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Lewin J, Lukaszewski T, Sangster P, Williamson E, McEleny K, Al Wattar BH, Yasmin E. Reproductive outcomes after surgical sperm retrieval in couples with male factor subfertility: a 10-year retrospective national cohort. Fertil Steril 2023; 119:589-595. [PMID: 36592648 DOI: 10.1016/j.fertnstert.2022.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine any significant differences in the reproductive outcome from intracytoplasmic sperm injection (ICSI) with surgical sperm retrieval (SSR) between cycles using fresh and cryopreserved sperm and between cycles using epididymal and testicular sperm. DESIGN A retrospective national cohort study using data from the UK Human Fertilisation and Embryology Authority, including all ICSI cycles performed in the United Kingdom over a 10-year period. SETTING Hospital. PATIENT(S) All nondonor ICSI cycles from 2008 to 2017 categorized by sperm source and cryopreservation status. INTERVENTION(S) Intracytoplasmic sperm injection with SSR using fresh or cryopreserved sperm and using ejaculated, testicular, and epididymal sperm. MAIN OUTCOME MEASURE(S) Live birth rate, pregnancy rate, and implantation rate. RESULT(S) We analyzed data from 214,649 ICSI cycles, including 199,818 cycles of ejaculated sperm, 5,646 cycles of epididymal sperm, and 9,185 cycles of testicular sperm. Live births rates per ICSI cycle were 28.5%, 30.6%, and 28.7% for ejaculated, epididymal, and testicular sperm cycles, respectively. Epididymal sperm cycles had a higher live birth rate than that of testicular sperm cycles (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.014-1.123). This was despite a higher mean male age (42.5 vs. 40.6 years; 95% CI of difference, 1.81-1.85 years) and female age (34.3 vs. 34.0 years; 95% CI of difference, 0.32-0.34 years) in epididymal cycles than in testicular cycles. Implantation (61.2% vs. 58.0%; OR, 1.086; 95% CI, 1.041-1.133) and clinical pregnancy rates (34.3% vs. 31.3%; OR, 1.085; 95% CI, 1.039-1.132) were also higher in epididymal cycles than in testicular cycles. There were no statistically significant differences in outcomes between cycles using fresh sperm and those using cryopreserved sperm for SSR-ICSI. CONCLUSION(S) Our study indicates that reproductive outcomes of SSR-ICSI are at least comparable with those of ICSI using ejaculated sperm and does not support the preferential use of fresh sperm over cryopreserved sperm in SSR-ICSI. Births per SSR-ICSI cycle were higher for cycles using epididymal sperm than for cycles using testicular sperm; however, the differences were small, which may provide reassurance to patients undergoing these procedures. The results must be interpreted with caution because multivariable analysis was not possible because of aggregation of data.
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Affiliation(s)
- Jonathan Lewin
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Tomasz Lukaszewski
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Phillippa Sangster
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; Department of Urology, University College London Hospitals, London, United Kingdom
| | - Elizabeth Williamson
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Kevin McEleny
- Newcastle Fertility Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Bassel H Al Wattar
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom.
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Yu C, Zhou C, Lin F, Zhang W, Wang X, Hu L, Lu R. Analysis of the Growth and Development of Children Born with ICSI of Epididymal and Testicular Spermatozoa: A Propensity Matching Study. Curr Pharm Des 2023; 29:2668-2678. [PMID: 37929741 DOI: 10.2174/0113816128264448231022201641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The study aimed to evaluate whether singleton live births (at 0, 1, 6, 12, and 24 months) following intracytoplasmic sperm injection (ICSI) using sperm of different origins (ejaculated or non-ejaculated sperm) are associated with the growth and development of children born. METHODS This was a retrospective cohort study conducted at a single center from January 2016 to December 2019. Follow-up data of the children were obtained from the Jiangsu Province Maternal and Child database. A total of 350 singleton live births after fresh embryo transfer (ET) with ICSI were included. Based on the origin of the sperm, the patients were divided into two groups: the ejaculated group (n = 310) and the non-ejaculated group (n = 40). Propensity score matching was used to control for multiple baseline covariates, resulting in 80 singleton live births (ejaculated sperm) matched to 40 singleton live births (non-ejaculated). The non-ejaculated group was further divided into two subgroups: the PESA group (n = 23) and the TESA group (n = 17). The primary outcome of the study was the growth and development of children. Secondary outcomes included the 2PN rate, high-cleavage embryo rate, blastocyst formation rate, and others. RESULTS After matching parental age, BMI, occupation, and maternal serum AMH level, there was no significant difference found in the growth and development of children between the non-ejaculated and ejaculated group or the PESA group and TESA group, respectively. However, the 2PN rate and the blastocyst formation rate were higher in the ejaculated group compared to the non-ejaculated group (91.02 and 85.45, P = 0.002) and (67.37 and 56.06, P = 0.019), respectively. The high-quality cleavage embryo rate was also higher in the TESA group compared to the PESA group (85.06 and 65.63, P = 0.001). CONCLUSION This study suggests that there are no significant differences in the growth and development of children born following ICSI using sperm of different origins (ejaculated or non-ejaculated). For nonobstructive azoospermia (OA) patients, sperm derived from the testis may be more effective than derived from the epididymis. However, due to the limited sample size of the non-ejaculated group in this study, further investigations with larger sample sizes are needed to validate these findings.
