1
|
Cariati F, Orsi MG, Bagnulo F, Del Mondo D, Vigilante L, De Rosa M, Sciorio R, Conforti A, Fleming S, Alviggi C. Advanced Sperm Selection Techniques for Assisted Reproduction. J Pers Med 2024; 14:726. [PMID: 39063980 PMCID: PMC11278480 DOI: 10.3390/jpm14070726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Male infertility accounts for approximately 40% of infertility cases. There are many causes of male infertility, including environmental factors, age, lifestyle, infections, varicocele, and cancerous pathologies. Severe oligozoospermia, cryptozoospermia, and azoospermia (obstructive and non-obstructive) are identified as severe male factor infertility, once considered conditions of sterility. Today, in vitro fertilization (IVF) techniques are the only treatment strategy in cases of male factor infertility for which new methodologies have been developed in the manipulation of spermatozoa to achieve fertilization and increase success rates. This review is an update of in vitro manipulation techniques, in particular sperm selection, emphasizing clinical case-specific methodology. The success of an IVF process is related to infertility diagnosis, appropriate choice of treatment, and effective sperm preparation and selection. In fact, selecting the best spermatozoa to guarantee an optimal paternal heritage means increasing the blastulation, implantation, ongoing pregnancy and live birth rates, resulting in the greater success of IVF techniques.
Collapse
Affiliation(s)
- Federica Cariati
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Maria Grazia Orsi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (M.G.O.); (A.C.)
| | - Francesca Bagnulo
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Daniela Del Mondo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy;
| | - Luigi Vigilante
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Martina De Rosa
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| | - Romualdo Sciorio
- Fertility Medicine and Gynaecological Endocrinology Unit, Department Woman Mother Child, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (M.G.O.); (A.C.)
| | - Steven Fleming
- Discipline of Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, NSW 2050, Australia;
| | - Carlo Alviggi
- Department of Public Health, School of Medicine, University of Naples Federico II, 80131 Naples, Italy; (F.C.); (L.V.); (M.D.R.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Federico II Polyclinic, 80131 Naples, Italy;
| |
Collapse
|
2
|
Esteves SC, Coimbra I, Hallak J. Surgically retrieved spermatozoa for ICSI cycles in non-azoospermic males with high sperm DNA fragmentation in semen. Andrology 2023; 11:1613-1634. [PMID: 36734283 DOI: 10.1111/andr.13405] [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: 11/08/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Intracytoplasmic sperm injection (ICSI) using surgically retrieved spermatozoa outside the classic context of azoospermia has been increasingly used to overcome infertility. The primary indications include high levels of sperm DNA damage in ejaculated spermatozoa and severe oligozoospermia or cryptozoospermia, particularly in couples with ICSI failure for no apparent reason. Current evidence suggests that surgically retrieved spermatozoa for ICSI in the above context improves outcomes, mainly concerning pregnancy and miscarriage rates. The reasons are not fully understood but may be related to the lower levels of DNA damage in spermatozoa retrieved from the testis compared with ejaculated counterparts. These findings are consistent with the notion that excessive sperm DNA damage can be a limiting factor responsible for the failure to conceive. Using testicular in preference of low-quality ejaculated spermatozoa bypasses post-testicular sperm DNA damage caused primarily by oxidative stress, thus increasing the likelihood of oocyte fertilization by genomically intact spermatozoa. Despite the overall favorable results, data remain limited, and mainly concern males with confirmed sperm DNA damage in the ejaculate. Additionally, information regarding the health of ICSI offspring resulting from the use of surgically retrieved spermatoa of non-azoospermic males is still lacking. Efforts should be made to improve the male partner's reproductive health for safer ICSI utilization. A comprehensive andrological evaluation aiming to identify and treat the underlying male infertility factor contributing to sperm DNA damage is essential for achieving this goal.
Collapse
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, Campinas, SP, Brazil
- Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Igor Coimbra
- Department of Surgery, Division of Urology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Jorge Hallak
- Department of Surgery, Division of Urology, University of São Paulo Medical School, São Paulo, SP, Brazil
- Department of Pathology, Reproductive Toxicology Unit, University of São Paulo Medical School, São Paulo, SP, Brazil
- Men's Health Study Group, Institute for Advanced Studies, University of São Paulo, São Paulo, SP, Brazil
- Androscience, Science and Innovation Center in Andrology and High-Complex Clinical and Andrology Research Laboratory, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Elenkov A, Zarén P, Sundell B, Lundin L, Giwercman A. Testosterone deficiency and metabolic disturbances in men who fathered a child by use of donated spermatozoa. Sci Rep 2022; 12:14458. [PMID: 36002478 PMCID: PMC9402707 DOI: 10.1038/s41598-022-17864-y] [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: 03/23/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Dose–response association between level of impairment of semen quality and risk of morbidity or premature death has been reported. Therefore, it can be presumed that men utilizing donated spermatozoa, i.e. patients with non-obstructive azoospermia, are at highest risk for adverse health outcomes. To evaluate the risks of prescription of medications for common metabolic disturbances and testosterone replacement therapy (TRT) among men who father children with donated spermatozoa—who presumably do it due to severe impairment of fertility. We used Swedish nationwide register data on all fathers who had a live-born child between 2007 and 2014 in order to compare men who fathered children with donated spermatozoa to the ones who became fathers by using own gametes. Cox regression analysis was used in order to estimate the post-conception incidence of prescription of medicines for hypertension (HT), diabetes (type 1 and 2), dyslipidaemia (DLE) or TRT. Starting the follow up at time of conception, models were adjusted for age, educational level, and previous cancer treatment. In total 410,119 childbirths were included in the analysis. Among them, for 390 fathers donated spermatozoa were utilized. Fathers to children conceived with donated spermatozoa had higher risk for having TRT prescribed (HR: 18.14; 95%CI: 11.71–28.10; p ≪ 0.001). Same was true for DLE (HR: 2.08; 95%CI: 1.27–3.39; p = 0.003) but not diabetes. Fathers to children conceived by use of donated spermatozoa are at significantly increased risk for testosterone treatment and dyslipidaemia, necessitating stringent follow up and inclusion in prevention programs.
Collapse
Affiliation(s)
- Angel Elenkov
- Reproductive Medicine Centre, Skane University Hospital Malmo, Malmö, Sweden. .,Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden.
| | - Peter Zarén
- Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| | - Bianca Sundell
- Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| | - Lovisa Lundin
- Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skane University Hospital Malmo, Malmö, Sweden.,Department of Translational Medicine, Clinical Research Centre, Lund University, Jan Waldenströms gata 35, Building 60, Plan 9, 20502, Malmö, Sweden
| |
Collapse
|
4
|
Esteves SC, Zini A, Coward RM, Evenson DP, Gosálvez J, Lewis SEM, Sharma R, Humaidan P. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia 2021; 53:e13874. [PMID: 33108829 PMCID: PMC7988559 DOI: 10.1111/and.13874] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 12/12/2022] Open
Abstract
We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.
