Results of percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in two major groups of patients with obstructive azoospermia

Meniru, Godwin I.; Gorgy, Amin; Podsiadly, Barbara; Craft, Ian

doi:10.1093/humrep/12.11.2443

Cited by 24 publications

(15 citation statements)

References 18 publications

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“…The only study that reported implantation rate [13] showed similar findings (19% and 16%) to the present 15.8% for congenital and 15.0% for acquired OA, respectively, with no difference between the groups.…”

Section: Discussionsupporting

confidence: 82%

“…Mansour et al [10] reported similar FRs in the two groups (56.6% vs 55.2%) but a significantly higher pregnancy rate in the acquired OA group (37% vs 20.4% per transfer). Meniru et al [13] used PESA as their preferred method of retrieval in 1997, and found no difference in outcome between the groups. More recently, a further large series with over 100 cycles (all MESA) in each group showed similar FR, pregnancy/cycle and delivery/cycle rates between the congenital and acquired groups (73.1%, 61.6% and 53.6% vs 72.4%, 48.5% and 46.6%, respectively [11]).…”

Section: Discussionmentioning

confidence: 99%

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Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta‐analysis

2004

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OBJECTIVE To define whether the outcome of intracytoplasmic sperm injection (ICSI) using sperm surgically retrieved from men with obstructive azoospermia (OA) depends on the cause of obstruction. PATIENTS AND METHODS We first analysed our data and then used a meta‐analysis of published data (including ours) to compare the outcome of ICSI in OA, classified in terms of congenital and acquired causes. The present study comprised 82 couples who underwent 127 ICSI cycles using surgically retrieved sperm. The cause was classified as congenital bilateral absence of vas deferens (CBAVD, in 20), after vasectomy (56), infective/inflammatory (21), noninfective (24) and ejaculatory (five). Five reports (687 cycles) including the present were identified as suitable for meta‐analysis. RESULTS Analysis of the present data showed that fertilization and live‐birth rates were highest in men with a previous vasectomy and no infective cause (vasectomy 51% and 23%; not infective 53% and 29%, respectively) and lowest in men with infective or inflammatory causes. There was no difference in outcome if the sperm was fresh or frozen, or whether epididymal or testicular. Meta‐analysis comparing congenital (CBAVD) and acquired causes showed a significantly increased fertilization rate (95% confidence interval, 0.84–1) with acquired causes. Meta‐analysis of the three papers reporting delivery outcome showed no difference in live‐birth rate but a significantly higher miscarriage rate in the congenital group (relative risk 2.67). CONCLUSION In ICSI cycles in men with OA the cause appears to influence the outcome, but outcome is not affected by whether the retrieved sperm is fresh, frozen, epididymal or testicular. The meta‐analysis suggested a higher fertilization rate and lower miscarriage rate in acquired causes of OA.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta‐analysis

2004

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“…Many authors are confirming the efficiency of PESA (3,7,10). Our results have shown that the chance of obtaining motile spermatozoa in a first PESA procedure was 81%, thus confirming the efficiency of this procedure.…”

Section: Discussionsupporting

confidence: 85%

Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia

et al. 2003

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Objectives: Assessing the efficiency of repeated percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia, and also the possibility of cryopreservation of remaining material for future use in intracytoplasmic sperm injection (ICSI).Method: Retrospective study, in which 79 procedures of PESA were assessed in 58 patients (mean age = 45 years), whose partners had mean age of 34 years. Vasectomy was the most frequent cause of obstructive azoospermia (n = 46).Results: Motile spermatozoa were obtained in 65 procedures (82%). PESA was twice repeated for 15 patients, 3 times for 5 patients, and 4 times for 1 patient. Spermatozoa were found in 13 (87%) patients in the second attempt, in 4 (80%) patients in the third attempt, and in the only patient that had accomplished 4 procedures. In 30 procedures (37%), we have obtained enough material for cryopreservation. In 12 among the 13 samples thawed (n = 13 patients), motile spermatozoa were found, and ICSI was accomplished. Four patients that did not use their samples requested the elimination of the material. Total rate of pregnancy per transference was 21/55 (38%). In 14 PESA procedures, it was not possible to find spermatozoa; in these cases, the patients opted for accomplishing the procedure of testicular sperm aspiration (TESA).Conclusion: PESA is an efficient and simple method of retrieving spermatozoa, allowing repeated procedures. Additionally, spermatozoa collected through PESA can be cryopreserved.

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“…[89] However, there are some reports showing enough evidence for their compatibility of fertilization. [1011] In spite of normal spermatogenesis, sperms could not be ejaculated into the semen due to either obstruction in the ejaculatory ducts or a congenital absence of the vas deferens. In this study, the sperms obtained from the epididymis were used for IVF and for ICSI.…”

Section: Discussionmentioning

confidence: 99%

The outcome of ART in males with impaired spermatogenesis

Mangoli¹,

Sp²,

Desai³

et al. 2008

J Hum Reprod Sci

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AIMS:This study was conducted to evaluate the outcomes of assisted reproductive technology (ART) procedures, viz., intrauterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in males with impaired spermatogenesis.SETTINGS AND DESIGN:The subjects of the study were infertile couples who were undergoing ART treatment due to male factor indications. The project was designed to correlate the outcome of the ART treatment and its efficacy in different study groups.METHODS:Males were grouped as: 1. oligozoospermia (n = 153), 2. asthenoteratozoospermia (n = 158), 3. obstructive azoospermia (n = 110) and 4. nonobstructive azoospermia (n = 58). Patients from groups 1 and 2 were considered for IUI, IVF and ICSI. Those from group 3 were considered for IVF and ICSI and the 4th group underwent only ICSI treatment.RESULTS:Oligozoospermia showed lower pregnancy rates with IUI than with both IVF and ICSI. An average minimum native and postharvest count was obtained to get an acceptable IUI outcome. Asthenoteratozoospermia had the lowest pregnancy rate with IUI as compared to IVF, whereas ICSI showed significantly higher pregnancy rates in this group. Obstructive azoospermia showed significant improvement with ICSI over IVF. In nonobstructive azoospermia, ICSI resulted in a 27.58% pregnancy rate.CONCLUSION:The IUI outcome was impressive though less effective whereas there was no difference between the IVF and ICSI outcomes in oligozoospermia. In asthenoteratozoospermia, ICSI showed a significant advantage over IUI and IVF, with IUI resulting in poor outcome in this group. In obstructive azoospermia, ICSI had a distinct advantage over IVF whereas in nonobstructive azoospermia, ICSI, the only option, was found to be effective and helpful in achieving an acceptable pregnancy rate.

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Results of percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in two major groups of patients with obstructive azoospermia

Cited by 24 publications

References 18 publications

Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta‐analysis

Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta‐analysis

Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia

The outcome of ART in males with impaired spermatogenesis

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