Ejaculation failure on the day of oocyte retrieval for IVF: Case report

Comparison of fresh testicular sperm aspiration and use of either thawed pre-frozen sperm or oocyte freezing: impact on cumulative live birth rates for couples experiencing ejaculation failure

STUDY QUESTION

Is there a difference in the cumulative live birth rate (CLBR) after fresh testicular sperm aspiration (TESA) compared with the use of either pre-frozen sperm or oocyte freezing for couples experiencing ejaculation failure on the day of oocyte retrieval?

SUMMARY ANSWER

After adjusting for confounding factors, the use of pre-frozen sperm or the freezing and thawing of oocytes appeared to be as effective as TESA in achieving CLBRs for couples experiencing temporary ejaculation failure.

WHAT IS KNOWN ALREADY

Male patients may be concerned about experiencing temporary ejaculation failure on the day of their partner's oocyte retrieval, in which case they may choose surgical sperm retrieval, oocyte freezing on the day, or have their sperm frozen in advance. However, the clinical efficacy of these three options has not yet been evaluated.

STUDY DESIGN, SIZE, DURATION

A retrospective data analysis was conducted on 65 178 oocyte retrieval cycles at a university-affiliated IVF center from January 2012 to May 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The overall characteristics, completed cycle characteristics, and clinical outcomes were analyzed among couples with ejaculation failure who underwent three distinct clinical interventions, with those receiving TESA serving as the control group. The primary outcome measure was the CLBR, and the secondary outcome measures were the clinical pregnancy rate (CPR) and live birth rate (LBR) per embryo transfer. A robust (modified) Poisson regression model was used to evaluate the association between the three clinical options for ejaculation failure and CLBRs.

MAIN RESULTS AND ROLE OF CHANCE

Of the eligible oocyte retrieval cycles, 756 cycles (1.2%) experienced ejaculation failure, with 640 cycles completing treatment. These treatments included 325 cycles using TESA, 227 cycles utilizing pre-frozen sperm, and 88 cycles involving frozen-thawed oocytes. The CLBRs for the TESA, thawed-sperm and thawed-oocyte groups were 36.9%, 48.9%, and 34.1%, respectively, showing a statistically significant difference (P = 0.007). Specifically, the thawed-sperm group demonstrated a significantly higher CLBR compared to the TESA group, while no significant difference was observed between the TESA and thawed-oocyte groups. Similarly, the CPRs and LBRs per embryo transfer for the three groups were 37.4%, 50.0%, and 41.8%, respectively (P = 0.005), and 29.9%, 39.6%, and 33.0%, respectively (P = 0.030). Again, the thawed-sperm group showed a significantly higher CPR and a significantly higher LBR, but no significant differences for the thawed-oocyte group, compared to the TESA group. Notably, the significant differences in both CLBR and LBR emerged after the second embryo transfer. However, after adjusting for multiple factors, including female age at oocyte retrieval, type and duration of infertility, female body mass index, number of previous IVF cycles, ovarian stimulation protocol, endometrial thickness on the last ultrasound, insemination method, number of oocytes retrieved, number of fertilized oocytes, and number of usable embryos on Day 3, the analysis revealed no significant association between CLBR and the use of pre-frozen sperm (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.81-1.44) or thawed oocytes (RR 1.01, 95% CI 0.76-1.33), compared with TESA.

LIMITATIONS, REASONS FOR CAUTION

Given that the study is retrospective and the sample size is too small, particularly concerning the use of thawed oocytes, we acknowledge that the data present here is only suggestive and refers to an association that warrants cautious interpretation. Therefore, further research in the form of prospective studies as well as randomized controlled trials is needed to provide a definitive answer to the research question.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings suggest that using pre-frozen sperm or frozen-thawed oocytes can offer comparable CLBRs to TESA for cases of temporary ejaculation failure, providing clinical alternatives that may reduce the logistical challenges in ART cycles.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Nature Science Foundation of China (grant nos. 82101672, 82171589), the National Key Research and Development Program of China (grant nos. 2022YFC2702504, 2019YFE0109500), the Basic and Applied Basic Research Foundation of Guangdong Province (grant no. 2021A1515010774), and the Guangzhou Municipal Science and Technology Project (grant nos. 202102010075, 2023A4J0578). The authors declare that they have no conflict of interest in relation to the data in this paper.