Collapse
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction ClinicReferral Center for Male ReproductionCampinasSPBrazil
- Department of Surgery (Division of Urology)University of Campinas (UNICAMP)CampinasSPBrazil
- Faculty of HealthAarhus UniversityAarhusDenmark
| | - Armand Zini
- Division of UrologyDepartment of SurgerySt. Mary's HospitalMcGill UniversityMontrealQuébecCanada
| | - Robert Matthew Coward
- Department of UrologyUniversity of North CarolinaChapel HillNCUSA
- UNC FertilityRaleighNCUSA
| | - Donald P. Evenson
- SCSA DiagnosticsBrookingsSDUSA
- Sanford Medical SchoolUniversity of South DakotaSioux FallsSDUSA
| | - Jaime Gosálvez
- Unit of GeneticsDepartment of BiologyUniversidad Autónoma de MadridMadridSpain
| | | | - Rakesh Sharma
- American Center for Reproductive MedicineCleveland ClinicClevelandOHUSA
| | - Peter Humaidan
- Faculty of HealthAarhus UniversityAarhusDenmark
- Fertility Clinic SkiveSkive Regional HospitalSkiveDenmark
| |
Collapse
|
5
|
Alharbi M, Almarzouq A, Zini A. Sperm retrieval and intracytoplasmic sperm injection outcomes with testicular sperm aspiration in men with severe oligozoospermia and cryptozoospermia. Can Urol Assoc J 2020; 15:E272-E275. [PMID: 33119503 DOI: 10.5489/cuaj.6798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Several studies addressed the role of testicular sperm aspiration with intracytoplasmic sperm injection (ICSI) in azoospermic men, but few have included non-azoospermic men. The aim of this study was to evaluate testicular sperm aspiration (TESA) sperm retrieval rates and ICSI outcomes in men with severe oligozoospermia. METHODS Data were collected retrospectively from 88 consecutive, non-azoospermic, infertile men with idiopathic severe oligozoospermia who underwent TESA between January 2011 and January 2018. Patients were categorized into four groups according to sperm concentration: <5 and >1 million/ml (group 1), <1 and > 0.1 million/ml (group 2), <0.1 million/ml (group 3), and cryptozoospermia (group 4). RESULTS Mean male age was 37±7 years and the mean female age was 33±4 years. Sperm was recovered successfully in 90% (79/88) of the men overall and in 100% (30/30) of the men in group 1, 97% (29/30) of the men in group 2, 88% (15/17) of the men in group 3, and 45% (5/11) of the men in group 4. Most (65%, 57/88) of the couples had an embryo transfer (ET). The overall clinical pregnancy rate per ET was 46% (26/57). The clinical pregnancy rates (per ET) were 43% (9/21) in group 1, 65% (13/20) in group 2, 36% (4/11) in group 3, and 0% (0/5) in group 4. CONCLUSIONS Our data indicate TESA allows for high sperm retrieval rates and acceptable ICSI pregnancy rates in men with severe oligozoospermia. However, in our experience, TESA sperm retrieval rates and ICSI outcomes are poor in cryptozoospermic men.
Collapse
Affiliation(s)
- Mohannad Alharbi
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.,Department of Surgery, College of Medicine, Qassim University, Qassim, Saudi Arabia
| | - Ahmad Almarzouq
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.,OVO Fertility Clinic, Montreal, QC, Canada
| |
Collapse
|
6
|
Cai H, Gordts S, Sun J, Meng B, Shi J. Reproductive outcomes with donor sperm in couples with severe male-factor infertility after intracytoplasmic sperm injection failures. J Assist Reprod Genet 2020; 37:1883-1893. [PMID: 32440933 PMCID: PMC7468038 DOI: 10.1007/s10815-020-01828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate reproductive outcomes of artificial insemination and IVF with donor sperm (AID or IVF-D) for male-factor couples with a history of unsuccessful ICSI attempt. METHODS This retrospective cohort includes couples with severe male-factor infertility who failed ICSI treatment, and subsequently underwent semen donation treatment. We report the following outcomes: (1) live birth rates in AID and IVF-D treatment for couples with severe male infertility factors and prior ICSI failures; (2) paternal impact on embryo development of the same oocyte cohort; (3) prognostic factors in obtaining a live birth with donor semen. RESULTS Of 92 women with failed ICSI cycles (26 with multiple attempts), 45 couples underwent AID treatment. Live birth rate per cycle of AID was 18.9%. Fifty-three patients underwent IVF-D including 6 couples who previously did not conceive with AID. Embryological outcomes including fertilization, viable cleavage embryos, and blastocyst formation rates were significantly lower in ICSI cycles with partner sperm compared with IVF-D (P < 0.01). Logistic regression analysis showed that female age and the severity of spermatogenetic disorder are prognostic factors in obtaining a live birth with donated sperm. CONCLUSION Couples with severe male infertility factor (azoospermia or extreme oligoasthenospermia) and a history of unsuccessful ICSI cycles benefit from treating with donor sperm. ICSI fertilization, embryo viability, and progression of the embryo to the blastocyst stage are significantly deteriorated by semen parameters. The prognostic factors identified may help couples plan their treatment and prepare for their parenthood journey.
Collapse
Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000, Leuven, Belgium
| | - Jianhua Sun
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Bin Meng
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China.
| |
Collapse
|
7
|
Sharpe A, Bhandari H, Miller D. Is there a role for phosphodiesterase inhibitors in the treatment of male subfertility? HUM FERTIL 2020; 25:13-23. [PMID: 32666851 DOI: 10.1080/14647273.2020.1793420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) is frequently used to overcome severe deficits in semen quality. Concerns, however, are arising over its increasing use for non-male factor infertility. Moreover, increased risk of cardiovascular disease, congenital abnormalities, aneuploidies and childhood cancers have all been reported in the literature in relation to ICSI and it is possible that the quality of sperm chosen for injection may be an important factor in these unwanted outcomes. Given the wider adoption of ICSI to treat beyond the requirements of male infertility alone, research focussed on alternative methods to diagnose and treat the infertile couple is gaining increasing attention. This review focuses on the information available to date on the use of non-selective phosphodiesterase inhibitors (PDEI), specifically pentoxifylline (PF), caffeine (CF) and theophylline (TP) to stimulate sperm motility, thereby potentially reducing the need for ICSI in certain patient groups who may benefit from either expectant management or from a less stressful, minimally invasive and inexpensive treatment such as intrauterine insemination (IUI). The review focuses firstly on the mechanism of action of PDEI followed by treatment effects on sperm parameters such as motility and hyperactivated motility and sperm DNA integrity. Specific clinical implications are discussed that outline the potential role of PDEI in clinical practice and highlights areas in need of further research.
Collapse
Affiliation(s)
- Abigail Sharpe
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - David Miller
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
8
|
Abstract
Sperm DNA damage reduces pregnancy rates in couples undergoing in vitro fertilization (IVF). Because it has been shown that testicular sperm have lower DNA damage than ejaculated sperm, it is an attractive idea to consider using testicular sperm for IVF for men with high sperm DNA damage. In fact, there are multiple centers throughout the world now offering sperm retrieval for IVF to manage this condition. However, there is insufficient evidence to conclude that testicular sperm improves pregnancy/live birth rates. Further studies are required before offering sperm retrieval as a standard of care to manage high sperm DNA damage.
Collapse
|
9
|
Esteves SC, Santi D, Simoni M. An update on clinical and surgical interventions to reduce sperm DNA fragmentation in infertile men. Andrology 2019; 8:53-81. [DOI: 10.1111/andr.12724] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic Referral Center for Male Reproduction Campinas Brazil
- Department of Surgery (Division of Urology) University of Campinas (UNICAMP) Campinas Brazil
- Faculty of Health Aarhus University Aarhus Denmark
| | - Daniele Santi
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
| |
Collapse
|
10
|
Richardson AL, Baskind NE, Karuppusami R, Balen AH. Effect of deprivation on in vitro fertilisation outcome: a cohort study. BJOG 2019; 127:458-465. [DOI: 10.1111/1471-0528.16012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- AL Richardson
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - NE Baskind
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| | - R Karuppusami
- Department of Biostatistics Christian Medical College and Hospital Vellore India
| | - AH Balen
- Leeds Fertility Seacroft Hospital Leeds Teaching Hospitals NHS Trust Leeds UK
| |
Collapse
|
11
|
Abstract
Sperm retrieval combined with intracytoplasmic sperm injection (ICSI) is the treatment of choice for couples with untreatable azoospermia-related infertility. However, an increasing body of evidence has been mounting, suggesting that ICSI with testicular sperm instead of ejaculated sperm (when both are available) increases pregnancy outcomes in some specific scenarios. This has led to the exploration of extended indications for sperm retrieval. This review summarizes the current literature concerning sperm retrieval and ICSI for non-azoospermic men with elevated sperm DNA fragmentation, oligozoospermia, and cryptozoospermia.
