Intracytoplasmic sperm injection outcome of ejaculated versus extracted testicular spermatozoa in cryptozoospermic men

Capsule:
Testicular sperm extraction is justified in patients with cryptozoospermia who fail to conceive by ICSI using ejaculated spermatozoa, as it offers a higher pregnancy rate.

Authors:
Ido Ben-Ami, M.D., Ph.D., Arieh Raziel, M.D., Deborah Strassburger, Ph.D., Daphna Komarovsky, B.Sc., Raphael Ron-El, M.D., Shevach Friedler, M.D.

Volume 99, Issue 7, Pages 1867-1871, June 2013

Abstract:

Objective:
To compare intracytoplasmic sperm injection (ICSI) outcome of patients with cryptozoospermia after use of ejaculated versus testicular sperm in different cycles of the same patients.

Design:
Retrospective cohort study.

Setting:
University-affiliated infertility center.

Patient(s):
A total of 17 patients with cryptozoospermia who underwent a total of 116 ICSI cycles.

Intervention(s):
The patients initially underwent several ICSI cycles using ejaculated sperm (n = 68, 58.6%) that were followed by ICSI cycles using testicular sperm (n = 48, 41.4%).

Main Outcome Measure(s):
Fertilization rate, pregnancy rate (PR).

Result(s):
There were no significant differences in fertilization rates between the two subgroups. A comparison between testicular sperm extraction (TESE) versus ejaculated sperm cycles revealed significantly higher implantation rate (20.7% vs. 5.7%), higher PR (42.5% vs. 15.1%), and higher take home baby rate (27.5% vs. 9.4%). A multivariable logistic regression analysis showed three significant predictors for pregnancy, namely the use of testicular sperm (odds ratio [OR] 5.1, 95% confidence interval [95% CI] 1.8–14.8), use of motile sperm (OR 12.9, 95% CI 2.1–79.1), and female age (OR 0.83, 95% CI 0.7–0.9).

Conclusion(s):
Testicular sperm extraction is justified in patients with cryptozoospermia who fail to conceive by ICSI using ejaculated spermatozoa, as it offers higher PR.

  • Michael Eisenberg

    Good data to answer an interesting question. I wonder how often the authors were unable to identify sperm on TESE in these cryptozoospermic men.

  • jim hotaling

    This work is well done and methodologically sound. I wonder if the authors could comment on how use of ICSI, which relies on only one sperm, may bias results. Specifically, since men typically have a population of sperm from a semen sample or TESE procedure, could it be that it was easier for the technician to obtain a more viable sperm from the testicular sample versus the ejaculated one? This is the problem that plagues much of the work in this area and I would be curious to hear the authors thoughts on this issue.

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