Virtual Azoospermia and Cryptozoospermia--Fresh/Frozen Testicular or Ejaculate Sperm for Better IVF Outcome?

Abstract

Men diagnosed as having azoospermia occasionally have a few mature sperm cells in other ejaculates. Other men may have constant, yet very low quality and quantity of sperm cells in their ejaculates, resulting in poor intracytoplasmic sperm injection (ICSI) outcome. It has not been conclusively established which source of sperm cells is preferable for ICSI when both ejaculate and testicular (fresh or frozen) sperm cells are available. It is also unclear whether there is any advantage of fresh over frozen sperm if testicular sperm is to be used. We used ejaculate, testicular (fresh or frozen) sperm cells, or both for ICSI in 13 couples. Five of these couples initially underwent ICSI by testicular sperm extraction, because the males had total azoospermia, and in later cycles with ejaculate sperm cells. Ejaculate sperm cells were initially used for ICSI in the other 8 patients, and later with testicular sperm cells. The fertilization rate was significantly higher when fresh or frozen-thawed testicular sperm cells were used than when ejaculated sperm cells were used. Likewise, the quality of the embryos from testicular (fresh and frozen) sperm was higher than from ejaculated sperm (65.3% vs 53.2%, respectively, P , .05). The use of fresh testicular sperm yielded better implantation rates than both frozen testicular sperm and ejaculate. Therefore, fresh testicular sperm should be considered first for ICSI in patients with virtual azoospermia or cryptozoospermia because of their superior fertility.

Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia

“…As a result of these observations, a number of investigators have now compared ICSI outcomes with testicular vs. ejaculated spermatozoa in men with cryptozoospermia. To date, several studies have reported higher ICSI pregnancy rates using testicular vs. ejaculated spermatozoa (in most series, ejaculated spermatozoa were used in the initial ICSI cycles) in men with cryptozoospermia (Bendikson et al, 2008;Hauser et al, 2011;Ben-Ami et al, 2013). These clinical findings support experimental observations demonstrating that in animals with impaired spermatogenesis, post-testicular spermatozoa have poorer chromatin integrity than testicular spermatozoa (Suganuma et al, 2005).…”

“…All the couples were told of the potential risks of TESA and micro-TESE (bleeding, infection, pain, hypogonadism, irreversible testicular dysfunction). Patients were told that cryptozoospermia is not an absolute but rather a relative indication for sperm retrieval based on the understanding that (i) in some instances the number and/or quality of the ejaculated spermatozoa will not be adequate for ICSI and (ii) couples with cryptozoospermia have relatively poor ICSI pregnancy rates (using ejaculated spermatozoa) (Bendikson et al, 2008;Hauser et al, 2011).…”

“…In these men (with cryptozoospermia or virtual azoospermia), the presence of rare spermatozoa in the ejaculate is presumed to arise from small foci of spermatogenesis or be the result of fluctuations in spermatogenesis Bendikson et al, 2008). Alternatively, men with cryptozoospermia on a first semen analysis will intermittently produce an azoospermic ejaculate on subsequent semen analysis making it necessary for these men to undergo testicular sperm retrieval at the time of ICSI (Hauser et al, 2011). Currently, there is ongoing controversy as to whether one should use ejaculated or testicular spermatozoa for ICSI in men with cryptozoospermia (Bendikson et al, 2008;Hauser et al, 2011;Amirjannati et al, 2012;BenAmi et al, 2013).…”

“…Alternatively, men with cryptozoospermia on a first semen analysis will intermittently produce an azoospermic ejaculate on subsequent semen analysis making it necessary for these men to undergo testicular sperm retrieval at the time of ICSI (Hauser et al, 2011). Currently, there is ongoing controversy as to whether one should use ejaculated or testicular spermatozoa for ICSI in men with cryptozoospermia (Bendikson et al, 2008;Hauser et al, 2011;Amirjannati et al, 2012;BenAmi et al, 2013). Moreover, the optimal sperm retrieval technique in these men has not been established because these are uncommon cases.…”

Reactive Oxygen Species and Sperm Cells

“…Testicular sperm extraction (TESE) is a method of surgically retrieving sperm from the testis in patients with azoospermia or cryptozoospermia. ICSI using testicular sperm has a higher implantation rate and pregnancy rate than that using ejaculated sperm [112,113]. However, testicular sperm has a significantly higher aneuploidy rate than ejaculated sperm [111].…”