Collapse
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Matheus Roque
- MATER PRIME, Reproductive Medicine, São Paulo, SP, Brazil
| |
Collapse
|
12
|
Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 2019; 15:535-562. [PMID: 29967387 DOI: 10.1038/s41585-018-0051-8] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, which means that it can easily be incorporated into the routine practice of fertility centres worldwide, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable severe male factor infertility, but its (over)use in other male and non-male factor infertility scenarios is not evidence-based. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better chromatin integrity, the overall pregnancy rates from infertile men remain suboptimal. Treating the underlying male infertility factor before ICSI seems to be a promising way to improve ICSI outcomes, but data remain limited. Information regarding the health of ICSI offspring has accumulated over the past 25 years, and there are reasons for concern as risks of congenital malformations, epigenetic disorders, chromosomal abnormalities, subfertility, cancer, delayed psychological and neurological development, and impaired cardiometabolic profile have been observed to be greater in infants born as a result of ICSI than in naturally conceived children. However, as subfertility probably influences the risk estimates, it remains to be determined to what extent the observed adverse outcomes are related to parental factors or associated with ICSI.
Collapse
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil. .,Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Giuliano Bedoschi
- Division of Reproductive Medicine, Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo, Brazil
| | - Thor Haahr
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| |
Collapse
|
13
|
Jayasena CN, Luo R, Dimakopoulou A, Dearing C, Clarke H, Patel N, Stroud T, Seyani L, Ramsay J, Dhillo WS. Prevalence of abnormal semen analysis and levels of adherence with fertility preservation in men undergoing therapy for newly diagnosed cancer: A retrospective study in 2906 patients. Clin Endocrinol (Oxf) 2018; 89:798-804. [PMID: 30204263 DOI: 10.1111/cen.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sperm cryopreservation (freezing) should be offered to all men with cancer due to risk of infertility. However, many men with cancer already have impaired spermatogenesis prior to sperm cryopreservation. Furthermore, physical ill-health may hinder attendance of freeze visits. Investigating both the distribution of sperm functions and freeze attendance rates in men with newly diagnosed cancer, may identify patients benefiting from targeted reproductive fertility support. METHODS We performed a retrospective study of 2906 male patients undergoing sperm cryopreservation prior to cancer therapy at a single UK tertiary centre between 1989 and 2013; all patients were asked to attend three hospital semen collection visits prior to cancer therapy. RESULTS Fifteen per cent (433/2906) of men with newly diagnosed cancer had severely impaired semen quality (i.e., sperm total motile count, TMC < 1 million) during the first semen collection visit. However, patients with severely impaired semen quality had the poorest attendance of subsequent semen collection visits despite being requested to do so (non-attendance in TMC < 1 million: 43.4%; TMC < 1-30 million: 35.7%, P < 0.05 vs. <1 million; TMC > 30 million: 33.2%, P < 0.01 vs. <1 million). CONCLUSIONS This study expands understanding of the semen quality of men with newly diagnosed cancer, and their ability to adhere to fertility preservation recommendations. Our data suggest that patients with the poorest semen quality paradoxically suffer the poorest attendance rates of sperm cryopreservation appointments prior to commencing cancer therapy. We suggest that additional support may be of clinical benefit to men with newly diagnosed cancer and TMC < 1 million sperm.
Collapse
Affiliation(s)
- Channa N Jayasena
- Department of Andrology, Hammersmith Hospital, London, UK
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Rong Luo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Anastasia Dimakopoulou
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Chey Dearing
- School of Health Science and Nursing, Eastern Institute of Technology, Taradale, New Zealand
| | - Holly Clarke
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Nandita Patel
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Thomas Stroud
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Lataban Seyani
- Department of Clinical Biochemistry, Charing Cross Hospital, London, UK
| | | | - Waljit S Dhillo
- Department of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| |
Collapse
|
14
|
Inal HA, Kahyaoglu I, Turkkani A, Tuzluoglu D, Yilmaz N. Retrospective comparison of intracytoplasmic sperm injection outcomes of sperm retrieved from a testicular biopsy and freshly ejaculated semen in oligozoospermia. Rev Int Androl 2018; 16:131-136. [PMID: 30286866 DOI: 10.1016/j.androl.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/17/2017] [Accepted: 06/04/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to compare fertilisation, pregnancy rates and perinatal outcomes in patients undergoing intracytoplasmic sperm injection (ICSI) due to oligozoospermia. METHODS A total of 166 patients with oligozoospermia who underwent an ICSI procedure were included in the study. The subjects were divided into two groups according to the sperm retrieval technique used: group 1, ejaculated semen (n=111); group 2, surgical sperm retrieval (n=55). RESULTS Although the clinical pregnancy rate was lower in group 2, the difference was not statistically significant (36.4% vs. 42.3%, p=0.460). The difference between fertilisation and take-home baby rates of the groups were not significantly different, either (p=0.486, p=0.419, consecutively). CONCLUSION Two different sperm retrieval techniques used for ICSI had no statistically significant difference on intracytoplasmic sperm injection outcomes in oligozoospermic patients.
Collapse
Affiliation(s)
| | - Inci Kahyaoglu
- Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - Ayten Turkkani
- Etlik Zubeyde Hanim Women's Health Education and Research Hospital, Ankara, Turkey
| | - Deniz Tuzluoglu
- Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
| | - Nafiye Yilmaz
- Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey
| |
Collapse
|
15
|
Colpi GM, Francavilla S, Haidl G, Link K, Behre HM, Goulis DG, Krausz C, Giwercman A. European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia. Andrology 2018; 6:513-524. [DOI: 10.1111/andr.12502] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- G. M. Colpi
- Department of Andrology and IVF; San Carlo Clinic; Paderno-Dugnano/Milano Italy
| | - S. Francavilla
- Department of Life, Health and Environmental Sciences; University of L’ Aquila; L’ Aquila Italy
| | - G. Haidl
- Department of Dermatology/Andrology Unit; University of Bonn; Bonn Germany
| | - K. Link
- Department of Translational Medicine and Reproductive Medicine Centre; Lunds University and Skane University Hospital; Malmö Sweden
| | - H. M. Behre
- Center for Reproductive Medicine and Andrology; University Hospital; Martin Luther University Halle-Wittenberg; Halle Germany
| | - D. G. Goulis
- Unit of Reproductive Endocrinology; 1st Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - C. Krausz
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; Centre of Excellence DeNothe; University of Florence; Florence Italy
| | - A. Giwercman
- Department of Translational Medicine and Reproductive Medicine Centre; Lunds University and Skane University Hospital; Malmö Sweden
| |
Collapse
|
16
|
Zini A. ICSI with testicular sperm for couples with sperm DNA damage. Int Braz J Urol 2018; 44:664-666. [PMID: 30020583 PMCID: PMC6092666 DOI: 10.1590/s1677-5538.ibju.2018.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Armand Zini
- Department of Surgery, St. Mary's Hospital, McGill University, Montreal, Canada
| |
Collapse
|
17
|
Testicular sperm is superior to ejaculated sperm for ICSI in cryptozoospermia: An update systematic review and meta-analysis. Sci Rep 2018; 8:7874. [PMID: 29777145 PMCID: PMC5959851 DOI: 10.1038/s41598-018-26280-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/21/2018] [Indexed: 01/11/2023] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is well established and provides patients with severely impaired sperm quality with an opportunity to father a child. However, previous studies do not clearly indicate whether male with cryptozoospermia should use testicular sperm or ejaculated sperm for ICSI. The newest systematic review of this topic also gave a controversial conclusion that was based on incorrect pooling result. Moreover, two clinical studies published after the systematic review. In the present update systematic review and meta-analysis, a comprehensive citation search for relevant studies was performed using the Cochrane library databases, Embase, Ovid MEDLINE, PubMed, ScienceDirect, Scopus, and Web of Science up to September 2017. The search returned 313 records, in which six studies were included in quantitative synthesis. These studies involved 578 male infertility patients who had undergone 761 ICSI cycles. The risk ratios favour fresh testicular sperm for good quality embryo rate (1.17, 95% CI 1.05–1.30, P = 0.005), implantation rate (95% CI 1.02–2.26, P = 0.04), and pregnancy rate (RR = 1.74, 95% CI 1.20–2.52, P = 0.004). In conclusion, the existing evidence suggests that testicular sperm is better than ejaculated sperm for ICSI in male with cryptozoospermia.