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Affiliation(s)
- Chunmei Yu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Chao Zhou
- Reproduction Medical Center, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Feng Lin
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Wanchao Zhang
- Department of Wuqia County People Hospital, The Xinjiang Uygur Autonomous Region, China
| | - Xiaoyu Wang
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Lingmin Hu
- Changzhou Medical Center, Changzhou Maternal and Child Health Care Hospital, Nanjing Medical University, Jiangsu, Changzhou, China
| | - Renjie Lu
- Changzhou Medical Center, Changzhou Third People's Hospital, Nanjing Medical University, Jiangsu, China
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Li J, Chen J, Tian S, Jiao T, Wang J, Wei Y, Cheng Y, Xu Y, Chian RC, Li Y, Zhang S. Effects of different sperm sources on the clinical outcomes of in vitro oocyte maturation cycles combined with intracytoplasmic sperm injection. Front Endocrinol (Lausanne) 2023; 14:1115210. [PMID: 36891059 PMCID: PMC9986477 DOI: 10.3389/fendo.2023.1115210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES To evaluate the embryonic developments and clinical outcomes of different sperm sources with cycles of intracytoplasmic sperm injection (ICSI) and in vitro maturation (IVM). METHODS This retrospective study was approved by the hospital ethics committee and conducted in the hospital in vitro fertilization (IVF) clinic. From January 2005 to December 2018, 239 infertile couples underwent IVM-ICSI cycles and were divided into three groups according to different sperm sources. Group 1 comprised patients with percutaneous epididymal sperm aspiration (PESA; n = 62, 62 cycles), group 2 comprised patients with testicular sperm aspiration (TESA; n = 51, 51 cycles), and group 3 comprised patients with ejaculated sperm (n = 126, 126 cycles). We calculated the following outcomes: 1) outcomes per IVM-ICSI cycle: fertilization rate, cleavage rate, and embryo quality; 2) outcomes per embryo transfer cycle: endometrial thickness, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, and live birth rate. RESULTS There was no difference in basic characteristics among the three groups, such as the female partner's age, basal follicle-stimulating hormone (FSH), basal luteinizing hormone (LH), and antral follicle count (p > 0.1). There were no statistically significant differences according to the IVM-ICSI cycle among the three groups in fertilization rate, cleavage rate, and rate of good-quality embryos (p > 0.05). The results were similar among cycles regarding the number of transfer embryos and endometrial thickness per embryo transfer cycle among the three groups (p > 0.05). There were also similar clinical outcomes per embryo transfer cycle among the three groups, such as the biochemical pregnancy rate, clinical pregnancy rate, and live birth rate (p > 0.05). CONCLUSIONS Different sperm sources, percutaneous epididymal sperm aspiration, testicular sperm aspiration, and ejaculated sperm, do not affect the embryo and clinical outcomes after IVM-ICSI cycles.
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Affiliation(s)
- Jianhua Li
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jing Chen
- Reproductive Medicine Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shuang Tian
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Tingting Jiao
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Jianye Wang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yan Wei
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Yanbin Cheng
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Ye Xu
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Ri-Cheng Chian
- Center for Reproductive Medicine, Shanghai Tenth People’s Hospital of Tongji University, Shanghai, China
- *Correspondence: Ri-Cheng Chian, ; Youzhu Li, ; Shuiwen Zhang,
| | - Youzhu Li
- Reproductive Medicine Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
- *Correspondence: Ri-Cheng Chian, ; Youzhu Li, ; Shuiwen Zhang,
| | - Shuiwen Zhang
- Reproductive Medical Center, Department of Obstetrics and Gynecology, Seventh Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Ri-Cheng Chian, ; Youzhu Li, ; Shuiwen Zhang,
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Yu X, Lu S, Yuan M, Ma G, Li X, Zhang T, Gao S, Wei D, Chen ZJ, Liu H, Zhang H. Does ICSI outcome in obstructive azoospermia differ according to the origin of retrieved spermatozoa or the cause of epididymal obstruction? A comparative study. Int Urol Nephrol 2022; 54:3087-3095. [PMID: 36059025 PMCID: PMC9606059 DOI: 10.1007/s11255-022-03350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
Purpose To determine whether ICSI outcomes are affected by sperm source or genital tract inflammatory status. Methods A retrospective cohort study was conducted in all consecutive obstructive azoospermia patients who underwent testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) and ICSI between February 1, 2017, and December 31, 2020. Couples were excluded if they were diagnosed with monogenic disease, abnormal karyotype, or had female uterine malformation. The primary objective was to determine whether ICSI outcomes are affected by the use of testicular or epididymal spermatozoa, and the secondary objective was to explore the effect of granulocyte elastase on ICSI outcomes using epididymal spermatozoa. Results Compared with TESA, inflammatory and non-inflammatory PESA patients exhibited a better high-quality embryo rate, with significant differences among the three groups (49.43 vs. 55.39% and 56.03%; odds ratio, 6.345 and 6.631; 95% confidence interval, 0.340–12.350, and 1.712–11.550; P = 0.038 and P = 0.008, respectively). The fertilization rate, clinical pregnancy rate, live birth delivery rate, and congenital anomaly birth rate were similar in patients who underwent TESA or PESA (with or without inflammation). Conclusions The high-quality embryo rate in PESA patients was higher than that in TESA patients. After successful pregnancy, ICSI outcomes did not differ between patients with obstructive azoospermia who experienced TESA or PESA and those with or without genital tract inflammation. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03350-x.