TRIAL REGISTRATION NUMBER

N/A.

Management of transient ejaculation failure due to erectile difficulties encountered on the oocyte retrieval day

INTRODUCTION

Transient ejaculation failure can be seen on the oocyte retrieval day which might cause the cancelation of oocyte retrieval procedure. The aim of this study was to evaluate the management of these patients and to assess the clinical outcome of intracytoplasmic sperm injection (ICSI) using spermatozoa obtained from them.

METHODS

The records of the oocyte pick-up (OPU) procedures between November 2014 and January 2017 were reviewed, the management and ICSI outcomes of 26 patients with transient ejaculation failure due to erectile difficulties on the oocyte retrieval day were evaluated.

RESULTS

Intracavernosal injection (ICI), percutaneous sperm aspiration (PESA) and microdissection testicular sperm extraction (micro-TESE) were performed to 15, 6 and 5 patients, respectively. The sperm retrieval rate (SRR) and live birth rate (LBR) of ICI, PESA and micro-TESE were 26%, 63.6% and 100% and 40%, 16.7%, 38.4% respectively.

CONCLUSIONS

Although a limited number of cases were evaluated in this study, micro-TESE appears to be the preferable approach when assessed both in terms of sperm retrieval method success and ICSI results.

Depression in Chinese men undergoing different assisted reproductive technique treatments: prevalence and risk factors

PURPOSE

To explore the prevalence and risk factors for depression in men undergoing different assisted reproductive technique (ART) treatments in Chinese population.

METHOD

This was a prospective study of 844 men undergoing ART treatments. All men were distributed to four groups, according to they received treatments. The treatments included IUI (intrauterine insemination), IVF(in vitro fertilization), ICSI(intra cytoplasmatic sperm injection) and TESA/PESA (percutaneous epididymal sperm aspiration/testicular sperm aspiration). Their symptoms of depression were measured with use of the Center for Epidemiologic Studies of Depression scale(CES-D). Data were collected about age, BMI, education, duration of marriage, duration of infertility, smoking, type of infertility, infertility causes, history of ejaculation failure, and financial burden of the treatment. We estimated the prevalence of depressive symptom in men undergoing different ART and used logistic regression models to identify risk factors for depression in different groups.

RESULTS

The overall prevalence of depression was 13.3 % for men undergoing ART treatments: 14.5 % of IUI group, 12.4 % of IVF group, 19.2 % of ICSI group and 6.2 % of TESA/PESA group. Prevalence of depression among IUI group, IVF group and ICSI group were not significantly different. For IUI group, the factors were found to increase depression risk were treatment financial burden and duration of marriage, to decrease depression risk was age. For IVF group, the risk factors independently associated with depression were both male and female infertility, unexplained infertility, and history of ejaculation failure.

CONCLUSION

In a sample of Chinese men undergoing ART treatments, the prevalence of depression was higher than other country. The risk factors for depression varied in different ART treatments groups. when routine screening to identify the sub-group of vulnerable men which need counselling before ART treatments, we should also consider which pattern of ART treatments the man underwent.

Semen cryopreservation in pubertal boys before gonadotoxic treatment and the role of endocrinologic evaluation in predicting sperm yield

OBJECTIVE

To evaluate the feasibility of semen cryopreservation in pubertal boys before they receive gonadotoxic therapy and to identify which pretreatment parameters might predict successful cryopreservation.

DESIGN

Retrospective data analysis.

SETTING

Tertiary fertility center, academic children's hospital.

PATIENT(S)

Between 1995 and 2005, 80 boys (median age 16.6 years, range 13.7-18.9 years) consulted the outpatient clinic of andrology for semen cryopreservation before a potentially gonadotoxic treatment.

