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Klami R, Tomás C, Mankonen H, Perheentupa A. ICSI outcome after microdissection testicular sperm extraction, testicular sperm aspiration and ejaculated sperm. Reprod Biol 2024; 24:100825. [PMID: 38000348 DOI: 10.1016/j.repbio.2023.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/04/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023]
Abstract
We conducted a case-controlled single-center cohort study to evaluate the intracytoplasmic sperm injection (ICSI) outcome in severe male infertility with different methods of sperm obtention. The data was compiled from a tertiary university hospital. The micro-TESE procedures were performed from 2008 to 2023, with a sperm recovery rate (SRR) of 45 %. The ICSI treatments were carried out between 2011 and 2023. The aim of the study was to compare the ICSI outcome using sperm obtained by microdissection testicular extraction (micro-TESE), testicular sperm aspiration (TESA), and ejaculated sperm with sperm concentration less than 15 million per milliliter. We included a total of 462 ICSI cycles, of which 340 ICSIs with ejaculated sperm of men with oligozoospermia, with or without asthenozoospermia or teratozoospermia (OAT group), 51 ICSIs with TESA sperm of men with obstructive azoospermia (OA, TESA group), and 71 ICSIs with micro-TESE sperm of men with non-obstructive azoospermia (NOA, micro-TESE group). The patient characteristics, fertilization rate, pregnancy rate, and pregnancy outcome data were similar between the groups. The fertilization rates were 66.0 % in the OAT group, 68.3 % in the TESA group and 62.8 % in the micro-TESE group and live birth rate per embryo transfer were 23.7 %, 28.9 %, and 25.0 %, respectively, without statistical difference. The obstetrical outcome was similar in all the groups. The overall clinical results in all ICSI cycles performed for treating severe male factor infertility were similar, independent of the method of collection of spermatozoa. The results also confirm the efficacy of micro-TESE in the treatment of severe male factor infertility.
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Affiliation(s)
- Rauni Klami
- Department of Obstetrics and Gynecology, Turku University Hospital, PL52, 20521 Turku, Finland; Institute of Medicine, University of Turku, Turku, Finland.
| | | | - Harri Mankonen
- Department of Obstetrics and Gynecology, Turku University Hospital, PL52, 20521 Turku, Finland; Institute of Medicine, University of Turku, Turku, Finland
| | - Antti Perheentupa
- Department of Obstetrics and Gynecology, Turku University Hospital, PL52, 20521 Turku, Finland; Institute of Medicine, University of Turku, Turku, Finland
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Flannigan R, Tadayon Najafabadi B, Violette PD, Jarvi K, Patel P, Bach PV, Domes T, Zini A, Grober E, Mak V, Fischer MA, Chan P, Lo K, Chow V, Wu C, Grantmyre J, Patry G. 2023 Canadian Urological Association guideline: Evaluation and management of azoospermia. Can Urol Assoc J 2023; 17:228-240. [PMID: 37581550 PMCID: PMC10426420 DOI: 10.5489/cuaj.8445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | | | - Philippe D. Violette
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Premal Patel
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Phil Vu Bach
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Trustin Domes
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Ethan Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Mak
- Division of Urology, Department of Surgery, Mackenzie Health, Richmond Hill, ON, Canada
| | - Marc Anthony Fischer
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Chow
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Chris Wu
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - John Grantmyre
- Division of Urology, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Genevieve Patry
- Division of Urology, Department of Surgery, Hôtel-Dieu De Lévis, Lévis, QC, Canada
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Cryopreservation of Human Spermatozoa: Functional, Molecular and Clinical Aspects. Int J Mol Sci 2023; 24:ijms24054656. [PMID: 36902084 PMCID: PMC10002855 DOI: 10.3390/ijms24054656] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Cryopreservation is an expanding strategy to allow not only fertility preservation for individuals who need such procedures because of gonadotoxic treatments, active duty in dangerous occupations or social reasons and gamete donation for couples where conception is denied, but also for animal breeding and preservation of endangered animal species. Despite the improvement in semen cryopreservation techniques and the worldwide expansion of semen banks, damage to spermatozoa and the consequent impairment of its functions still remain unsolved problems, conditioning the choice of the technique in assisted reproduction procedures. Although many studies have attempted to find solutions to limit sperm damage following cryopreservation and identify possible markers of damage susceptibility, active research in this field is still required in order to optimize the process. Here, we review the available evidence regarding structural, molecular and functional damage occurring in cryopreserved human spermatozoa and the possible strategies to prevent it and optimize the procedures. Finally, we review the results on assisted reproduction technique (ARTs) outcomes following the use of cryopreserved spermatozoa.