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Affiliation(s)
- Xiaochen Yu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Shaoming Lu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Mingzhen Yuan
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Gang Ma
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Xiao Li
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Taijian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Shanshan Gao
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Hongbin Liu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China. .,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
| | - Haobo Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China. .,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China. .,The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
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Li L, Liao H, Li M, Xiao J, Wu L. Comparative Clinical Study of Percutaneous Epididymal Sperm Aspiration and Testicular Biopsy in the Outcome of ICSI-Assisted Fertility Treatment in Patients with Obstructive Azoospermia. Front Surg 2022; 9:901601. [PMID: 36034342 PMCID: PMC9407240 DOI: 10.3389/fsurg.2022.901601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare and contrast the effects of percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) on the outcome of intracytoplasmic sperm injection (ICSI)-assisted fertility treatment in patients with obstructive azoospermia. Methods Patients with obstructive azoospermia with an age distribution of 20–36 years admitted to the male department of the Reproductive Center of the Second Affiliated Hospital of South China University (Hengyang Nanhua Xing Hui Reproductive Health Hospital) from December 2018 to December 2020 were used in this study. One group was set up as the PESA group to perform PESA, and the other group was set up as the TESA group to perform percutaneous testicular biopsy for sperm extraction. Patients who were unsuccessful in PESA continued to undergo TESA, and if sperm were retrieved, they were classified as the TESA group. General information on male patients and their partners was collected and compared in patients from different sperm source groups. Embryo development (normal fertilization rate, high-quality embryo rate, and high-quality blastocyst rate) and pregnancy outcome (clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate) were compared between the two groups. Results Finally, there were 26 patients in the PESA group and 31 patients in the TESA group. There were no significant differences in terms of age, years of infertility, testosterone level, (FSH) follicle-stimulating hormone level, and testicular volume between the male patients in the PESA and TESA groups of two different sperm sources, and no significant differences were found in the general conditions of the female patients in terms of age, number of eggs obtained, number of sinus follicles, basal FSH value, and basal E2 value (p > 0.05). The rate of high-quality blastocysts in the TESA group was significantly higher than that in the PESA group (p < 0.05); the differences in clinical normal fertilization rate, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, and ectopic pregnancy rate between the two groups were not statistically significant (p > 0.05). Conclusion ICSI with different sources of sperm in patients with male factor infertility alone, which had no significant effect on embryo development, embryo implantation rate, clinical pregnancy rate, and miscarriage rate, resulting in better clinical outcomes.
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Affiliation(s)
- Lian Li
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Hongqing Liao
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Meiqing Li
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Jianghua Xiao
- The Second Affiliated Hospital, Reproductive Center, Hengyang Medical School, University of South China, Hengyang, China
- Hengyang Nanhua Xinghui Reproductive Health Hospital, Reproductive Center, Hengyang, China
| | - Lei Wu
- Department of Urology Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
- Correspondence: Lei Wu
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Barrachina F, Battistone MA, Castillo J, Mallofré C, Jodar M, Breton S, Oliva R. Sperm acquire epididymis-derived proteins through epididymosomes. Hum Reprod 2022; 37:651-668. [PMID: 35137089 PMCID: PMC8971652 DOI: 10.1093/humrep/deac015] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 12/30/2021] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Are epididymosomes implicated in protein transfer from the epididymis to spermatozoa? SUMMARY ANSWER We characterized the contribution of epididymal secretions to the sperm proteome and demonstrated that sperm acquire epididymal proteins through epididymosomes. WHAT IS KNOWN ALREADY Testicular sperm are immature cells unable to fertilize an oocyte. After leaving the testis, sperm transit along the epididymis to acquire motility and fertilizing abilities. It is well known that marked changes in the sperm proteome profile occur during epididymal maturation. Since the sperm is a transcriptional and translational inert cell, previous studies have shown that sperm incorporate proteins, RNA and lipids from extracellular vesicles (EVs), released by epithelial cells lining the male reproductive tract. STUDY DESIGN, SIZE, DURATION We examined the contribution of the epididymis to the post-testicular maturation of spermatozoa, via the production of EVs named epididymosomes, released by epididymal epithelial cells. An integrative analysis using both human and mouse data was performed to identify sperm proteins with a potential epididymis-derived origin. Testes and epididymides from adult humans (n = 9) and adult mice (n = 3) were used to experimentally validate the tissue localization of four selected proteins using high-resolution confocal microscopy. Mouse epididymal sperm were co-incubated with carboxyfluorescein succinimidyl ester (CFSE)-labeled epididymosomes (n = 4 mice), and visualized using high-resolution confocal microscopy. PARTICIPANTS/MATERIALS, SETTING, METHODS Adult (12-week-old) C57BL/CBAF1 wild-type male mice and adult humans were used for validation purposes. Testes and epididymides from both mice and humans were obtained and processed for immunofluorescence. Mouse epididymal sperm and mouse epididymosomes were obtained from the epididymal cauda segment. Fluorescent epididymosomes were obtained after labeling the epididymal vesicles with CFSE dye followed by epididymosome isolation using a density cushion. Immunofluorescence was performed following co-incubation of sperm with epididymosomes in vitro. High-resolution confocal microscopy and 3D image reconstruction were used to visualize protein localization and sperm-epididymosomes interactions. MAIN RESULTS AND THE ROLE OF CHANCE Through in silico analysis, we first identified 25 sperm proteins with a putative epididymal origin that were conserved in both human and mouse spermatozoa. From those, the epididymal origin of four sperm proteins (SLC27A2, EDDM3B, KRT19 and WFDC8) was validated by high-resolution confocal microscopy. SLC27A2, EDDM3B, KRT19 and WFDC8 were all detected in epithelial cells lining the human and mouse epididymis, and absent from human and mouse seminiferous tubules. We found region-specific expression patterns of these proteins throughout the mouse epididymides. In addition, while EDDM3B, KRT19 and WFDC8 were detected in both epididymal principal and clear cells (CCs), SLC27A2 was exclusively expressed in CCs. Finally, we showed that CFSE-fluorescently labeled epididymosomes interact with sperm in vitro and about 12-36% of the epididymosomes contain the targeted sperm proteins with an epididymal origin. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION The human and mouse sample size was limited and our results were descriptive. The analyses of epididymal sperm and epididymosomes were solely performed in the mouse model due to the difficulties in obtaining epididymal luminal fluid human samples. Alternatively, human ejaculated sperm and seminal EVs could not be used because ejaculated sperm have already contacted with the fluids secreted by the male accessory sex glands, and seminal EVs contain other EVs in addition to epididymosomes, such as the abundant prostate-derived EVs. WIDER IMPLICATIONS OF THE FINDINGS Our findings indicate that epididymosomes are capable of providing spermatozoa with a new set of epididymis-derived proteins that could modulate the sperm proteome and, subsequently, participate in the post-testicular maturation of sperm cells. Additionally, our data provide further evidence of the novel role of epididymal CCs in epididymosome production. Identifying mechanisms by which sperm mature to acquire their fertilization potential would, ultimately, lead to a better understanding of male reproductive health and may help to identify potential therapeutic strategies to improve male infertility. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Spanish Ministry of Economy and Competitiveness (Ministerio de Economía y Competividad; fondos FEDER 'una manera de hacer Europa' PI13/00699 and PI16/00346 to R.O.; and Sara Borrell Postdoctoral Fellowship, Acción Estratégica en Salud, CD17/00109 to J.C.), by National Institutes of Health (grants HD040793 and HD069623 to S.B., grant HD104672-01 to M.A.B.), by the Spanish Ministry of Education, Culture and Sports (Ministerio de Educación, Cultura y Deporte para la Formación de Profesorado Universitario, FPU15/02306 to F.B.), by a Lalor Foundation Fellowship (to F.B. and M.A.B.), by the Government of Catalonia (Generalitat de Catalunya, pla estratègic de recerca i innovació en salut, PERIS 2016-2020, SLT002/16/00337 to M.J.), by Fundació Universitària Agustí Pedro i Pons (to F.B.), and by the American Society for Biochemistry and Molecular Biology (PROLAB Award from ASBMB/IUBMB/PABMB to F.B.). Confocal microscopy and transmission electron microscopy was performed in the Microscopy Core facility of the Massachusetts General Hospital (MGH) Center for Systems Biology/Program in Membrane Biology which receives support from Boston Area Diabetes and Endocrinology Research Center (BADERC) award DK57521 and Center for the Study of Inflammatory Bowel Disease grant DK43351. The Zeiss LSM800 microscope was acquired using an NIH Shared Instrumentation Grant S10-OD-021577-01. The authors have no conflicts of interest to declare.
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Affiliation(s)
- F Barrachina
- Molecular Biology of Reproduction and Development Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Program in Membrane Biology, Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M A Battistone
- Program in Membrane Biology, Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J Castillo
- Molecular Biology of Reproduction and Development Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - C Mallofré
- Department of Pathology, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - M Jodar
- Molecular Biology of Reproduction and Development Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Biochemistry and Molecular Genetics Service, Hospital Clínic, Barcelona, Spain
| | - S Breton
- Program in Membrane Biology, Nephrology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - R Oliva
- Molecular Biology of Reproduction and Development Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Fundació Clínic per a la Recerca Biomèdica, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Biochemistry and Molecular Genetics Service, Hospital Clínic, Barcelona, Spain
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7
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Fisher JS, Kim ED. Azoospermia: vasal agenesis. Asian J Androl 2022; 24:1-4. [PMID: 31621656 PMCID: PMC8788597 DOI: 10.4103/aja.aja_113_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- J Sam Fisher
- Department of Urology, University of Tennessee, Knoxville, TN 37920, USA
| | - Edward D Kim
- Department of Urology, University of Tennessee, Knoxville, TN 37920, USA
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8
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Lopes LS, Baccaglini W, von Muhlen B, Placco Araujo Glina F, Albertini Daiuto S, Linck Pazeto C, Glina S. Does acquired obstructive azoospermia have less impact than congenital azoospermia on ICSI results? Systematic review and meta-analysis. Andrologia 2021; 53:e14096. [PMID: 33982319 DOI: 10.1111/and.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Willy Baccaglini
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | - Bruno von Muhlen
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | | | | | | | - Sidney Glina
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil.,Projeto Alfa, São Paulo, Brazil
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9
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Jin L, Li Z, Gu L, Huang B. Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China. Sci Rep 2020; 10:5145. [PMID: 32198466 PMCID: PMC7083972 DOI: 10.1038/s41598-020-62102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.
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Affiliation(s)
- Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Longjie Gu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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10
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Shih KW, Shen PY, Wu CC, Kang YN. Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis. Transl Androl Urol 2019; 8:631-640. [PMID: 32038959 DOI: 10.21037/tau.2019.11.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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 (I2) 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, I2=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.