INTERVENTION(S)

We assessed the pretreatment semen parameters, hormone levels, and patients' characteristics.

MAIN OUTCOME MEASURE(S)

Measurement of the number of adolescents able to cryopreserve semen.

RESULT(S)

Thirteen boys were unable to produce semen by masturbation. In 53 boys semen quality was adequate for cryopreservation. In 14 patients semen analysis did not show motile spermatozoa, and therefore semen cryopreservation could not be performed. Although inhibin B showed a strong correlation with sperm count, no significant difference was found in serum T, inhibin B, LH, and FSH levels in the patients with or without successful sperm yield. Moreover, median age was not different between patients with and without a successful sperm yield.

CONCLUSION(S)

Semen cryopreservation in boys is a feasible method to preserve spermatozoa before gonadotoxic therapy is started and should be offered to all pubertal boys despite their young age. Serum hormone levels do not predict sperm yield.

Combined use of phosphodiesterase-5 inhibitors and selective serotonin reuptake inhibitors for temporary ejaculation failure in couple undergoing assisted reproductive technologies

OBJECTIVE

To explore the drug treatment for temporary ejaculation failure in couple undergoing assisted reproductive technologies (ART).

DESIGN

Case report.

SETTING

Andrology unit, center for reproductive medicine.

PATIENT (S)

Five patients suffering from temporary ejaculation failure during ART.

INTERVENTION(S)

Assisted reproductive technology. Semen samples were collected by masturbation. The combined use of phosphodiesterase-5 inhibitor (PDE5-I; vardenafil, 10 mg) and selective serotonin reuptake inhibitor (SSRI; sertraline, 50 mg) to treat patients who failed to collect semen on the day of egg retrieval.

RESULT(S)

Five patients with unexpected ejaculation failure during ART treatments were identified; two patients could not produce spermatozoa 3 h after taking PDE5-I (sildenafil, 50 mg), However, the use of PDE5-I (vardenafil, 10 mg) plus SSRI (sertraline, 50 mg) enabled them to provide spermatozoa successfully. It suggested that the combined protocol could be more efficient for temporary ejaculation failure than sildenafil alone. On the day of the egg retrieval, we directly prescribed vardenafil and sertraline for the other three patients and got sperm samples without difficulty 2 h later.

CONCLUSION(S)

The results indicate that the combined protocol of vardenafil plus sertraline could resolve the unpredictable ejaculation failure during ART. We presume that it might be helpful for attenuating the patients' stress and anxiety.

Observational clinical follow-up of oocyte cryopreservation using a slow-freezing method with 1,2-propanediol plus sucrose followed by ICSI

BACKGROUND

The value of oocyte cryopreservation remains controversial. Two major problems exist: poor survival and injury to the oocyte meiotic spindle after freezing and thawing.

METHODS

For slow oocyte cryopreservation, we used 1.5 mol/l 1,2-propanediol and 0.3 mol/l sucrose. We waited 3 h after thawing for possible recovery of the meiotic spindles before performing ICSI.

RESULTS

Forty-three women undergoing IVF or ICSI cycles cryopreserved some or all of their harvested oocytes; of these, 20 thawed their cryopreserved oocytes for personal use and one for donation. The survival rate of oocytes after thawing was 75%, with 67% of oocytes fertilizing normally after ICSI. All 21 cycles (100%) resulted in fertilization and embryo transfers. Seven pregnancies (33%) resulted. Four women delivered five babies with normal karyotypes. Three conceptions are ongoing. Compared to 38 cycles of frozen-thawed embryos at the pronuclear stage in the same period, the percentages of survival, pregnancy and implantation were similar. Additionally, four unmarried women with white blood cell diseases underwent oocyte freezing before preconditioning treatment for haematopoietic stem cell transplantation.

CONCLUSIONS

This protocol achieved reproducible success of survival, fertilization and pregnancy for freezing and thawing of human oocytes. The 3 h post-thaw incubation could permit restoration of the meiotic spindles, thus facilitating normal fertilization.