Collapse
|
18
|
Huang HY, Lai YL, Yao DJ. Dielectrophoretic Microfluidic Device for in Vitro Fertilization. MICROMACHINES 2018; 9:E135. [PMID: 30424069 PMCID: PMC6187277 DOI: 10.3390/mi9030135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022]
Abstract
The aim of this work was to create a microfluidic platform that uses in vitro fertilization (IVF) and avoids unnecessary damage to oocytes due to the dielectrophoretic force manipulation of the sperms and oocytes that occurs in a traditional IVF operation. The device from this research can serve also to decrease medium volumes, as well as the cost of cell culture under evaporation, and to prevent unnecessary risk in intracytoplasmic sperm injection (ICSI). To decrease the impact and destruction of the oocyte and the sperm, we adopted a positive dielectrophoretic force to manipulate both the sperms and the oocyte. The mouse oocytes were trapped with a positive dielectrophoretic (p-DEP) force by using Indium Tin Oxide (ITO)-glass electrodes; the ITO-glass electrode chip was fabricated by wet etching the ITO-glass. The polydimethylsiloxane (PDMS) flow-focusing microfluidic device was used to generate microdroplets of micrometer size to contain the zygotes. The volume of the microdroplets was controlled by adjusting the flow rates of both inlets for oil and the DEP buffer. As a result, the rate of fertilization was increased by about 5% beyond that of the DEP treatment in traditional IVF, and more than 20% developed to the blastocyst stage with a low sperm-oocyte ratio.
Collapse
Affiliation(s)
- Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan 333, Taiwan.
- Department of Obstetrics and Gynecology, Chang Gung University and College of Medicine, 259, Wen-Hua 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan.
| | - Yun-Li Lai
- Department of Power Mechanical Engineering, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan.
- Institute of NanoEngineering and MicroSystems, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan.
| | - Da-Jeng Yao
- Department of Power Mechanical Engineering, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan.
- Institute of NanoEngineering and MicroSystems, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan.
| |
Collapse
|
19
|
Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis. Fertil Steril 2017; 108:456-467.e1. [PMID: 28865546 DOI: 10.1016/j.fertnstert.2017.06.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare sperm DNA fragmentation (SDF) levels between testicular and ejaculated sperm and to evaluate outcomes of intracytoplasmic sperm injection (ICSI) with the use of testicular (Testi-ICSI) versus ejaculated (Ejac-ICSI) sperm in nonazoospermic men with high SDF. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Normo- and oligozoospermic men with high levels of SDF in semen subjected to Testi-ICSI or Ejac-ICSI. INTERVENTION(S) Summary mean difference (MD) and odds ratio (OR) were calculated with the use of an inverse variance model and fixed- or random-effects models, respectively. MAIN OUTCOME MEASURE(S) Primary outcomes were SDF levels, clinical pregnancy rates (CPRs), and live birth rates (LBRs). Secondary outcomes were fertilization and miscarriage rates. RESULT(S) Five studies involving 143 patients provided paired SDF rates for testicular and ejaculated sperm, revealing lower SDF in testicular sperm (MD -24.58%). Four studies involving 507 cycles and 3,840 oocytes reported clinical outcomes of Testi-ICSI and Ejac-ICSI. Fertilization rates were not different between sperm sources, but a trend to lower rates was observed with Testi-ICSI. CPRs were higher for Testi-ICSI than for Ejac-ICSI, as were LBRs, whereas miscarriage rates were reduced with Testi-ICSI. CONCLUSION(S) Testicular sperm have lower levels of SDF than ejaculated sperm, with Testi-ICSI for high post-testicular SDF men improving reproductive outcomes compared with Ejac-ICSI. Infertile couples may benefit from Testi-ICSI if male partners have confirmed high SDF in the ejaculate.
Collapse
|
20
|
Majzoub A, Agarwal A, Esteves SC. The value of sperm DNA fragmentation testing in real-life clinical presentations. Transl Androl Urol 2017; 6:S416-S418. [PMID: 29082978 PMCID: PMC5643688 DOI: 10.21037/tau.2017.03.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil
| |
Collapse
|
21
|
Bach PV, Schlegel PN. Sperm DNA damage and its role in IVF and ICSI. Basic Clin Androl 2016; 26:15. [PMID: 27980786 PMCID: PMC5137216 DOI: 10.1186/s12610-016-0043-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
While the semen analysis has traditionally been relied upon to differentiate fertile and infertile men, its utility has been questioned in the current era of assisted reproductive technologies. The desire for more sophisticated diagnostic and predictive tools has led to increased use of sperm DNA damage in the management of male infertility. Despite the availability of numerous assays to measure sperm DNA damage, our understanding of the etiology, measurement, and clinical implications of sperm DNA damage remains incomplete. While the current evidence is fraught with heterogeneity that complicates attempts at comparison and meta-analysis, there does appear to be a role for sperm DNA damage in the development and maintenance of pregnancy in the era of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, as noted by the American Society for Reproductive Medicine, the routine and widespread use of sperm DNA damage testing is not yet supported. Further studies are needed to standardize the measurement of sperm DNA damage and to clarify the exact role of sperm DNA damage within the myriad of other male and female factors contributing to reproductive outcomes in IVF and ICSI.
Collapse
Affiliation(s)
- Phil Vu Bach
- Department of Urology, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065 USA
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065 USA
| |
Collapse
|
22
|
Cui X, Ding P, Gao G, Zhang Y. Comparison of the Clinical Outcomes of Intracytoplasmic Sperm Injection Between Spermatozoa Retrieved From Testicular Biopsy and From Ejaculate in Cryptozoospermia Patients. Urology 2016; 102:106-110. [PMID: 27894976 DOI: 10.1016/j.urology.2016.08.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/17/2016] [Accepted: 08/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of intracytoplasmic sperm injection (ICSI) between spermatozoa retrieved from testicular biopsy and from ejaculate in cryptozoospermia patients. MATERIALS AND METHODS The clinical data of 285 cryptozoospermia patients who underwent ICSI treatment in our center during the period from March 2009 to November 2013 were retrospectively analyzed. Within them, ejaculated sperms were used in 214 cases (group 1), and testicular sperms extracted by testicular sperm aspiration or conventional testis dissection sperm extraction were used in 71 cases (group 2). Good-quality embryo, fertilization, embryo implantation, pregnancy, and birth rates after ICSI were compared between the 2 groups. RESULTS Comparing the ejaculated sperm group with the testicular sperm group, fertilization rates were 59.6% and 60.6%, good-quality embryo rates were 36.8% and 46.1%, embryo implantation rates were 30.7% and 52.1%, pregnancy rates were 33.3% and 53.6%, and birth rates were 27.1% and 44.6%, respectively. CONCLUSION Using testicular sperms can achieve higher rates of embryo implantation, pregnancy, and birth compared with those using ejaculated sperms for ICSI treatment in cryptozoospermia patients.
Collapse
Affiliation(s)
- Xianfeng Cui
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Pan Ding
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Ge Gao
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Yunshan Zhang
- Center for Reproductive Medicine, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
| |
Collapse
|
23
|
Zini A, Bach PV, Al-Malki AH, Schlegel PN. Use of testicular sperm for ICSI in oligozoospermic couples: how far should we go? Hum Reprod 2016; 32:7-13. [PMID: 27816927 DOI: 10.1093/humrep/dew276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/08/2016] [Accepted: 09/16/2016] [Indexed: 11/14/2022] Open
Abstract
In 1992 and subsequently, several reports indicated that ICSI was a successful technique to achieve clinical pregnancy and live birth using spermatozoa with severely impaired characteristics. The initial optimism over the ability of ICSI to overcome significant sperm abnormalities was later tempered by the findings of more recent publications suggesting that some sperm deficits may not be as effectively treated with ICSI. In search for effective treatment for couples with severe male factor, a number of small retrospective and prospective studies have reported high pregnancy and live birth rates using testicular sperm for men with necrozoospermia, cryptozoospermia and oligozoospermia with or without elevated sperm DNA damage. Although the data suggest that there may be some benefit in performing testicular sperm retrieval (TSR)-ICSI in select groups of non-azoospermic infertile men, there are potential risks involved with TSR. Clinicians should balance these risks prior to the recommendation of TSR-ICSI on the result of a semen analysis or sperm DNA test alone. Careful evaluation and management of male factor infertility is important. The use of TSR-ICSI in the absence of specific sperm DNA defects is still experimental.
