ANDROLOGY
ISSN: 2047-2919
ORIGINAL ARTICLE
Correspondence: Valerie Mitchell, Institut de Biologie de la ^ pital Reproduction-Spermiologie-CECOS, Ho gional Jeanne de Flandre, Centre Hospitalier Re Universitaire de Lille, F-59037 Lille, France. E-mail: [email protected]
Keywords: congenital bilateral absence of the vas deferens, intracytoplasmic sperm injection, spermatogenesis Received: 23-Oct-2014 Revised: 21-Jan-2015 Accepted: 22-Jan-2015
Congenital bilateral absence of the vas deferens: the impact of spermatogenesis quality on intracytoplasmic sperm injection outcomes in 108 men 1,6 1
M. A. Llabador, 2A. Pagin, 3C. Lefebvre-Maunoury, 4F. Marcelli, B. Leroy-Martin, 4,5J. M. Rigot and 1,5V. Mitchell
^ pital Jeanne de Flandre, Institut de Biologie de la Reproduction-Spermiologie-CECOS, Ho partement de Toxicologie et Ge nopathies, Centre de Biologie Pathologie, Institut de Biochimie et De culaire, 3Service de M cologie Endocrinienne, Biologie Mole edecine de la Reproduction et Gyne ^ pital Jeanne-de-Flandre, Centre Hospitalier Re gional Universitaire de Lille, 4De partement Ho ^ pital Calmette, 5EA 4308 Game togene se et Qualite du Gam d’Andrologie, Ho ete, Lille, France, and 6 ^ pital Bichat-Claude Bernard Present address: Laboratoire de Biologie de la Reproduction, Ho (AP-HP), F-75877 Paris, France 1 2
doi: 10.1111/andr.12019
SUMMARY In azoospermic men with congenital bilateral absence of the vas deferens (CBAVD), it is not known whether the outcomes of intracytoplasmic sperm injection (ICSI) depend on the quality of testicular spermatogenesis (as determined histopathologically). We retrospectively studied the impact of spermatogenesis quality on ICSI outcomes in 108 azoospermic men with CBAVD consulting in a university hospital’s department of andrology and reproductive biology. As part of an ICSI program, sperm samples were obtained from the epididymis [by microsurgical epididymal sperm aspiration (MESA); n = 47] or the testis [by testicular sperm extraction (TESE); n = 14] or both (MESA + TESE, n = 47). In the TESE group (i.e., TESE-only and MESA + TESE), spermatogenesis was normal in 21 of the 108 men (19.4%) and hypospermatogenesis occurred in 33 (30.5%). The fertilization rate was significantly lower in the hypospermatogenic group than in the normospermatogenesis group (65.6 and 72.9%, respectively; p = 0.02); this was also true for the embryo cleavage rate (88.6 and 92.1%, respectively; p = 0.007), and the proportion of embryos with fewer than 30% of enucleate fragments (79.5 and 86.9%, respectively; p = 0.02). Our study results showed that impaired spermatogenesis had a negative impact on certain early-stage biological outcomes of ICSI. In CBAVD, male factors are likely to exert a harmful effect on the early stages of embryo development.
INTRODUCTION Congenital bilateral absence of the vas deferens (CBAVD) is usually diagnosed when evaluating infertility in men in apparent good health. The prevalence of CBAVD in the general population is 1 in 1000, accounting most infertile males with cystic fibrosis and 1–2% of all male infertility (Wagenknecht et al., 1983; Jequier et al., 1985). The condition is found in 3–8% of men with azoospermia and 17–30% of men with obstructive azoospermia (Jequier et al., 1985; Chillon et al., 1995). In such cases, spermatozoa have to be surgically extracted from the epididymis and/or the testis. Although conventional in vitro fertilization with epididymal spermatozoa is reasonably successful in men with CBAVD (Silber et al., 1987, 1990; Patrizio et al., 1993), the advent of intracytoplasmic sperm injection (ICSI) (Palermo et al., 1992) with © 2015 American Society of Andrology and European Academy of Andrology
spermatozoa collected surgically has significantly improved the outcomes of infertility management in this context (Craft et al., 1993; Schoysman et al., 1993; Van Steirteghem et al., 1993; Devroey et al., 1994; Schlegel et al., 1994; Tournaye et al., 1994; Nagy et al., 1995; Silber et al., 1995). Spermatozoa can be obtained by microsurgical epididymal sperm aspiration (MESA) (Tournaye et al., 1994) and by testicular sperm extraction (TESE) (Devroey et al., 1994; Silber et al., 1995). Given that the male gamete might affect the development of the resulting embryos, it is commonly thought that epididymal spermatozoa should be used in preference to testicular spermatozoa, even when the latter are produced by normal spermatogenesis (Buffat et al., 2006). Otherwise, many studies have evaluated the quality of the spermatogenesis in CBAVD obstruction although it is generally assumed that sperm production is normal in CBAVD. Thus, Andrology, 1–8
