Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis

Abstract

Background: Intracytoplasmic sperm injection (ICSI) is a popular treatment for male infertility due to obstructive azoospermia (OA). Testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) are two common sperm retrieval approaches for ICSI among men with OA. However, the comparative efficacies of TESA and PESA have been debated for more than a decade and there has been no synthesis of the available evidence. This meta-analysis compared fertility outcomes between TESA and PESA among men with OA undergoing ICSI.Methods: We searched Embase, PubMed, ScienceDirect, and Web of Science to identify studies comparing the effectiveness of TESA and PESA for ICSI. Study quality was assessed using the Newcastle-Ottawa scale. Data were pooled using a random-effects model. Outcomes were fertilization rate, implantation rate, pregnancy rate, and miscarriage rate. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs). Study heterogeneity was evaluated by the I-square (I 2 ) statistic.Results: Of 2,965 references retrieved, eight studies met eligibility criteria. These studies included 2,020 men receiving 2,060 ICSI cycles. The pooled results showed no significant differences in pregnancy and miscarriage rates between TESA and PESA groups, but TESA yielded a significantly higher implantation rate than PESA (OR =1.58, P=0.02, I 2 =24%).Conclusions: TESA and PESA yielded similar pregnancy and miscarriage rates for couples receiving ICSI because of OA, but each demonstrated unique advantages and disadvantages. Further studies are required to evaluate safety outcomes and efficacy for specific clinical groups.

Intracytoplasmic sperm injection outcomes in patients with orgasmic dysfunction and anejaculation by percutaneous epididymal sperm aspiration (PESA)

“…The spermatozoa collected by PESA are more motile than those retrieved by TESA, and laboratory processing of epididymal sperm is easier than that of testicular sperm. Furthermore, Shih et al reported that TESA and PESA yielded similar pregnancy and miscarriage rates (19). For these reasons, we believe that PESA, like TESA, is an appropriate and convenient way to obtain sperm for ICSI in cases of patients with orgasmic dysfunction and anejaculation.…”

Does ICSI outcome in obstructive azoospermia differ according to the origin of retrieved spermatozoa or the cause of epididymal obstruction? A comparative study

“…Previous studies showed different fertilization rates and miscarriage rates between TESA and PESA [14,[33][34][35]. A systematic review in 2019 gathered previous study data and found that there were no significant differences in pregnancy or miscarriage rates between the TESA and PESA treatment groups, although the fertilization rate was slightly higher using PESA and the implantation rate was numerically higher using TESA [16]. In our study, the fertilization rate, 2PN cleavage rate, implantation rate, no embryo suitable for transfer cycles rate, biochemical pregnancy rate, clinical pregnancy rate, ectopic pregnancy rate, singleton pregnancy rate, and twin pregnancy rate did not differ among the three groups.…”

“…Whether the source of sperm affects ICSI outcomes in OA patients is still debatable, and studies from different reproductive centers have not been unanimous [ 13 – 15 ]. A systematic review and meta-analysis in 2019 collected previous studies and found that there were no significant differences in pregnancy or miscarriage rates between TESA and PESA treatment groups, although the fertilization rate was slightly higher using PESA and the implantation rate was numerically higher using TESA [ 16 ]. In addition, there is little evidence for the superiority of TESA or PESA, which is in accordance with a previous synthesis in the Cochrane Database [ 17 ].…”

Clinical and Neonatal Outcomes of Children Born After ICSI With or Without Surgically Acquired Sperm: A Retrospective Cohort Study

“…Their results indicated that there was no evidence of differences between the groups in the clinical outcomes and development of the children. A systematic review and meta-analysis performed in 2019 that compared fertility outcomes of TESA and PESA among men with obstructive azoospermia (OA) undergoing ICSI revealed that TESA and PESA yielded similar pregnancy and miscarriage rates for couples receiving ICSI because of OA ( 13 ). However, Ben-Ami I et al ( 14 ) revealed that compared with ejaculated sperm cycles, TESA cycles had a significantly higher implantation rate (20.7% vs. 5.7%), higher pregnancy rate (42.5% vs. 15.1%), and higher LBR (27.5% vs. 9.4%) ( 15 ).…”