ORIGINAL ARTICLE
Intracytoplasmic sperm injection outcomes with cryopreserved testicular sperm aspiration samples M. Roque1, M. Valle1, F. Marques1, M. Sampaio2 & S. Geber2,3 1 Origen – Center for Reproductive Medicine, Rio de Janeiro, Brazil; 2 Origen – Center for Reproductive Medicine, Belo Horizonte, Brazil; 3 Medical School – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Keywords Intracytoplasmic sperm injection— nonobstructive azoospermia—testicular sperm aspiration Correspondence Matheus Roque, Origen – Center for Reproductive Medicine, Av Rodolfo de Amoedo, 140 – Barra da Tijuca, Rio de Janeiro, RJ – CEP 22620-350, Brazil. Tel.: +55 21 21285353; Fax +55 21 24946292; E-mail: [email protected] Accepted: March 31, 2015 doi: 10.1111/and.12439
Summary Intracytoplasmic sperm injection (ICSI) may be performed with testicular frozen–thawed spermatozoa in patients with nonobstructive azoospermia (NOA). Sperm retrieval can be performed in advance of oocyte aspiration, as it may avoid the possibility of no recovery of spermatozoa on the day of oocyte pickup. There are few studies available in the literature concerning the use of frozen–thawed spermatozoa obtained from testicular sperm aspiration (TESA). To evaluate the effects and the outcomes of ICSI with frozen–thawed spermatozoa obtained by TESA, we performed a retrospective analysis of 43 ICSI cycles using frozen–thawed TESA. We obtained acceptable results with a fertilisation rate of 67.9%, an implantation rate (IR) of 17.1%, and clinical and ongoing pregnancy rates of 41.9% and 37.2% respectively. The results of this study suggest that performing ICSI using cryopreserved frozen–thawed testicular spermatozoa with TESA as a first option is a viable, safe, economic and effective method for patients with NOA.
Introduction Azoospermia is observed in approximately 1% of all men and in 10–15% of infertile men (Practice Committee of ASRM, 2008). Intracytoplasmic sperm injection (ICSI) with testicular spermatozoa has become a routine treatment for patients with obstructive azoospermia (OA) or nonobstructive azoospermia (NOA) (Nagy et al., 1995; Silber et al., 1995; Devroey et al., 1996; De Croo et al., 2000). Spermatozoa can be retrieved in almost 100% of patients with OA and in about 50–60% of patients with NOA (Verheyen et al., 2004; Dohle et al., 2012). In cases of NOA, spermatozoa can be obtained by testicular sperm extraction (TESE), testicular sperm aspiration (TESA), testicular fine-needle aspiration and testicular microdissection (micro-TESE) (Deruyver et al., 2014); however, there is currently no consensus as to which technique is best performed as a first option (Van Peperstraten et al., 2008). Therefore, the least invasive technique has been suggested to be performed first (Van Peperstraten et al., 2008). Diagnostic testicular biopsy followed by cryopreservation of spermatozoa from testicular tissue may avoid a second invasive procedure on the day of oocyte retrieval (Habermann et al., 2000; Giorgetti et al., 2005; Hauser 252
et al., 2005; Wu et al., 2005; Kalsi et al., 2011). The use of frozen–thawed testicular spermatozoa in NOA patients has been described with acceptable results of ICSI. However, in cases where extremely low numbers of spermatozoa are retrieved, cryopreservation has been described as very difficult (Friedler et al., 1997; Ben-Yosef et al., 1999; Verheyen et al., 2004). Most of the studies that have evaluated the use of frozen–thawed spermatozoa have performed TESE (Friedler et al., 1997; Ben-Yosef et al., 1999; Habermann et al., 2000; Verheyen et al., 2004; Giorgetti et al., 2005). Moreover, there are only limited data available analysing the efficacy of ICSI with frozen–thawed spermatozoa retrieved with TESA (Sereni et al., 2008). The aim of this study was to analyse the outcomes of ICSI using frozen–thawed testicular spermatozoa obtained by TESA. Materials and methods This retrospective study included 43 patients with NOA submitted to ICSI cycles with the use of frozen–thawed testicular spermatozoa retrieved with TESA. The study was performed in a private assisted reproduction centre between June 2009 and November 2011. The study was approved by our Institutional Review Board, and written © 2015 Blackwell Verlag GmbH Andrologia 2016, 48, 252–256