Collapse
Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Phil V Bach
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Ahmad H Al-Malki
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
24
|
Zheng JF, Chen XB, Zhao LW, Gao MZ, Peng J, Qu XQ, Shi HJ, Jin XL. ICSI treatment of severe male infertility can achieve prospective embryo quality compared with IVF of fertile donor sperm on sibling oocytes. Asian J Androl 2016; 17:845-9. [PMID: 25652630 PMCID: PMC4577602 DOI: 10.4103/1008-682x.146971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Azoospermia, cryptozoospermia and necrospermia can markedly decrease the ability of males to achieve pregnancy in fertile females. However, patients with these severe conditions still have the option to be treated by intracytoplasmic sperm injection (ICSI) to become biological fathers. This study analyzed the fertilization ability and the developmental viabilities of the derived embryos after ICSI treatment of the sperm from these patients compared with in vitro fertilization (IVF) treatment of the proven-fertile donor sperm on sibling oocytes as a control. On the day of oocyte retrieval, the number of sperm suitable for ICSI collected from two ejaculates or testicular sperm extraction was lower than the oocytes, and therefore, excess sibling oocytes were treated by IVF with donor sperm. From 72 couples (73 cycles), 1117 metaphase II oocytes were divided into 512 for ICSI and 605 for IVF. Compared with the control, husbands’ sperm produced a lower fertilization rate in nonobstructive azoospermia (65.4% vs 83.2%; P < 0.001), crytozoospermia (68.8% vs 75.5%; P < 0.05) and necrospermia (65.0% vs 85.2%; P < 0.05). The zygotes derived in nonobstructive azoospermia had a lower cleavage rate (96.4% vs 99.4%; P < 0.05), but the rate of resultant good-quality embryos was not different. Analysis of the rates of cleaved and good-quality embryos in crytozoospermia and necrospermia did not exhibit a significant difference from the control. In conclusion, although the sperm from severe male infertility reduced the fertilization ability, the derived embryos had potential developmental viabilities that might be predictive for the expected clinical outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Hui-Juan Shi
- China National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, SIPPR, Shanghai, China,
| | - Xing-Liang Jin
- China National Population and Family Planning Key Laboratory of Contraceptive Drugs and Devices, SIPPR, Shanghai, China; Sydney Centre for Regenerative and Developmental Medicine, Kolling Institute for Medical Research, Sydney Medical School, University of Sydney, St. Leonards, NSW, Australia,
| |
Collapse
|
25
|
Nordhoff V, Fricke RK, Schüring AN, Zitzmann M, Kliesch S. Treatment strategies for severe oligoasthenoteratozoospermia (OAT) (<0.1 million/mL) patients. Andrology 2015; 3:856-63. [PMID: 26266459 DOI: 10.1111/andr.12077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/27/2015] [Accepted: 06/20/2015] [Indexed: 12/23/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) using spermatozoa from patients with severe oligoasthenoteratozoospermia is still a challenge. Although spermatozoa are available, lower fertilisation rates as well as compromised pregnancy rates are observed after ICSI. We aimed at identifying respective parameters in the pre-values of ejaculate samples used for couple counselling. The clinical pre-values of 121 patients and their corresponding 228 ICSI cycles performed between 2002 and 2010 were retrospectively analysed. Patients were divided into three groups: (i) group 1 (G1, n = 51) where all patients showed at least once <0.1 million/mL and ICSI was performed using ejaculate alone; (ii) group 2 (G2, n = 14) patients had once <0.1 Mill/mL or azoospermia and a testicular biopsy before start of ICSI; (iii) group 3 (G3, n = 56) patients were azoospermic and directed immediately to testicular sperm extraction (TESE). The pre-values of G2 differed significantly from G1 in terms of volume and motility. Lutenizing hormone (LH) and follicle-stimulating hormone (FSH) values were equal in G1 and G2, but showed significant differences in comparison to G3. Testis volume was significantly higher in G3. In the corresponding ICSI cycles, the percentage of cancelled embryo transfers was highest in G3. We did not find any correlations of hormonal markers or sperm pre-values with the success rates of ICSI. In our patient cohort, spermatozoa retrieved either from ejaculate or testicular biopsies have nearly identical chances in achieving pregnancies. Patients in need of TESE before ICSI have significantly lower sperm counts. However, it is not possible to calculate threshold values as indicator for TESE.
Collapse
Affiliation(s)
- V Nordhoff
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - R K Fricke
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - A N Schüring
- UKM Kinderwunschzentrum, Department of Gynaecology and Obstetrics, University Hospital of Münster, Münster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital of Münster, Münster, Germany
| |
Collapse
|
26
|
Alrabeeah K, Wachter A, Phillips S, Cohen B, Al-Hathal N, Zini A. Sperm retrieval outcomes with microdissection testicular sperm extraction (micro-TESE) in men with cryptozoospermia. Andrology 2015; 3:462-6. [DOI: 10.1111/andr.12000] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
- K. Alrabeeah
- Department of Surgery; McGill University; Montreal QC Canada
| | - A. Wachter
- OVO Fertility Clinic; Montreal QC Canada
| | | | - B. Cohen
- OVO Fertility Clinic; Montreal QC Canada
| | - N. Al-Hathal
- Department of Surgery; McGill University; Montreal QC Canada
| | - A. Zini
- Department of Surgery; McGill University; Montreal QC Canada
| |
Collapse
|
27
|
Alrabeeah K, Yafi F, Flageole C, Phillips S, Wachter A, Bissonnette F, Kadoch IJ, Zini A. Testicular sperm aspiration for nonazoospermic men: sperm retrieval and intracytoplasmic sperm injection outcomes. Urology 2015; 84:1342-6. [PMID: 25432825 DOI: 10.1016/j.urology.2014.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/07/2014] [Accepted: 08/27/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate testicular sperm aspiration (TESA) sperm retrieval rates and intracytoplasmic sperm injection outcomes in nonazoospermic men. MATERIALS AND METHODS Data were collected retrospectively from 54 consecutive, nonazoospermic, infertile men who underwent TESA between March 2007 and September 2012. Sperm retrieval rates and clinical pregnancy outcomes were recorded. Patients were subgrouped based on clinical diagnosis: group 1, anejaculation (primary, situational); group 2, idiopathic severe oligoasthenozoospermia; and group 3, severe oligoasthenozoospermia after vasovasostomy. RESULTS Mean (± standard deviation) paternal and maternal ages were 39 ± 7 and 35 ± 5 years, respectively. Using TESA, sperm recovery was successful in 94% (51 of 54) of the men overall and in 100% (17 of 17) of the men in group 1, 90% (28 of 31) in group 2, and 100% (6 of 6) in group 3. Overall, 35% of the couples achieved a clinical pregnancy using TESA sperm (with a mean of 1.7 ± 0.9 embryos transferred per cycle). The clinical pregnancy rates were 40% in group 1, 33% in group 2, and 33% in group 3 with no significant difference in paternal or maternal age between groups. CONCLUSION The data indicate that TESA yields high sperm retrieval rates in select groups of nonazoospermic infertile men, and this approach results in acceptable pregnancy rates regardless of the male infertility etiology. Randomized controlled trials comparing ejaculated vs testicular sperm are needed to assess the true benefit of TESA-intracytoplasmic sperm injection in these couples.