1
M. A. Llabador et al.
histopathological studies of the spermatogenesis quality from CBAVD patients have generated divergent results, with either normal or altered spermatogenesis (Kaplan et al., 1968; Goldstein & Schlossberg, 1988; Silber et al., 1990; Gottlieb et al., 1991; Okada et al., 1999; Viville et al., 2000; Weiske et al., 2000; Meng et al., 2001).However, it is not known whether the outcomes of ICSI depend on the quality of spermatogenesis in men with CBAVD. By evaluating our data over a period of 10 years, we primarily sought to analyze the impact of the quality of testicular spermatogenesis (as determined histopathologically) on ICSI outcomes in azoospermic men with CBAVD.
MATERIALS AND METHODS Patients The study participants (n = 108) were recruited by the Department of Andrology at Lille University Medical Centre (France). All patients underwent a clinical examination with palpation of the testis, epididymis and vas deferens. Each patient’s medical history was recorded and all the participants gave their prior, written, informed consent to participation. CBAVD was diagnosed on the basis of the clinical examination and an ultrasound assessment of the vas deferens and seminal vesicles. An ultrasound of the kidneys was always performed at the same time. Azoospermia was confirmed on at least two semen analyses. A low semen volume, pH of
ISSN: 2047-2919
ORIGINAL ARTICLE
Correspondence: Valerie Mitchell, Institut de Biologie de la ^ pital Reproduction-Spermiologie-CECOS, Ho gional Jeanne de Flandre, Centre Hospitalier Re Universitaire de Lille, F-59037 Lille, France. E-mail: [email protected]
Keywords: congenital bilateral absence of the vas deferens, intracytoplasmic sperm injection, spermatogenesis Received: 23-Oct-2014 Revised: 21-Jan-2015 Accepted: 22-Jan-2015
Congenital bilateral absence of the vas deferens: the impact of spermatogenesis quality on intracytoplasmic sperm injection outcomes in 108 men 1,6 1
M. A. Llabador, 2A. Pagin, 3C. Lefebvre-Maunoury, 4F. Marcelli, B. Leroy-Martin, 4,5J. M. Rigot and 1,5V. Mitchell
^ pital Jeanne de Flandre, Institut de Biologie de la Reproduction-Spermiologie-CECOS, Ho partement de Toxicologie et Ge nopathies, Centre de Biologie Pathologie, Institut de Biochimie et De culaire, 3Service de M cologie Endocrinienne, Biologie Mole edecine de la Reproduction et Gyne ^ pital Jeanne-de-Flandre, Centre Hospitalier Re gional Universitaire de Lille, 4De partement Ho ^ pital Calmette, 5EA 4308 Game togene se et Qualite du Gam d’Andrologie, Ho ete, Lille, France, and 6 ^ pital Bichat-Claude Bernard Present address: Laboratoire de Biologie de la Reproduction, Ho (AP-HP), F-75877 Paris, France 1 2
doi: 10.1111/andr.12019
SUMMARY In azoospermic men with congenital bilateral absence of the vas deferens (CBAVD), it is not known whether the outcomes of intracytoplasmic sperm injection (ICSI) depend on the quality of testicular spermatogenesis (as determined histopathologically). We retrospectively studied the impact of spermatogenesis quality on ICSI outcomes in 108 azoospermic men with CBAVD consulting in a university hospital’s department of andrology and reproductive biology. As part of an ICSI program, sperm samples were obtained from the epididymis [by microsurgical epididymal sperm aspiration (MESA); n = 47] or the testis [by testicular sperm extraction (TESE); n = 14] or both (MESA + TESE, n = 47). In the TESE group (i.e., TESE-only and MESA + TESE), spermatogenesis was normal in 21 of the 108 men (19.4%) and hypospermatogenesis occurred in 33 (30.5%). The fertilization rate was significantly lower in the hypospermatogenic group than in the normospermatogenesis group (65.6 and 72.9%, respectively; p = 0.02); this was also true for the embryo cleavage rate (88.6 and 92.1%, respectively; p = 0.007), and the proportion of embryos with fewer than 30% of enucleate fragments (79.5 and 86.9%, respectively; p = 0.02). Our study results showed that impaired spermatogenesis had a negative impact on certain early-stage biological outcomes of ICSI. In CBAVD, male factors are likely to exert a harmful effect on the early stages of embryo development.
