17,18).…”

Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series

“…Neither study compared IVF-ICSI outcomes between ejaculated and matched testicular derived sperm from the same individual. Additionally, these studies did not stratify for the cohort of men who have had repeated IVF-ICSI failure, a group that may benefit from testis-derived sperm [10, 11, 40, 41]. Our small case series documents a possible benefit for this population.…”

Current Approach to Recurrent Implantation Failures: Review

“…TİB'li hasta grubunda testiküler spermatozoa kullanımı ile daha yüksek gebelik oranları elde edilmesine rağmen bu konu ile ilgili daha fazla randomize kontrollü çalışmaya ihtiyaç vardır. 49,52 Karyotip Tayini TİB'li hastalarda kromozomal anomali insidansı %2,5 olup normal populasyona göre daha yüksek olduğundan bu hasta grubunda çiftlere karyotip analizi önerilmektedir. bir veya iki blastomer biyopsisi ve blastokist aşa-masında yapılan hücre biyopsisidir.…”