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Affiliation(s)
- Kuan-Wei Shih
- Department of Urology, Taipei Medical University Hospital, Taipei
| | - Ping-You Shen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, Taipei.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Yi-No Kang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei
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11
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Lopes LS, Cury VN, Cha JD, Lampa Junior VM, Marques JL, Mizrahi FE, Figueiredo FWDS, Barbosa CP, Glina S. Do assisted reproduction outcomes differ according to aetiology of obstructive azoospermia? Andrologia 2019; 52:e13425. [DOI: 10.1111/and.13425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leonardo Seligra Lopes
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
| | | | | | - Valdir Martins Lampa Junior
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
| | | | | | | | - Caio Parente Barbosa
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
- Department of Sexual and Reproductive Health and Population Genetics Faculdade de Medicina do ABC Santo André Brazil
| | - Sidney Glina
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Projeto Alfa São Paulo Brazil
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12
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Shakhssalim N, Sadeghi MR, Akhondi MM, Akhavizadegan H. Testis biopsy in absolute head teratospermia: Is it a logical option? Urologia 2019; 87:80-82. [PMID: 31469040 DOI: 10.1177/0391560319870428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Absolute head teratospermia (100% abnormal head morphology) is associated with poor fertility and assisted reproductive techniques results. We aimed to find if it is possible to bypass this disorder using sperm retrieved by testis biopsy. METHODS Multiple testis biopsies were performed in patients with infertility and absolute head teratospermia who were not able to provide semen on the injection day from 2006 to 2018. Then, the found sperms were evaluated based on being proper or not proper for intracytoplasmic sperm injection. RESULTS Only 2 patients, of a total of 22 (9%), had relatively proper sperms for microinjection. DISCUSSION There is no benefit to performing testis biopsy in non-azoospermic patients with absolute abnormal head morphology.
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Affiliation(s)
- Nasser Shakhssalim
- Avicenna Infertility Center, Avicenna Research Institute (ARI), ACECR, Shahid Beheshti University, Tehran, Iran.,Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Reza Sadeghi
- Avicenna Infertility Center, Avicenna Research Institute (ARI), ACECR, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Mehdi Akhondi
- Avicenna Infertility Center, Avicenna Research Institute (ARI), ACECR, Shahid Beheshti University, Tehran, Iran
| | - Hamed Akhavizadegan
- Avicenna Infertility Center, Avicenna Research Institute (ARI), ACECR, Shahid Beheshti University, Tehran, Iran.,Baharloo Hospital, Urology Department, Tehran University of Medical Sciences, Tehran, Iran
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13
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Yang Q, Luo X, Bai R, Zhao F, Dai S, Li F, Zhu J, Liu J, Niu W, Sun Y. Shorter leukocyte telomere length is associated with risk of nonobstructive azoospermia. Fertil Steril 2019; 110:648-654.e1. [PMID: 30196961 DOI: 10.1016/j.fertnstert.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the association between leukocyte telomere length and the risk of nonobstructive azoospermia (NOA). DESIGN The mean leukocyte telomere length (LTL) among men with NOA, obstructive azoospermia (OA), and normospermic subjects was determined by quantitative polymerase chain reaction (PCR). We used logistic regression to investigate the association between LTL and the risk of NOA after adjustment for age and body mass index (BMI). Partial correlation analysis was also used to evaluate the relationship of clinical parameters with the mean LTL among men with OA and NOA. SETTING Reproductive medicine center. PATIENTS(S) A total of 866 men, including 270 normospermic controls, 247 OA and 349 NOA patients. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Leukocyte telomere length. RESULT(S) The mean relative LTL of men with NOA was significantly shorter than that of those with OA and in normospermic controls (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.64-0.98 vs. OR 0.92, 95% CI 0.70-1.24 vs. OR 0.99, 95% CI 0.83-1.22), respectively). Subjects with shorter telomeres (lowest tertile) had a significantly higher risk of NOA than those with longer telomeres (highest tertile). Interestingly, we also found that a low relative LTL was associated with poor efficiency of spermatogenesis using the Johnsen score after testis biopsy and histopathology in azoospermic patients, after adjusting for patient age and BMI. CONCLUSION(S) This is the first report that short LTL is associated with NOA, shedding light on an important biological pathway involved in the etiology of this form of male factor infertility.
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Affiliation(s)
- Qingling Yang
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Luo
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Rui Bai
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Feifei Zhao
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Shanjun Dai
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Fangyuan Li
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Jing Zhu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Jinhao Liu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Wenbin Niu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China
| | - Yingpu Sun
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, and Henan Province Key Laboratory for Reproduction and Genetics, Zhengzhou, Henan, People's Republic of China.
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14
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Hibi H, Sumitomo M, Fukunaga N, Sonohara M, Asada Y. Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration. Reprod Med Biol 2017; 17:59-63. [PMID: 29371822 PMCID: PMC5768967 DOI: 10.1002/rmb2.12069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/24/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose To assess normal fertilization, clinical pregnancy, and live birth rates after the use of microscopic epididymal sperm aspiration (MESA). Methods One-hundred-and-sixty azoospermic participants who underwent MESA were evaluated. The MESA was performed by using a micropuncture method with a micropipette. In cases in which motile sperm were not obtained after the MESA, conventional or micro-testicular sperm extraction (TESE) was completed. Results Adequate motile sperm were retrieved in 71 participants by using MESA and in 59 out of 89 participants by using TESE. Of the total number of patients, 123 underwent intracytoplasmic sperm injection. After MESA, the normal fertilization rate was 73.5% and the clinical pregnancy rate per case was 95.7%. Healthy deliveries resulted after MESA in 65 (92.9%) cases and after TESE in 38 (71.7%) cases. Conclusion The MESA specimen collection does not have any special requirements, such as mincing tissue disposition. The MESA also can reduce the amount of laboratory work that is needed for cryopreservation. In the authors' experience, MESA is a beneficial procedure and should be given priority over TESE.