Collapse
Affiliation(s)
- Khalid Alrabeeah
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Faysal Yafi
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | | | | | | | - Francois Bissonnette
- OVO Fertility Clinic, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Isaac Jacques Kadoch
- OVO Fertility Clinic, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada; OVO Fertility Clinic, Montreal, Quebec, Canada.
| |
Collapse
|
28
|
Bessonnat J, Brouillet S, Sintzel S, Gillois P, Bergues U, Boutte-Busquet C, Thomas-Cadi C, Hennebicq S. In cryptozoospermia or severe oligozoospermia is sperm freezing useful? Basic Clin Androl 2014; 24:15. [PMID: 25780588 PMCID: PMC4349690 DOI: 10.1186/2051-4190-24-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022] Open
Abstract
Background Intracytoplasmic Sperm Injection (ICSI) is an Assisted Reproduction Technique (ART) which offers the chance to conceive to patients presenting very low sperm counts (cryptozoospermia/severe oligozoospermia). Sperm freezing before the oocyte pick-up, can prevent from a lack of spermatozoa on the day of the ICSI. It can avoid the cancellation of the ICSI or the use of TESE (Testicular sperm extraction). The objective of this study was to analyse the practice of sperm freezing for these patients in our center over 8 years and the rate of use of these frozen sperms. We also compared the outcome of ICSIs with frozen versus ejaculated sperm. Material and methods We performed a retrospective epidemiological study between 2004 and 2011. We recruited all the patients having a sperm count below 1 Million/mL and who were waiting for their first ICSI attempt. Results 169 patients were recruited: 84 cryopreserved their sperm before the ICSI (secured ICSI) while 85 did not (non-secured ICSI). Both groups were split in cryptozoospermia (<103 spermatozoa/ml): 19 and 17 patients respectively, very severe oligozoospermia (103–105/ml): 37 and 13 patients, and severe oligozoospermia (105–106/ml): 28 and 55 patients. The part of secured ICSI significantly increased from 29% during 2004–2007 to 74% during 2008–2011(p = 0.0029) and the frozen sperm was used in 5.9% of the cases. Median age was significantly higher in the non secured ICSI group (33.57 vs 35.52 for men, p = 0.0069 and 30.45 vs 32.26 for women, p = 0.025) but no significant difference was found in the outcome of the ICSI between frozen-thawed sperm and fresh ejaculated sperm. Conclusion Sperm freezing before ICSI for severe oligozoospermic and cryptozoospermic patients significantly increased in our practice but the rate of use remain very low. This encourages to define more accurate criteria leading to sperm freezing. Electronic supplementary material The online version of this article (doi:10.1186/2051-4190-24-15) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Julien Bessonnat
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France ; University Joseph Fournier, Grenoble, France ; Andrology, Genetic and Cancer Team, AGIM-FRE 3405, Faculty of Medicine, Grenoble, France
| | - Sophie Brouillet
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France ; University Joseph Fournier, Grenoble, France ; Andrology, Genetic and Cancer Team, AGIM-FRE 3405, Faculty of Medicine, Grenoble, France
| | - Sarah Sintzel
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France ; University Joseph Fournier, Grenoble, France
| | - Pierre Gillois
- University Joseph Fournier, Grenoble, France ; UMR 5525, Technics of Medical Engineering and Complexity, Grenoble, France
| | - Ulrike Bergues
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France
| | - Caroline Boutte-Busquet
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France
| | - Claire Thomas-Cadi
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France
| | - Sylviane Hennebicq
- Laboratoire d'Aide à la procréation-CECOS, University Hospital of Grenoble, Grenoble, France ; University Joseph Fournier, Grenoble, France ; Andrology, Genetic and Cancer Team, AGIM-FRE 3405, Faculty of Medicine, Grenoble, France
| |
Collapse
|
29
|
Impact of sperm cell source on the results of intracytoplasmic sperm injection. Arch Gynecol Obstet 2014; 291:663-9. [PMID: 25193430 DOI: 10.1007/s00404-014-3448-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE There is an ongoing debate whether the source of sperm cells, the etiology or the extent of male factor infertility has influence on the outcome of ICSI cycles. METHODS The results of intracytoplasmic sperm injection (ICSI) according to the source of spermatozoa in patients with severe male factor infertility were compared in a retrospective study: 249 couples underwent a total of 337 fresh ICSI cycles with the use of fresh motile testicular or fresh motile ejaculated spermatozoa. RESULTS For all variables, there were no statistically significant differences in the ICSI results between both groups. Fertilization rates were 46.8% for testicular and 47.6% for ejaculated spermatozoa. Live birth rates per embryo transfer were 20.4% using testicular spermatozoa and 22.8% using ejaculated spermatozoa. CONCLUSIONS Neither the source of spermatozoa nor the etiology of severe male infertility has relevant impact on the results of ICSI cycles as long as fresh motile, morphologically normal spermatozoa are used. Therefore, in case of cryptozoospermia, we recommend to preferentially use ejaculated spermatozoa to prevent those men from an unnecessary testicular biopsy avoiding risks and costs implied.
Collapse
|
30
|
Ben-Ami I, Raziel A, Strassburger D, Komarovsky D, Ron-El R, Friedler S. Intracytoplasmic sperm injection outcome of ejaculated versus extracted testicular spermatozoa in cryptozoospermic men. Fertil Steril 2013; 99:1867-71. [PMID: 23490166 DOI: 10.1016/j.fertnstert.2013.02.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare intracytoplasmic sperm injection (ICSI) outcome of patients with cryptozoospermia after use of ejaculated versus testicular sperm in different cycles of the same patients. DESIGN Retrospective cohort study. SETTING University-affiliated infertility center. PATIENT(S) A total of 17 patients with cryptozoospermia who underwent a total of 116 ICSI cycles. INTERVENTION(S) The patients initially underwent several ICSI cycles using ejaculated sperm (n = 68, 58.6%) that were followed by ICSI cycles using testicular sperm (n = 48, 41.4%). MAIN OUTCOME MEASURE(S) Fertilization rate, pregnancy rate (PR). RESULT(S) There were no significant differences in fertilization rates between the two subgroups. A comparison between testicular sperm extraction (TESE) versus ejaculated sperm cycles revealed significantly higher implantation rate (20.7% vs. 5.7%), higher PR (42.5% vs. 15.1%), and higher take home baby rate (27.5% vs. 9.4%). A multivariable logistic regression analysis showed three significant predictors for pregnancy, namely the use of testicular sperm (odds ratio [OR] 5.1, 95% confidence interval [95% CI] 1.8-14.8), use of motile sperm (OR 12.9, 95% CI 2.1-79.1), and female age (OR 0.83, 95% CI 0.7-0.9). CONCLUSION(S) Testicular sperm extraction is justified in patients with cryptozoospermia who fail to conceive by ICSI using ejaculated spermatozoa, as it offers higher PR.
Collapse
Affiliation(s)
- Ido Ben-Ami
- IVF and Infertility Unit, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | | | | | | | |
Collapse
|
31
|
Matsuura K, Uozumi T, Furuichi T, Sugimoto I, Kodama M, Funahashi H. A microfluidic device to reduce treatment time of intracytoplasmic sperm injection. Fertil Steril 2012; 99:400-7. [PMID: 23122951 DOI: 10.1016/j.fertnstert.2012.10.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 10/12/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a microfluidic device that can reduce the intracytoplasmic sperm injection (ICSI) treatment time by increasing sperm concentration. DESIGN We compared the ICSI treatment time required for porcine sperm using a method employing the microfluidic device and one using the conventional microdroplet method. SETTINGS Academic research laboratories at Okayama University. ANIMAL(S) Reproductive cells of porcine sperm, oocytes, and embryos. INTERVENTION(S) Cell manipulations, ICSI, and embryo culture. MAIN OUTCOME MEASURE(S) Average ICSI treatment time and sperm concentration. RESULT(S) The average ICSI treatment time (mean ± SEM) using the method with the microfluidic device for poor-quality semen (sperm concentration, 2.0 × 10(4) cells/mL) was significantly shorter than the treatment time using the conventional microdroplet method (265 ± 15 seconds [n = 43] vs. 347 ± 19 seconds [n = 50]). When diluted semen with a sperm concentration of 2.0 × 10(5) cells/mL was used, no significant difference was observed between the two methods (n = 50 and n = 48). CONCLUSION(S) The microfluidic device can reduce the time required for ICSI treatment that is used to increase sperm concentration in poor-quality semen samples. The results suggest that this device may be clinically useful for ICSI treatment in human assisted reproductive technology.