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Marinaro JA. Optimizing outcomes for men with severe infertility. Curr Opin Urol 2023; 33:45-49. [PMID: 36193850 DOI: 10.1097/mou.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To evaluate recent evidence related to optimizing outcomes for men with severe infertility, including effect of ejaculatory abstinence interval on semen parameters and assisted reproductive technology (ART) outcomes, and impact of cryopreservation on surgically retrieved testicular sperm obtained from men with nonobstructive azoospermia (also referred to as azoospermia due to spermatogenic dysfunction). RECENT FINDINGS Recent evidence strongly suggests that a short abstinence interval improves sperm motility and ART outcomes. Similarly, recent studies have concluded that using fresh vs. frozen testicular sperm results in higher live birth rates. SUMMARY Although the World Health Organization currently recommends a 2- to 7-day ejaculatory abstinence period, this interval is based more on the need to standardize semen parameters than clinical outcomes. In fact, recent evidence suggests that shorter abstinence consistently improves sperm motility and ART outcomes for infertile men. Similarly, recent studies have reported an improvement in live birth rates with fresh (vs. frozen) testicular sperm, though their retrospective design and lack of intention to treat analyses makes it difficult to draw strong conclusions. Although additional, well designed studies are needed, providers may be able to leverage these techniques in their practice to improve outcomes for some infertile men.
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Gat I, Umanski A, Kaufman S, Kedem A, Avraham S, Youngster M, Yerushalmi G, Kugel C, Hourvitz A, Levtzion-Korach O. What can we learn about posthumous sperm retrieval after extra long-term follow-up? J Assist Reprod Genet 2022; 39:1661-1665. [PMID: 35689734 DOI: 10.1007/s10815-022-02535-8] [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: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe spermatozoa extraction rate by testicular sperm extraction (TESE) for posthumous sperm retrieval (PMSR) and examine harvest time impact on sperm motility; to compare long-term sperm usage between married vs. single deceased men. METHODS This retrospective study included all PMSR cases in Shamir Medical Center during 2003-2021. We evaluated sperm cryopreservation according to latency time after death. Then, we assessed sperm usage according to Israeli PMSR regulations. RESULTS The study included 69 (35 married and 34 singles) deceased men with average age of 30.3 ± 7.8 years. Sperm was cryopreserved in 65 cases (94.2%) after maximum and average harvest time of 40 and 16.5 ± 8.1 h, respectively. Motile sperm extraction was associated with significantly shorter harvest time compared with non-motile sperm (13.8 ± 7.3 vs. 18.7 ± 8.1 h, p = 0.046). Sperm usage among married deceased was significantly higher than single (15.6% vs. 0%, p = 0.05). Disposal requests were lower among single compared to married men relatives without reaching statistical difference. Eventually, single men had significantly higher rate of non-used cryopreserved samples (93.8% vs 69.6%, p = 0.01). CONCLUSION This large long-term cohort study demonstrates high efficacy of PMSR. We found significant harvest latency time difference between motile and non-motile preserved sperm. Clinical sperm usage rate justifies the efforts for PMSR among married deceased. However, contradicting policy on the topic of single men (which implies liberal sperm preservation but rigid prevention of usage) results with high non-used sperm rate and relatives' extremely sophisticated emotional burden.
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Affiliation(s)
- Itai Gat
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel.
- IVF Department, Shamir Medical Center, Zrifin, Israel.