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Affiliation(s)
- Hatsuki Hibi
- Department of Urology Kyoritsu General Hospital Nagoya Japan
| | - Makoto Sumitomo
- Department of Urology Aichi Medical University School of Medicine Nagakute Japan
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15
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Hammoud I, Bailly M, Bergere M, Wainer R, Izard V, Vialard F, Selva J, Boitrelle F. Testicular Spermatozoa Are of Better Quality Than Epididymal Spermatozoa in Patients With Obstructive Azoospermia. Urology 2017; 103:106-111. [DOI: 10.1016/j.urology.2016.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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16
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Schiewe MC, Rothman C, Spitz A, Werthman PE, Zeitlin SI, Anderson RE. Validation-verification of a highly effective, practical human testicular tissue in vitro culture-cryopreservation procedure aimed to optimize pre-freeze and post-thaw motility. J Assist Reprod Genet 2016; 33:519-28. [PMID: 26847133 PMCID: PMC4818637 DOI: 10.1007/s10815-016-0659-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/07/2016] [Indexed: 10/31/2022] Open
Abstract
PURPOSE The aim of our paper was to validate a testicular biopsy procedure that simplifies handling, processing, and cryopreservation, while at the same time optimizes sperm motility before freezing and after thawing. METHODS Two prospective studies were conducted to verify, optimize, and understand the virtues of pre-freeze testicular tissue IVC at different temperatures (21, 30, or 37 °C). Testicular tissue was obtained from clinical specimens designated for whole tissue cryopreservation (i.e., intact mass of tubules) and/or for fresh use in IVF-ICSI cycles. Whole testicular biopsy pieces (1-3 mm(3)) were diluted in glycerol containing freeze solutions, slow cooled to 4 °C and then rapidly frozen in LN2 vapor. Fresh and post-thaw testicular biopsy tissue were evaluated for changes in the quantity (%) and pattern of motility (I-IV: twitching to rapid progression, respectively) over a 1 week duration. The clinical effectiveness of IVC-cryopreserved whole testicular biopsy tissue was also validated analyzing fresh embryo transfers. RESULTS More reliable recovery of motile testicular sperm was achieved using whole tissue freeze preservation combined with IVC (24-96 h) post-acquisition at an incubation temperature of 30 °C compared to ambient temperature (21 °C) or 37 °C. Up to 85 % of the pre-freeze motility was conserved post-thaw (+3 h) for easy ICSI selection. Sperm longevity was optimized to fresh tissue levels by implementing testicular biopsy sucrose dilution post-thaw. Favorable clinical outcomes were proven using frozen-thawed testicular biopsy sperm for ICSI. CONCLUSIONS By employing minimal tissue manipulation, integrating pre-freeze IVC processing at 30 °C and the freezing of whole testicular biopsy tissue, we have reduced the labor and improved the efficacy of processing testicular tissue for freeze-preservation and subsequent ICSI use.
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Affiliation(s)
- M C Schiewe
- Ovagen Fertility/Southern California Institute for Reproductive Sciences (SCIRS), Newport Beach, CA, USA. .,California Cryobank (CCB), Los Angeles, CA, USA.
| | - C Rothman
- California Cryobank (CCB), Los Angeles, CA, USA.,Center for Male Reproduction and Vasectomy Reversal, Los Angeles, CA, USA
| | - A Spitz
- Department of Urology, University of California, Irvine (UCI), CA, USA
| | - P E Werthman
- Center for Male Reproduction and Vasectomy Reversal, Los Angeles, CA, USA
| | - S I Zeitlin
- Department of Urology, University of California, Los Angeles (UCLA), CA, USA
| | - R E Anderson
- Southern California Center for Reproductive Medicine (SCCRM), Newport Beach, CA, USA
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17
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Weng SPF, Surrey MW, Danzer HC, Hill DL, Chen PC, Wu TCJ. Chromosome abnormalities in embryos derived from microsurgical epididymal sperm aspiration and testicular sperm extraction. Taiwan J Obstet Gynecol 2015; 53:202-5. [PMID: 25017267 DOI: 10.1016/j.tjog.2014.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/09/2012] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the patterns of chromosome abnormalities in embryos derived from intracytoplasmic sperm injection (ICSI) in microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) in comparison to embryos that are derived from naturally ejaculated (EJAC) patients. MATERIALS AND METHODS Male partners with azoospermia who required MESA or TESE for ICSI were studied for chromosomal abnormalities. The ICSI patients with EJAC sperm served as the control group. Preimplantation genetic diagnosis (PGD) was performed by fluorescence in situ hybridization (FISH). Chromosome abnormalities were categorized as polyploidy, haploidy, aneuploidy, and complex abnormality (which involves more than two chromosomes). Fertilization, embryo development, and patterns of chromosome abnormalities were accessed and evaluated. RESULTS There was no difference between the MESA, TESE, and EJAC patient groups in the rates of fertilization and pregnancy and the percentages of euploid embryos. In all three groups, less than one-half of the embryos for each group were normal (41 ± 31%, 48 ± 38%, and 48 ± 31% in MESA, TESA, and EJAC, respectively). Complex chromosomal abnormality was significantly more frequent in the MESA group than in the EJAC group (48.3% vs. 26.5%, respectively; p < 0.001). Furthermore, the overall pattern of chromosomal aneuploidy was similar among all three studied groups. CONCLUSION We suggest that MESA and TESE, followed by ICSI and PGD, appear to be acceptable approaches for treating men with severe spermatogenesis impairment.
