Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection

Abstract

Objective: To evaluate the impact of sperm defect severity and the type of azoospermia on the outcomes of intracytoplasmic sperm injection (ICSI). Materials and Methods:This study included 313 ICSI cycles that were divided into two major groups according to the source of spermatozoa used for ICSI: 1) Ejaculated (group 1; n = 220) and 2) Testicular/Epididymal (group 2; n = 93). Group 1 was subdivided into four subgroups according to the results of the semen analysis:, n = 41), 2) double defect (a combination of two single defects, n = 45), 3) triple defect (OAT, n = 48), and 4) control (no sperm defects; n = 86). Group 2 was subdivided according to the type of azoospermia: 1) obstructive (OA: n = 39) and 2) non-obstructive (NOA: n = 54). Fertilization (2PN), cleavage, embryo quality, clinical pregnancy and miscarriage rates were statistically compared using one-way ANOVA and Chi-square analyses. Results: Significantly lower fertilization rates were obtained when either ejaculated sperm with triple defect or testicular sperm from NOA patients (63.4 ± 25.9% and 52.2 ± 29.3%, respectively) were used for ICSI as compared to other groups (~73%; P < 0.05). Epididymal and testicular spermatozoa from OA patients fertilized as well as normal or mild/moderate deficient ejaculated sperm. Cleavage, embryo quality, pregnancy and miscarriage rates did not differ statistically between ejaculated and obstructive azoospermia groups. However, fertilization, cleavage and pregnancy rates were significantly lower for NOA patients. Conclusion: Lower fertilization rates are achieved when ICSI is performed with sperm from men with oligoasthenoteratozoospermic and non-obstructive azoospermic, and embryo development and pregnancy rates are significantly lower when testicular spermatozoa from NOA men are used.

Sperm retrieval techniques for assisted reproduction

“…ICSI provides fertilization rates of 45-75% per injected oocyte when epididymal or testicular spermatozoa from men with OA are used. In such cases, clinical pregnancy and live birth rates reported in the recent literature range from 26-57% and 18-55%, respectively (24,(35)(36)(37)(38) (Table-3). …”

“…Surgically retrieved-spermatozoa are often compromised in quality, particularly in the cases of NOA and after freezing and thawing (24). Therefore, great caution should be applied during processing of such specimens.…”

Congenital bilateral absence of the vas deferens: the impact of spermatogenesis quality on intracytoplasmic sperm injection outcomes in 108 men

“…In view of the role of the CFTR protein in spermatogenesis, the possible involvement of CFTR gene mutations in disruptions of sperm production cannot be totally ruled out (Denning et 478 Andrology, 2015, 3, 473-480 1994; Van der Ven et al, 1996;Larriba et al, 1998;Lewis-Jones et al, 2000). It is generally assumed that defective spermatogenesis in patients with non-obstructive azoospermia affects the ICSI outcomes (Ghazzawi et al, 1998;Monz o et al, 2001;Verza & Esteves, 2008;He et al, 2010). In contrast, little is known about the potential impact of spermatogenesis quality on ICSI outcomes in CBAVD patients with obstructive azoospermia.…”

Engaging Practicing Gynecologists in the Management of Infertile Men

“…ICSI is associated with lower fertilization rates per injected oocyte as well as clinical pregnancy and delivery rates when testicular spermatozoa from men with NOA are used in comparison to epididymal/testicular sperm from men with OA [113][114][115]. Once a live birth is achieved, newborn parameters of infants conceived were not significantly different among the groups, and no major differences are noted in the offspring's neonatal profile [113].…”