M. Roque et al.
informed consent was obtained from all the patients involved in the study. In all cases, azoospermia was confirmed with at least two semen analyses, and cryptozoospermia was excluded prior to the treatment using highspeed centrifugation. All patients had a previous analysis of serum testosterone, follicle-stimulating hormone (FSH), karyotype, Y chromosome microdeletion and physical examination performed. All female patients were submitted to a complete infertility evaluation, and only women who had serum FSH levels 35 and
Intracytoplasmic sperm injection outcomes with cryopreserved testicular sperm aspiration samples M. Roque1, M. Valle1, F. Marques1, M. Sampaio2 & S. Geber2,3 1 Origen – Center for Reproductive Medicine, Rio de Janeiro, Brazil; 2 Origen – Center for Reproductive Medicine, Belo Horizonte, Brazil; 3 Medical School – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Keywords Intracytoplasmic sperm injection— nonobstructive azoospermia—testicular sperm aspiration Correspondence Matheus Roque, Origen – Center for Reproductive Medicine, Av Rodolfo de Amoedo, 140 – Barra da Tijuca, Rio de Janeiro, RJ – CEP 22620-350, Brazil. Tel.: +55 21 21285353; Fax +55 21 24946292; E-mail: [email protected] Accepted: March 31, 2015 doi: 10.1111/and.12439
Summary Intracytoplasmic sperm injection (ICSI) may be performed with testicular frozen–thawed spermatozoa in patients with nonobstructive azoospermia (NOA). Sperm retrieval can be performed in advance of oocyte aspiration, as it may avoid the possibility of no recovery of spermatozoa on the day of oocyte pickup. There are few studies available in the literature concerning the use of frozen–thawed spermatozoa obtained from testicular sperm aspiration (TESA). To evaluate the effects and the outcomes of ICSI with frozen–thawed spermatozoa obtained by TESA, we performed a retrospective analysis of 43 ICSI cycles using frozen–thawed TESA. We obtained acceptable results with a fertilisation rate of 67.9%, an implantation rate (IR) of 17.1%, and clinical and ongoing pregnancy rates of 41.9% and 37.2% respectively. The results of this study suggest that performing ICSI using cryopreserved frozen–thawed testicular spermatozoa with TESA as a first option is a viable, safe, economic and effective method for patients with NOA.
Introduction Azoospermia is observed in approximately 1% of all men and in 10–15% of infertile men (Practice Committee of ASRM, 2008). Intracytoplasmic sperm injection (ICSI) with testicular spermatozoa has become a routine treatment for patients with obstructive azoospermia (OA) or nonobstructive azoospermia (NOA) (Nagy et al., 1995; Silber et al., 1995; Devroey et al., 1996; De Croo et al., 2000). Spermatozoa can be retrieved in almost 100% of patients with OA and in about 50–60% of patients with NOA (Verheyen et al., 2004; Dohle et al., 2012). In cases of NOA, spermatozoa can be obtained by testicular sperm extraction (TESE), testicular sperm aspiration (TESA), testicular fine-needle aspiration and testicular microdissection (micro-TESE) (Deruyver et al., 2014); however, there is currently no consensus as to which technique is best performed as a first option (Van Peperstraten et al., 2008). Therefore, the least invasive technique has been suggested to be performed first (Van Peperstraten et al., 2008). Diagnostic testicular biopsy followed by cryopreservation of spermatozoa from testicular tissue may avoid a second invasive procedure on the day of oocyte retrieval (Habermann et al., 2000; Giorgetti et al., 2005; Hauser 252
et al., 2005; Wu et al., 2005; Kalsi et al., 2011). The use of frozen–thawed testicular spermatozoa in NOA patients has been described with acceptable results of ICSI. However, in cases where extremely low numbers of spermatozoa are retrieved, cryopreservation has been described as very difficult (Friedler et al., 1997; Ben-Yosef et al., 1999; Verheyen et al., 2004). Most of the studies that have evaluated the use of frozen–thawed spermatozoa have performed TESE (Friedler et al., 1997; Ben-Yosef et al., 1999; Habermann et al., 2000; Verheyen et al., 2004; Giorgetti et al., 2005). Moreover, there are only limited data available analysing the efficacy of ICSI with frozen–thawed spermatozoa retrieved with TESA (Sereni et al., 2008). The aim of this study was to analyse the outcomes of ICSI using frozen–thawed testicular spermatozoa obtained by TESA. Materials and methods This retrospective study included 43 patients with NOA submitted to ICSI cycles with the use of frozen–thawed testicular spermatozoa retrieved with TESA. The study was performed in a private assisted reproduction centre between June 2009 and November 2011. The study was approved by our Institutional Review Board, and written © 2015 Blackwell Verlag GmbH Andrologia 2016, 48, 252–256
M. Roque et al.
informed consent was obtained from all the patients involved in the study. In all cases, azoospermia was confirmed with at least two semen analyses, and cryptozoospermia was excluded prior to the treatment using highspeed centrifugation. All patients had a previous analysis of serum testosterone, follicle-stimulating hormone (FSH), karyotype, Y chromosome microdeletion and physical examination performed. All female patients were submitted to a complete infertility evaluation, and only women who had serum FSH levels 35 and