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - Ana Umanski
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel
| | - Sarita Kaufman
- Sperm Bank & Andrology Unit, Shamir Medical Center, Zrifin, Israel
| | - Alon Kedem
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Avraham
- IVF Department, Shamir Medical Center, Zrifin, Israel
| | | | | | - Chen Kugel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- National Institute of Forensic Medicine, Abu Kabir, Tel Aviv, Israel
| | - Ariel Hourvitz
- IVF Department, Shamir Medical Center, Zrifin, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Levtzion-Korach
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Zrifin, Israel
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Punjani N, Romanski PA, Bortoletto P, Kang C, Spandorfer S, Kashanian JA. The use of fresh compared to frozen ejaculated sperm has no impact on fresh embryo transfer cycle reproductive outcomes. J Assist Reprod Genet 2022; 39:1409-1414. [PMID: 35513747 DOI: 10.1007/s10815-022-02507-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the reproductive outcomes of fresh embryo transfer (ET) cycles utilizing fresh versus frozen ejaculated sperm. METHODS First autologous fresh embryo transfer cycles at a single high-volume academic institution between 2013 and 2019 were retrospectively reviewed. IVF cycles using ejaculated sperm were included, and cycles using donor or surgically retrieved sperm were excluded. Sperm concentration was stratified as ≥ 5 and < 5 million/ml. The primary outcome was live birth, and the secondary outcomes were clinical intrauterine pregnancy (IUP) and miscarriage. A multivariable logistic regression model for the aforementioned outcomes was adjusted a priori for sperm concentration as well as maternal and paternal age. RESULTS A total of 6128 couples were included. Of these, 5780 (94.3%) utilized fresh sperm, and 348 (5.7%) frozen sperm. A total of 5716 (93.2%) had sperm concentrations ≥ 5 million/ml and 412 (6.7%) had sperm concentrations < 5 million/ml. On multivariable logistic regression, the use of freshly ejaculated sperm was not associated with significantly different odds of clinical IUP, miscarriage, or live birth when compared to cycles using frozen sperm. CONCLUSION For couples conceiving via fresh ET, the use of fresh versus frozen ejaculated sperm is not associated with reproductive outcomes.
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Affiliation(s)
- Nahid Punjani
- Division of Urology, Weill Cornell Medicine, 525 E 68th St, Starr 900, New York, NY, 10065, USA
| | - Phillip A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6Th Floor, New York City, NY, 10021, USA
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6Th Floor, New York City, NY, 10021, USA
| | - Caroline Kang
- Division of Urology, Weill Cornell Medicine, 525 E 68th St, Starr 900, New York, NY, 10065, USA
| | - Steven Spandorfer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6Th Floor, New York City, NY, 10021, USA
| | - James A Kashanian
- Division of Urology, Weill Cornell Medicine, 525 E 68th St, Starr 900, New York, NY, 10065, USA.
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Kızılay F, Altay B, Aşçı R, Çayan S, Ekmekçioğlu O, Yaman Ö, Kadıoğlu A. Retrospective analysis of factors affecting sperm retrieval with microscopic testicular sperm extraction in infertile men with Klinefelter syndrome: A multicentre study. Andrologia 2022; 54:e14379. [PMID: 35102587 DOI: 10.1111/and.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to evaluate the data currently available on predictors of sperm retrieval (SR) in infertile men with Klinefelter syndrome (KS). The data of infertile patients with KS who were evaluated for primary infertility in the andrology outpatient clinics of six centres were retrospectively reviewed. SR, fertilization and pregnancy rates were evaluated. While SR was achieved with microscopic testicular sperm extraction (mTESE) in 57.7% of the cases, the positive pregnancy rate was 22%. While mosaicism was significantly associated with achieving pregnancy, it was not significant for SR (p = 0.002 and p = 0.136 respectively). However, receiving medical treatment prior to mTESE was a positive factor for both achieving pregnancy (p = 0.010) and successful SR (p = 0.032). Unsurprisingly, fertilization rate was a variable that increased the pregnancy rate (p = 0.001). In addition, total testosterone value correlated with SR (p < 0.001). For patients with KS, pregnancy can be achieved by obtaining sperm through mTESE, especially in those with mosaic karyotype, normal partner fertility, a high fertilization rate and who receive appropriate medical treatment before mTESE.
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Affiliation(s)
- Fuat Kızılay
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Barış Altay
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Ramazan Aşçı
- Faculty of Medicine, Department of Urology, Ondokuz Mayıs University, Samsun, Turkey
| | - Selahittin Çayan
- Faculty of Medicine, Department of Urology, Mersin University, Mersin, Turkey
| | - Oğuz Ekmekçioğlu
- Faculty of Medicine, Department of Urology, Erciyes University, Kayseri, Turkey
| | - Önder Yaman
- Faculty of Medicine, Department of Urology, Ankara University, Ankara, Turkey
| | - Ateş Kadıoğlu
- Istanbul Faculty of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
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