Collapse
Affiliation(s)
- Koji Matsuura
- Research Core for Interdisciplinary Sciences, Okayama University, Okayama, Japan.
| | | | | | | | | | | |
Collapse
|
32
|
Hershko-Klement A, Rovner E, Yekutieli D, Ghetler Y, Gonen O, Cohen I, Wiser A, Berkovitz A, Shulman A. Embryo quality and implantation rates are not influenced by total motile count values in an ICSI programme: a novel point of view. INTERNATIONAL JOURNAL OF MOLECULAR EPIDEMIOLOGY AND GENETICS 2012; 3:205-212. [PMID: 23050051 PMCID: PMC3459219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/05/2012] [Indexed: 06/01/2023]
Abstract
Total motile count (TMC) is a useful tool for sperm evaluation, comprising both quantitative and motility parameters. Although frequently used, TMC has not yet been evaluated as a contributory variable for intracytoplasmic sperm injection (ICSI) cycles. In this study we evaluate the possible role of TMC as a prognostic parameter in cycles designated for ICSI. We also test the existence of a possible TMC-threshold value that might be predictive for ICSI cycle outcome in the everyday practice. This is a retrospective cohort study in which the research question is addressed by a locally weighted regression (LOESS) analysis. Primary outcome measures are fertilization rate, good quality embryos rate and implantation rate. A total of 666 patients were included, contributing 1456 cycles. The effect of TMC over the fertilization rate was significant, depicting an inverted U-shaped curve: with up to approximately 10 million motile sperm, fertilization rates increased as TMC increased, but from this point on decreased. A slight increment in the rate of good embryo formation with increasing value of TMC was noted, but this did not reach a statistical significance. TMC values demonstrated no effect in the case of implantation rates. ICSI may offer an advantage related to fertilization rates for the sub-fertile male population, with a motile sperm count up to 10 million.
Collapse
|
33
|
The effect of immature oocytes quantity on the rates of oocytes maturity and morphology, fertilization, and embryo development in ICSI cycles. J Assist Reprod Genet 2012; 29:803-10. [PMID: 22644633 DOI: 10.1007/s10815-012-9799-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The goal was to evaluate the role of the number of retrieved immature oocytes on mature oocyte counts and morphology, and also the rates of fertilization and embryo development in ICSI cycles. METHODS 101 ICSI cycles were included in this prospective evaluation. Patients were divided into 2 groups of A (≤ 2 immature oocytes) and B (> 2 immature oocytes). In sub-analysis, the impacts of the number of GV and MI oocytes were assessed on the rates of fertilization and embryo development. Also, correlations between the numbers of immature and mature oocytes, as well as maternal age between two groups were analyzed. Assessments of oocyte morphology, fertilization, embryo quality and development were done accordingly. RESULTS There was no correlation between the immature oocytes quantity with the number of mature ones. There were insignificant differences for embryo development between two groups, but fertilization rate was higher in group A (P = 0.03). In sub-analysis, insignificant differences were observed between two groups of ≤ and >2 GV and MI oocytes for rates of fertilization and embryo development. Also, the rates of clinical pregnancy and delivery were insignificant between groups. The rate of morphologically abnormal oocytes had no significant difference between two groups, except for wide perivitelline space (PVS) which was higher in group A (P = 0.03). There was no significant difference for maternal age between two groups. CONCLUSIONS In cases with few retrieved immature oocytes, rates of fertilization and incidence of wide PVS may increase, although immature oocytes may not have any negative impacts on early embryo development, or the rates on number of mature oocytes.
Collapse
|
34
|
Amirjannati N, Heidari-Vala H, Akhondi MA, Hosseini Jadda SH, Kamali K, Sadeghi MR. Comparison of intracytoplasmic sperm injection outcomes between spermatozoa retrieved from testicular biopsy and from ejaculation in cryptozoospermic men. Andrologia 2011; 44 Suppl 1:704-9. [DOI: 10.1111/j.1439-0272.2011.01253.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
35
|
Maggiulli R, Neri QV, Monahan D, Hu J, Takeuchi T, Rosenwaks Z, Palermo GD. What to do when ICSI fails. Syst Biol Reprod Med 2011; 56:376-87. [PMID: 20849223 DOI: 10.3109/19396361003770321] [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 refinement of gamete micromanipulation techniques has made conception possible for couples with male factor infertility who otherwise would remain childless. Moreover, intracytoplasmic sperm injection (ICSI) has ensured that such refractory cases can now generate offspring as successfully as in couples that merely require in vitro insemination. However, despite the now sterling record of ICSI it does not assure a successful outcome for every patient. This can be due, for instance, to the inability of the spermatozoon to activate the oocyte, and applies obviously in cases where spermatozoa are absent from the ejaculate or testicular biopsy. In the present paper we describe in detail the reasons for such failure and review the options that may help overcome it. In particular, we outline the treatment protocol for the situation in which spermatozoa are unable to induce oocyte activation. Further, we report on the clinical outcome achieved with spermatozoa retrieved from the testis, and in cases of extreme oligozoospermia we also explore the option of replicating a single spermatozoon while gaining information on its genomic content. For the most extreme situation in which men have no identifiable germ cells, we will discuss the current status of efforts to accomplish neo-gametogenesis through embryonic stem cell differentiation.
Collapse
Affiliation(s)
- Roberta Maggiulli
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Berlinguer F, Madeddu M, Pasciu V, Succu S, Spezzigu A, Satta V, Mereu P, Leoni GG, Naitana S. Semen molecular and cellular features: these parameters can reliably predict subsequent ART outcome in a goat model. Reprod Biol Endocrinol 2009; 7:125. [PMID: 19900288 PMCID: PMC2777909 DOI: 10.1186/1477-7827-7-125] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/09/2009] [Indexed: 11/16/2022] Open
Abstract
Currently, the assessment of sperm function in a raw or processed semen sample is not able to reliably predict sperm ability to withstand freezing and thawing procedures and in vivo fertility and/or assisted reproductive biotechnologies (ART) outcome. The aim of the present study was to investigate which parameters among a battery of analyses could predict subsequent spermatozoa in vitro fertilization ability and hence blastocyst output in a goat model. Ejaculates were obtained by artificial vagina from 3 adult goats (Capra hircus) aged 2 years (A, B and C). In order to assess the predictive value of viability, computer assisted sperm analyzer (CASA) motility parameters and ATP intracellular concentration before and after thawing and of DNA integrity after thawing on subsequent embryo output after an in vitro fertility test, a logistic regression analysis was used. Individual differences in semen parameters were evident for semen viability after thawing and DNA integrity. Results of IVF test showed that spermatozoa collected from A and B lead to higher cleavage rates (0 < 0.01) and blastocysts output (p < 0.05) compared with C. Logistic regression analysis model explained a deviance of 72% (p < 0.0001), directly related with the mean percentage of rapid spermatozoa in fresh semen (p < 0.01), semen viability after thawing (p < 0.01), and with two of the three comet parameters considered, i.e tail DNA percentage and comet length (p < 0.0001). DNA integrity alone had a high predictive value on IVF outcome with frozen/thawed semen (deviance explained: 57%). The model proposed here represents one of the many possible ways to explain differences found in embryo output following IVF with different semen donors and may represent a useful tool to select the most suitable donors for semen cryopreservation.
