[ICSI with non-ejaculated sperm: what about children?]

Analysis of the Growth and Development of Children Born with ICSI of Epididymal and Testicular Spermatozoa: A Propensity Matching Study

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.

[Azoospermia: management and results: a series of 90 cases]

OBJECTIVE

To report our 15-year experience in managing azoospermic males at the Brest University Hospital.

PATIENTS AND METHODS

From 1996 to 2010, 90 azoospermic males were followed: 41 with non-obstructive azoospermia (NOA) and 49 with obstructive azoospermia (OA). Surgical methods proposed for retrieving sperm were Microsurgical Epididymal Sperm Aspiration (MESA) for men with OA and microdissection Testicular Sperm Extraction (mTESE) for those with NOA.

RESULTS

Spermatozoa were retrieved in 56.1% of the testicular biopsies for NOA. The embryo transfer rate per cycle for injection intracytoplasmique d'un spermatozoïde (ICSI) with epididymal spermatozoa (OA) was higher to that of ICSI with ejaculated spermatozoa (93.2% vs. 86.6%, P<0.05), but the rate was lower for ICSI with testicular sperm (NOA) (70.2% vs. 86.6%, P<0.01). The rate of clinical pregnancy per embryo transfer was 31.4% following ICSI with epididymal spermatozoa but it was of 24.2% with testicular sperm and 23.1% with ejaculated sperm.

CONCLUSION

ICSI are usually difficult in NOA because they are done with very few spermatozoa. When spermatozoa are retrieved from surgical techniques, more than 50% of the OA couples and almost 30% of the NOA couples conceived at least one child.