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Affiliation(s)
- Shao-Ping Fred Weng
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | | | | | | | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Tsung-Chieh Jackson Wu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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18
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Miyaoka R, Esteves SC. Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role? Clinics (Sao Paulo) 2013; 68 Suppl 1:111-9. [PMID: 23503960 PMCID: PMC3583159 DOI: 10.6061/clinics/2013(sup01)12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/11/2012] [Indexed: 01/06/2023] Open
Abstract
Obstructive azoospermia is a relatively common male infertility condition. The main etiologies of obstructive azoospermia include congenital, surgical-derived, traumatic and post-infectious cases. Although seminal tract reconstruction is a cost-effective treatment in most cases, this approach may not be feasible or desired in some cases. In such cases, assisted reproduction techniques offer a method for achieving pregnancy, notably via sperm retrieval and intracytoplasmic sperm injection. This process requires several considerations and decisions to be made, including the cause and duration of obstruction, which sperm retrieval technique to use, and whether to use fresh or frozen-thawed sperm. We present a review of obstructive azoospermia and assisted reproduction techniques, highlighting the most relevant aspects of the decision-making process for use in clinical practice.
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Affiliation(s)
- Ricardo Miyaoka
- Referral Center for Male Reproduction, ANDROFERT - Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil
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19
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Lu YH, Gao HJ, Li BJ, Zheng YM, Ye YH, Qian YL, Xu CM, Huang HF, Jin F. Different sperm sources and parameters can influence intracytoplasmic sperm injection outcomes before embryo implantation. J Zhejiang Univ Sci B 2012; 13:1-10. [PMID: 22205614 DOI: 10.1631/jzus.b1100216] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the effects of sperm with different parameters and sources on the outcomes of intracytoplasmic sperm injection (ICSI), 1972 ICSI cycles were analyzed retrospectively. Groups 1 to 5 were composed of cycles using ejaculated sperm and were grouped according to sperm quantity, quality, and morphology into normal (288 cycles), or mild (329 cycles), moderate (522 cycles), severe (332 cycles), and extremely severe (171 cycles) oligozoospermia and/or asthenozoospermia and/or teratozoospermia (OAT) groups. Group 6 was composed of 250 cycles using testicular or epididymal sperm, and Group 7 consisted of 80 cycles using frozen-thawed sperm. We found that fertilization rates were gradually reduced from Groups 1 to 6, and reached statistical difference in Groups 5 and 6 (P<0.05). The high-quality embryo rate was higher in Group 1 than in Groups 2, 3, 5, 6, and 7 (P<0.05). No statistical differences were observed in the rates of embryo cleavage, clinical pregnancy, miscarriage, live-birth, premature birth, low birth weight, weeks of premature birth, average birth weight, or sex ratio for all seven groups (P>0.05). A total of nine cases of malformation were observed, with a malformation rate of 1.25% (9/719). In conclusion, different sperm sources and parameters can affect ICSI outcomes before embryo implantation. A full assessment of offspring malformation will require further study using a larger sample size.
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Affiliation(s)
- Yue-hong Lu
- Department of Reproductive Endocrinology, Key Laboratory of Reproductive Genetics, Ministry of Education, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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Reply by the Authors. Urology 2011. [DOI: 10.1016/j.urology.2011.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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He X, Cao Y, Zhang Z, Zhao J, Wei Z, Zhou P, Cong L. Spermatogenesis affects the outcome of ICSI for azoospermic patients rather than sperm retrieval method. Syst Biol Reprod Med 2010; 56:457-64. [PMID: 20942727 DOI: 10.3109/19396368.2010.513078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study investigated the clinical outcome of intracytoplasmic sperm injection (ICSI) with epididymal and testicular sperm of azoospermic patients exhibiting various disturbances in spermatogenesis, in order to understand the possible factors that might affect ICSI outcome. Of the 134 patients, 92 were diagnosed as being obstructive azoospermic (OA group) with normal spermatogenesis and the remaining 42 patients were diagnosed as being non-obstructive azoospermic (NOA group) with hypospermatogenesis. The 92 OA patients underwent 112 ICSI cycles, which were divided into two subgroups according to their sperm retrieval methods: 1) OA-PESA group (n=51) with sperm obtained by percutaneous sperm aspiration (PESA) cycles and 2) OA-TEFNA group (n=61) with sperm obtained by testicular fine needle sperm aspiration (TEFNA) cycles. The NOA patients diagnosed with hypospermatogenesis according to histopathological analysis and hormone analysis, underwent 42 ICSI cycles with TEFNA. The results showed that the fertilization, cleavage, and clinical pregnancy rates portrayed a significant difference (44.9% vs. 64.1%, P<0.001, 79.8% vs. 89.0%, P<0.001, and 21.4% vs. 40.2%, P=0.047, respectively) between NOA and OA groups. Moreover, the miscarriage rate in the NOA group was visibly higher even though it did not reach a statistical difference (33.3% vs. 15.6%, P=0.433) compared with the miscarriage rate of the OA group. The same statistical differences were observed between the subgroup OA-TEFNA and the NOA group. No statistical difference was observed between OA-PESA and OA-TEFNA groups for the fertilization, cleavage, clinical pregnancy, and miscarriage rates. This study indicates that defective spermatogenesis affects the ICSI clinical outcome of azoospermic patients rather than the sperm retrieval methods.