Collapse
Affiliation(s)
- Fiammetta Berlinguer
- Department of Animal Biology, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Manuela Madeddu
- Department of Animal Biology, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Valeria Pasciu
- Presidenza, Biblioteca Veterinaria, Faculty of Veterinary Medicine, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Sara Succu
- Department of Animal Biology, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Antonio Spezzigu
- Department of Animal Biology, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Valentina Satta
- Department of Physiological, Biochemical and Cellular Science, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Paolo Mereu
- Department of Physiological, Biochemical and Cellular Science, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Giovanni G Leoni
- Department of Physiological, Biochemical and Cellular Science, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| | - Salvatore Naitana
- Department of Animal Biology, University of Sassari, Via Vienna 2, 07100 Sassari, Italy
| |
Collapse
|
37
|
Chen X, Zhang W, Luo Y, Long X, Sun X. Predictive value of semen parameters inin vitrofertilisation pregnancy outcome. Andrologia 2009; 41:111-7. [DOI: 10.1111/j.1439-0272.2008.00898.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
38
|
The outcome of intracytoplasmic sperm injection using occasional spermatozoa in the ejaculate of men with spermatogenic failure. J Urol 2008; 180:1060-4. [PMID: 18639294 DOI: 10.1016/j.juro.2008.05.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Indexed: 11/20/2022]
Abstract
PURPOSE Men with spermatogenic failure so profound that they are considered as having nonobstructive azoospermia occasionally have spermatozoa in the ejaculate. We compared intracytoplasmic sperm injection outcomes following the injection of ejaculated or surgically retrieved spermatozoa from these men. MATERIALS AND METHODS A study was performed of intracytoplasmic sperm injection cycles with no spermatozoa on initial semen analysis and 100 or fewer following centrifugation (cryptozoospermia). Only 16 couples that underwent intracytoplasmic sperm injection cycles with ejaculated spermatozoa and cycles with testicular spermatozoa were included. RESULTS Initial analysis was done to compare outcomes between the 2 semen origins. There was no difference in the rate of normal or abnormal fertilization between the 2 groups. The rate of clinical pregnancies seemed to favor testicular spermatozoa (47.4% vs 20.8%), although results were not significant. When a comparison was performed between the first testicular cycle and the ejaculated cycle closest in time to the cycle with testicular spermatozoa, a higher rate of normal fertilization with testicular spermatozoa was observed (60.9% vs 48.5%, p <0.05). Also, in this comparison a clear trend toward a higher percent of clinical pregnancies and deliveries in the testicular group was observed (50.0% vs 14.3%). CONCLUSIONS Transit through the male genital tract did not enhance the ability of ejaculated spermatozoa to achieve fertilization with intracytoplasmic sperm injection compared to that of testicular spermatozoa in men with severely impaired production. In ejaculated samples a lower number of spermatozoa available resulted in an impaired chance of achieving pregnancy. Using testicular spermatozoa may be a reasonable alternative for couples in whom multiple attempts at intracytoplasmic sperm injection have failed using ejaculated sperm from men with cryptozoospermia.
Collapse
|
39
|
Grimes DA, Lopez LM. “Oligozoospermia,” “azoospermia,” and other semen-analysis terminology: the need for better science. Fertil Steril 2007; 88:1491-4. [PMID: 17582404 DOI: 10.1016/j.fertnstert.2007.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 04/19/2007] [Accepted: 04/19/2007] [Indexed: 01/22/2023]
Abstract
The Greek-based terms used to describe semen-analysis abnormalities (e.g., "oligozoospermia" and "azoospermia") are unscientific, have overlapping definitions, and are often misinterpreted. The best course is to abandon these vague and difficult labels and simply report semen analyses quantitatively.
Collapse
Affiliation(s)
- David A Grimes
- Family Health International, Research Triangle Park, North Carolina 27709, USA.
| | | |
Collapse
|
40
|
Schachter M, Raziel A, Strassburger D, Rotem C, Ron-El R, Friedler S. Prospective, randomized trial of metformin and vitamins for the reduction of plasma homocysteine in insulin-resistant polycystic ovary syndrome. Fertil Steril 2007; 88:227-30. [PMID: 17336970 DOI: 10.1016/j.fertnstert.2006.11.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/08/2006] [Accepted: 11/16/2006] [Indexed: 10/23/2022]
Abstract
One hundred and two women with insulin-resistant polycystic ovary syndrome were randomized to treatment with a vitamin B preparation, metformin, or both, in conjunction with standard infertility treatment. Plasma homocysteine levels were significantly reduced by both B vitamins and metformin, but to a greater degree by B vitamins, and higher pregnancy rates were associated with vitamin B treatment.
Collapse
Affiliation(s)
- Morey Schachter
- In Vitro Fertilization and Infertility Unit, Assaf Harofeh Medical Center, Tel Aviv University, Zerifin, Israel.
| | | | | | | | | | | |
Collapse
|
41
|
Albert M. Modalités techniques de récupération et de congélation des spermatozoïdes. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/bf03035157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
42
|
Shen S, Khabani A, Klein N, Battaglia D. Statistical analysis of factors affecting fertilization rates and clinical outcome associated with intracytoplasmic sperm injection. Fertil Steril 2003; 79:355-60. [PMID: 12568845 DOI: 10.1016/s0015-0282(02)04675-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify and evaluate the statistically significant predictors of intracytoplasmic sperm injection (ICSI) fertilization rates and clinical pregnancy in a single population using appropriate statistical techniques. DESIGN Retrospective study. SETTING Fertility and Endocrinology Center, University of Washington Medical Center, Seattle, Washington. PATIENT(S) Four hundred forty-one patients undergoing their first attempt at IVF-ICSI from January 1, 1999, to May 21, 2001. INTERVENTION(S) Each ICSI procedure for an individual patient was performed by a single operator. Sperm parameters, oocyte age, culture condition, ICSI technique, and ICSI operator were assessed as variables influencing the fertilization rate. We also assessed the impact of patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred on the probability of achieving a clinical pregnancy. MAIN OUTCOME MEASURE(S) Fertilization rate and clinical pregnancy. RESULT(S) The 2 pronuclei (2PN) rate was significantly correlated with sperm motility, and there were significant differences in the 2PN rates among the ICSI operators. There was no difference in the 2PN rate among different sperm types or among the eight laboratory incubators or whether the eggs were cultured individually or in groups. Patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred were all statistically significant predictors of clinical pregnancy. CONCLUSION(S) In our program, sperm motility and ICSI operator are the two most important predictors for the ICSI fertilization rate in vitro. Patient age, serum E(2) concentration on the day of hCG administration, embryo quality, and number of embryos transferred were all statistically significant predictors of clinical pregnancy.
Collapse
Affiliation(s)
- Shehua Shen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | | | | | | |
Collapse
|
43
|
Borges E, Rossi-Ferragut LM, Pasqualotto FF, dos Santos DR, Rocha CC, Iaconelli A. Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients. SAO PAULO MED J 2002; 120:122-6. [PMID: 12436160 PMCID: PMC11151451 DOI: 10.1590/s1516-31802002000400007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXT Several sperm retrieval techniques are available for use on azoospeermic men. Comparisons between spermatozoa retrieved from the testicles and epididymis in relation to pregnancy and miscarriage rates are not well established. OBJECTIVE To compare pregnancy and miscarriage rates using sperm retrieved from the testes and epididymis using intracytoplasmic sperm injection. Furthermore, we evaluated the fertilization and pregnancy rates according to the status of the spermatozoa retrieved (motile or immotile). DESIGN Retrospective study. SETTING A private center for assisted fertilization. PARTICIPANTS One hundred and eight consecutive patients who presented with azoospermia were included in our study, on whom a total of 144 retrieval procedures were performed. PROCEDURES Of the 144 retrieval procedures, 104 were testicular sperm aspirations (TESA) and 40 were epididymal sperm aspirations (PESA). PESA was the first approach in obstructive patients (n = 68), whereas TESA was used when the former failed. For non-obstructive patients (n = 40), TESA was the method of retrieval. MAIN MEASUREMENTS Pregnancy and miscarriage rates according to spermatozoa characteristics (motile or immotile). RESULTS The number of cycles performed using spermatozoa retrieved from the testicles and epididymis was 81 and 30, respectively. Motile spermatozoa had higher fertilization (2PN) and pregnancy rates compared to immotile spermatozoa (p < 0.05). Also, motile spermatozoa had lower miscarriage rates compared to immotile spermatozoa (p < 0.0001). No differences were seen in pregnancy rates with testicular spermatozoa (n = 28) compared to epididymal spermatozoa (n = 13) (p = 0.1). However, the miscarriages rates were higher in spermatozoa retrieved from the testicles (n = 12) compared to epididymis retrievals (n = 1) (p = 0.01). CONCLUSIONS Although pregnancy rates were similar when the intracytoplasmic sperm injection was performed with spermatozoa retrieved from the testicles and epididymis, the use of testicular spermatozoa yields a significantly higher miscarriage rate. It is possible that the higher miscarriage rate seen in patients using spermatozoa retrieved from the testicles is linked to high genetic sperm abnormalities.
Collapse
Affiliation(s)
- Edson Borges
- Centro de Fertilização Assistida, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|