Factors affecting successful outcome from ICSI in men following previous vasectomy

Factors predicting the outcome of percutaneous epididymal sperm aspiration in men with obstructive azoospermia

Objectives: To report on the live birth rates (LBRs) following percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia (OA) and factors affecting treatment outcome which is under reported in the literature.Methods: This is a multicenter study that was conducted in Egypt including all couples undergoing intra cytoplasmic sperm injection (ICSI) for OA using PESA-derived sperms. Men were subdivided according to aetiology into congenital, iatrogenic and idiopathic groups. Fertilization, pregnancy and LBRs were determined and compared in each group. The longitudinal LBR, crude and expected cumulative delivery rates (CCDR, ECDR) were calculated. Multiple logistic regression analysis was used to determine significant associations between maternal, paternal and ICSI factors with successful live births.Results: Ninety couples were included in the study. Viable sperm for ICSI was retrieved in 89 men (98.9%). A total of 155 ICSI cycles with 17 frozen embryo transfers resulted in 81 pregnan-cies and 55 live births. After 5 cycles, the longitudinal LBR, CCDR and ECDR were 30%, 57.3% and 88.6% respectively. Maternal age and number of fertilized eggs were the only fac-tors significantly affecting LBRs.Conclusions: PESA is a minimally invasive procedure for secur-ing viable sperm for ICSI in OA men, with high cumulative delivery rates. Maternal age and number of fertilized eggs are the only factors that significantly affecting LBR. The contempo-rary longitudinal and cumulative LBRs provide objective out-come data to counsel OA patients undergoing fertility treat-ments.

TESE-ICSI outcomes per couple in vasectomized males are negatively affected by time since the intervention, but not other comorbidities

RESEARCH QUESTION

Does time since vasectomy (as obstructive interval) and the presence of different male comorbidities adversely affect the likelihood of achieving a newborn for vasectomized males undergoing testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI)?

DESIGN

This retrospective study included 364 couples with vasectomized males undergoing TESE-ICSI cycles with autologous oocytes at IVI Valencia. The main outcome was live birth rate (LBR). Subjects were divided according to the male risk factor evaluated into quartiles (obstructive interval, body mass index [BMI]) or groups (hypertension, diabetes mellitus, dyslipidaemia). The reproductive outcomes were calculated per embryo transfer, per ovarian stimulation completed, and per couple.

RESULTS

The average obstructive interval was 11.3 years. The LBR was 34.4% (95% CI 30.1-38.6) per embryo transfer, 27.8% (95% CI 24.1-31.5) per ovarian stimulation and 46.2% (95% CI 41.8-51.3) per couple. When considering obstructive interval, a significantly lower LBR per couple (P = 0.04) was found in the group with the longest obstruction time: Q1 42.1% (95% CI 33.5-50.7), Q2 49.1% (95% CI 36.1-62.1), Q3 56.3% (95% CI 46.7-65.9) and Q4 37.2% (95% CI 26.5-47.9) but the cumulative live birth rate (CLBR) was not affected (P = 0.63). LBR per ovarian stimulation of males with hypertension was significantly lower (P = 0.04) than healthy males: 13.5% (95% CI 2.5-24.5) and 28.6% (95% CI 24.7-32.5), respectively. The group of diabetic vasectomized males had a significantly higher CLBR (P = 0.02). The remaining risk factors assessed (smoking, dyslipidaemia and a high BMI) did not affect LBR compared with their healthy counterparts.

CONCLUSION

Time since vasectomy appears to negatively influence the LBR when assessed per couple. The CLBR was not affected by the obstructive interval or the presence of other male comorbidities apart from diabetes, which had a significant effect.

Does acquired obstructive azoospermia have less impact than congenital azoospermia on ICSI results? Systematic review and meta-analysis

An electronic-based search was performed with MEDLINE bases through PubMed, Cochrane through Central, and Embase until August 2020 for the purpose of evaluating the impact of the aetiology of obstructive azoospermia on ICSI cycles. In the final analysis, there were 15 cohort studies included, comparing a group of patients with acquired azoospermia and others due to congenital bilateral absence of the vas deferens submitted to ICSI. Those 15 articles within 4,480 couples were analysed, and similar fertilisation rate (65.1% vs. 65.3%; p = .38), pregnancy rate per cycle (40.0% vs. 43.1%; p = .06) and live birth rate (29.6% vs. 30.0%;p = .76) were found between groups. Comparing specifically post-vasectomy azoospermia and congenital groups, both presented a similar fertilisation rate (62.4% vs. 53.4%, respectively; OR 1.10; 95% CI, 0.79, 1.54; p = .56; I²  = 89%) and pregnancy rate per cycle (39.4% vs. 35.6%, respectively; OR 1.26; 95% CI, 0.96, 1.66; p = .09; I²  = 0%). However, a higher live birth rate was identified in the congenital group compared to vasectomy group (28.4% × 19.5%; OR 1.54; 95% CI, 1.11, 2.15; p = .01; I²  = 0%). The reasons for that are unclear and factors such as couple age and sperm DNA fragmentation should be considered.

Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens

OBJECTIVE

To assess the relationship between paternal age and the outcome of percutaneous epididymal sperm aspiration-intracytoplasmic sperm injection (ICSI) in patients with congenital bilateral absence of the vas deferens (CBAVD).

DESIGN

Prospective cohort study.

SETTING

In vitro fertilization centers.

PATIENT(S)

Eighty-five (male) CBAVD patients who underwent percutaneous epididymal sperm aspiration with ICSI were divided into 3 age groups; <30 years (n = 27); aged 30-40 years (n = 32); and aged >40 years (n = 26).

INTERVENTION(S)

History taking, clinical examination, semen analysis, percutaneous epididymal sperm aspiration with subsequent ICSI.

MAIN OUTCOME MEASURE(S)

Sperm retrieval, clinical pregnancy, and "take-home baby."

RESULT(S)

The number of sperm retrieved by percutaneous epididymal sperm aspiration significantly decreased with advancing age in the studied groups (0.63, 0.31, and 0.18 million, respectively), concomitant with significant decreases in the outcomes of clinical pregnancy (55.5%, 43.7%, and 23.1%, respectively) and "take-home baby" (48.1%, 40.6%, and 11.5%, respectively). Male age was significantly negatively correlated with retrieved sperm count, sperm motility, sperm vitality, and normal sperm morphology. Multiple logistic regression, adjusted for confounding factors, with male age, and sperm count obtained using percutaneous epididymal sperm aspiration, was significant. The receiver operating characteristic curve showed that a sperm count of 0.55 million as a cutoff value could predict clinical pregnancy with an accuracy of 77.4%, with 82.9% sensitivity and 62% specificity, and "take-home baby" with an accuracy of 81.7%, with 93.1% sensitivity and 62.5% specificity.

CONCLUSION(S)

In cases of CBAVD, male age has a negative effect on retrieved-sperm count, motility, vitality, and normal sperm morphology; number of retrieved sperm predicted both clinical pregnancy and "take-home baby" outcomes in subsequent ICSI.

Office-based sperm retrieval for treatment of infertility

This article describes sperm retrieval procedures that may be performed in an office setting. Indications for sperm retrieval, preprocedural preparation, and anesthetic considerations are discussed. Vasal sperm aspiration, percutaneous epididymal sperm aspiration, microsurgical epididymal sperm aspiration, testicular sperm aspiration, conventional, and microdissection testicular sperm extraction are reviewed. Success and complication rates as well as factors that may influence success (histopathology, cancerous cause, Klinefelter syndrome, Y microdeletions, varicocele, and hormone administration) are reviewed.