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Affiliation(s)
- Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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[ICSI with non-ejaculated sperm: what about children?]. ACTA ACUST UNITED AC 2009; 37:873-83. [PMID: 19818669 DOI: 10.1016/j.gyobfe.2009.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 09/03/2009] [Indexed: 02/01/2023]
Abstract
For men presenting azoospermia, the development of ICSI with epidydimal (MESA) or testicular (TESE) sperm, allowed them to father their own progeny. Little is known about the issue of these ICSI, in terms of efficiency and quality of the conceptus, and many controversies remain. Some studies emphasized that children born after Assisted Reproductive Technology (ART) with surgically sperm retrieved were at increased risk of birth defects. In this context, we proposed a retrospective analysis of pregnancy issues with non-ejaculated sperm.
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Garg T, LaRosa C, Strawn E, Robb P, Sandlow JI. Outcomes After Testicular Aspiration and Testicular Tissue Cryopreservation for Obstructive Azoospermia and Ejaculatory Dysfunction. J Urol 2008; 180:2577-80. [DOI: 10.1016/j.juro.2008.08.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Tullika Garg
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cean LaRosa
- Rutek Center for Reproductive Medicine, Webster, Texas
| | - Estil Strawn
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul Robb
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jay I. Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R. Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 2008; 40:219-26. [PMID: 18727731 DOI: 10.1111/j.1439-0272.2008.00846.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We evaluated the efficiency of microdissection testicular sperm extraction (MicroTESE) in patients with nonobstructive azoospermia (NOA) and their pregnancy outcomes in a programme based on in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI). Fifty-six MicroTESE procedures were performed in 53 patients with NOA. Pre-operative levels of luteinising hormone, follicle-stimulating hormone (FSH), testosterone and prolactin were obtained and a Doppler sonography examination was conducted. Sperm retrieval rate, mean age of female partner, mean ICSI and fertilisation rate, number and quality of embryos transferred, implantation, pregnancy and miscarriage rates were calculated. Samples for testicular histological analysis were taken trans-operatively in every case. Sperm retrieval rate, mean ICSI per case and fertilisation rate were 57.1%, 7.4% and 58.4% respectively. A significant difference in pre-operative testicular volume (P = 0.001), serum FSH (P = 0.008) and total testosterone levels (P = 0.021) was found in patients from whom sperm could be retrieved. Mean 1.9 type A embryos were transferred per cycle. Implantation, clinical pregnancy and miscarriage rates were 20%, 40% and 18.7% respectively. It is concluded that MicroTESE is a viable option for men with NOA, offering excellent results in couples undergoing IVF-ICSI. Pre-operative serum FSH, testicular volume and total testosterone levels may have a prognostic value, although more data are needed to determine their significance and whether or not patients should be excluded from an initial sperm retrieval attempt.
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Affiliation(s)
- P Ravizzini
- Clínica e Centro de Pesquisa em Reprodução Humana Roger Abdelmassih, São Paulo, Brazil.
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Nanassy L, Carrell DT. Paternal effects on early embryogenesis. ACTA ACUST UNITED AC 2008; 5:2. [PMID: 18485208 PMCID: PMC2397432 DOI: 10.1186/1743-1050-5-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 05/16/2008] [Indexed: 12/30/2022]
Abstract
Historically, less attention has been paid to paternal effects on early embryogenesis than maternal effects. However, it is now apparent that certain male factor infertility phenotypes are associated with increased DNA fragmentation and/or chromosome aneuploidies that may compromise early embryonic development. In addition, there is a growing body of evidence that the fertilizing sperm has more function than just carrying an intact, haploid genome. The paternally inherited centrosome is essential for normal fertilization, and the success of higher order chromatin packaging may impact embryogenesis. Epigenetic modifications of sperm chromatin may contribute to the reprogramming of the genome, and sperm delivered mRNA has also been hythesized to be necessary for embryogenesis. There is less information about the epigenetic factors affecting embryogenesis than genetic factors, but the epigenetics of gamete and early embryogenesis is a rapidly advancing field.
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Affiliation(s)
- Laszlo Nanassy
- Andrology and IVF Laboratories, University of Utah School of Medicine, Salt Lake City, UT, USA.
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de Cássia Savio Figueira R, Madaschi C, Nichi M, Rodrigues D, Pasqualotto FF, Iaconelli A, Borges E. A comparison of post-thaw results between embryos arising from intracytoplasmic sperm injection using surgically retrieved or ejaculated spermatozoa. Fertil Steril 2008; 91:727-32. [PMID: 18281039 DOI: 10.1016/j.fertnstert.2007.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/19/2007] [Accepted: 12/19/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the effect of freeze-thaw on embryos derived from intracytoplasmic sperm injection (ICSI) using surgically retrieved and ejaculated spermatozoa. DESIGN Retrospective study. SETTING Private IVF center. PATIENT(S) Three hundred eighty-three patients undergoing frozen-thawed ET cycles. INTERVENTION(S) Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) were the sperm surgical retrieval methods used for ICSI. Embryos resulting from ICSI using surgically retrieved and ejaculated spermatozoa were frozen, thawed, and transferred. MAIN OUTCOME MEASURE(S) Post-thaw survival, implantation, and pregnancy rates. RESULT(S) No differences were found between the ejaculated sperm and TESA/PESA groups in terms of post-thaw survival rate (68.4% vs. 66.1%, respectively), pregnancy rate (20.1% vs. 16.1%), and implantation rate (10.6% vs. 12.7%). Similar results were found for those variables when comparing TESA and PESA groups. CONCLUSION(S) Cleavage embryos arising from ICSI cycles using testicular and epididymal spermatozoa can be frozen with survival, pregnancy, and implantation rates comparable to those obtained with ejaculated spermatozoa.
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