Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia A meta analysis

Capsule:
Among cryptozoospermic men, use of testicular sperm for intracytoplasmic sperm injection offers no advantages in fertilization or pregnancy rates when compared with ejaculated sperm.

Authors:
Nikita Abhyankar, M.B.ChB., Martin Kathrins, M.D., Craig Niederberger, M.D.

Volume 105, Issue 6, Pages 1469-1475

Abstract:

Objective:
To examine outcomes of intracytoplasmic sperm injection (ICSI) using testicular versus ejaculated sperm among men with cryptozoospermia.

Design:
Meta-analysis.

Setting:
Not applicable.

Patient(s):
Men with cryptozoospermia undergoing consecutive ICSI cycles using ejaculated or testicular sperm.

Intervention(s):
A systematic search was performed using PubMed (inception to August 2015). Inclusion criteria were studies comparing ICSI outcomes among men with cryptozoospermia using ejaculated and testicular sperm.

Main Outcome Measure(s):
Primary outcomes included ICSI fertilization or pregnancy rates (PRs). Secondary analysis included number of retrieved oocytes, maternal and paternal ages. Meta-analysis of weighted data using a random effects model was performed. Results are reported as relative risk or weighted mean differences (WMD) with 95% confidence intervals (CI).

Result(s):
Five cohort studies were included, encompassing 272 ICSI cycles and 4,596 injected oocytes. There were no differences in ICSI PRs (relative risk [RR] 0.53, 95% CI 0.19–1.42, I2 = 67%) or fertilization rates (RR 0.91, 95% CI 0.78–1.06, I2 = 73%) between testicular and ejaculated sperm groups. There was a significant trend toward increasing maternal age (WMD 1.69 years, 95% CI −2.71 to −0.66) and paternal age (WMD 2.61 years, 95% CI −4.73 to −0.48) with testicular sperm. There was no difference between numbers of oocytes retrieved (WMD 0.95, 95% CI −0.15 to 2.05). Post-hoc power analysis revealed pβ <20% for PR analysis and pβ <10% for fertilization rate analysis. Conclusion(s):
The existing literature does not support a recommendation for men with cryptozoospermia to use testicular sperm in preference over ejaculated sperm for ICSI.

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