INTRODUCTION Congenital bilateral absence of the vas deferens (CBAVD) is usually diagnosed when evaluating infertility in men in apparent good health. The prevalence of CBAVD in the general population is 1 in 1000, accounting most infertile males with cystic fibrosis and 1–2% of all male infertility (Wagenknecht et al., 1983; Jequier et al., 1985). The condition is found in 3–8% of men with azoospermia and 17–30% of men with obstructive azoospermia (Jequier et al., 1985; Chillon et al., 1995). In such cases, spermatozoa have to be surgically extracted from the epididymis and/or the testis. Although conventional in vitro fertilization with epididymal spermatozoa is reasonably successful in men with CBAVD (Silber et al., 1987, 1990; Patrizio et al., 1993), the advent of intracytoplasmic sperm injection (ICSI) (Palermo et al., 1992) with © 2015 American Society of Andrology and European Academy of Andrology
spermatozoa collected surgically has significantly improved the outcomes of infertility management in this context (Craft et al., 1993; Schoysman et al., 1993; Van Steirteghem et al., 1993; Devroey et al., 1994; Schlegel et al., 1994; Tournaye et al., 1994; Nagy et al., 1995; Silber et al., 1995). Spermatozoa can be obtained by microsurgical epididymal sperm aspiration (MESA) (Tournaye et al., 1994) and by testicular sperm extraction (TESE) (Devroey et al., 1994; Silber et al., 1995). Given that the male gamete might affect the development of the resulting embryos, it is commonly thought that epididymal spermatozoa should be used in preference to testicular spermatozoa, even when the latter are produced by normal spermatogenesis (Buffat et al., 2006). Otherwise, many studies have evaluated the quality of the spermatogenesis in CBAVD obstruction although it is generally assumed that sperm production is normal in CBAVD. Thus, Andrology, 1–8
1
M. A. Llabador et al.
histopathological studies of the spermatogenesis quality from CBAVD patients have generated divergent results, with either normal or altered spermatogenesis (Kaplan et al., 1968; Goldstein & Schlossberg, 1988; Silber et al., 1990; Gottlieb et al., 1991; Okada et al., 1999; Viville et al., 2000; Weiske et al., 2000; Meng et al., 2001).However, it is not known whether the outcomes of ICSI depend on the quality of spermatogenesis in men with CBAVD. By evaluating our data over a period of 10 years, we primarily sought to analyze the impact of the quality of testicular spermatogenesis (as determined histopathologically) on ICSI outcomes in azoospermic men with CBAVD.
MATERIALS AND METHODS Patients The study participants (n = 108) were recruited by the Department of Andrology at Lille University Medical Centre (France). All patients underwent a clinical examination with palpation of the testis, epididymis and vas deferens. Each patient’s medical history was recorded and all the participants gave their prior, written, informed consent to participation. CBAVD was diagnosed on the basis of the clinical examination and an ultrasound assessment of the vas deferens and seminal vesicles. An ultrasound of the kidneys was always performed at the same time. Azoospermia was confirmed on at least two semen analyses. A low semen volume, pH of
