Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration intracytoplasmic sperm injection in cases of congenital bilateral absence of the vas deferens

Capsule:
In cases of congenital bilateral absence of the vas deferens, advanced paternal age has a negative effect on retrieved-sperm parameters.

Authors:
Samir Elhanbly, M.D., Moustafa A. El-Saied, M.D., Mohamed Fawzy, M.D., Abdelaziz El-Refaeey, M.D., Taymour Mostafa, M.D.

Volume 104, Issue 3, Pages 602-606

Abstract:

Objective:
To assess the relationship between paternal age and the outcome of percutaneous epididymal sperm aspiration–intracytoplasmic sperm injection (ICSI) in patients with congenital bilateral absence of the vas deferens (CBAVD).

Design:
Prospective cohort study.

Setting:
In vitro fertilization centers.

Patient(s):
Eighty-five (male) CBAVD patients who underwent percutaneous epididymal sperm aspiration with ICSI were divided into 3 age groups; <30 years (n = 27); aged 30–40 years (n = 32); and aged >40 years (n = 26).

Intervention(s):
History taking, clinical examination, semen analysis, percutaneous epididymal sperm aspiration with subsequent ICSI.

Main Outcome Measure(s):
Sperm retrieval, clinical pregnancy, and “take-home baby.”

Result(s):
The number of sperm retrieved by percutaneous epididymal sperm aspiration significantly decreased with advancing age in the studied groups (0.63, 0.31, and 0.18 million, respectively), concomitant with significant decreases in the outcomes of clinical pregnancy (55.5%, 43.7%, and 23.1%, respectively) and “take-home baby” (48.1%, 40.6%, and 11.5%, respectively). Male age was significantly negatively correlated with retrieved sperm count, sperm motility, sperm vitality, and normal sperm morphology. Multiple logistic regression, adjusted for confounding factors, with male age, and sperm count obtained using percutaneous epididymal sperm aspiration, was significant. The receiver operating characteristic curve showed that a sperm count of 0.55 million as a cutoff value could predict clinical pregnancy with an accuracy of 77.4%, with 82.9% sensitivity and 62% specificity, and “take-home baby” with an accuracy of 81.7%, with 93.1% sensitivity and 62.5% specificity.

Conclusion(s):
In cases of CBAVD, male age has a negative effect on retrieved-sperm count, motility, vitality, and normal sperm morphology; number of retrieved sperm predicted both clinical pregnancy and “take-home baby” outcomes in subsequent ICSI.

  • Interesting discussion. I’ve found that the success of PESA in men with CBAVD is also partially dependent upon how accessible the epididymis actually is. In some cases it is flat and PESA becomes quite difficult. Also, in my experience, a lot of couples typically prefer knowing that they have sperm cryopreserved ahead of time prior to moving onto IVF. This makes MESA preferable in most cases.

    • Taymour Mostafa

      Thanks for this remark. Actually, the epididymis in cases of CBAVD is full where PESA could be carried out. However, MESA could be carried out if it is flat.

  • msamplaski

    This study provides valuable information for men
    with CBAVD. Since increasing age has also been associated with increasing DNA
    fragmentation levels, it would be interesting to know if TESE in some of the
    older men would improve these outcomes.

    • Taymour Mostafa

      Actually, it is a good point to investigate raised from a clever researcher.

  • Interesting study. Not too many studies that have this many CBAVD subjects, which makes this group difficult to study. Nevertheless, enough patients to split them into 3 fairly equally sized cohorts to run logistic regression models on multiple factors. Take home message: older male = longer obstructive interval = less sperm retrieved with PESA = lower pregnancy and take home baby rate.

    One has to wonder if more sperm was retrieved from the epididymis microscopically instead of via PESA or directly from the testicle if pregnancy rates would be higher. Not sure if the study authors did subsequent sperm retrieval with a different technique and then the couple went through another ICSI cycle.

    I am also surprised that maternal age did not have as large of an impact on pregnancy or take home baby rates when there was almost a 10 year age difference between maternal ages in the 40 group.

    • Taymour Mostafa

      Thank you a lot for these constructive comments from a clever researcher. The question is, If MESA was used as the preferred sperm-retrieval technique in these individuals, can it be hypothesized that the obtained sperm count may also be influenced by age?. This consideration was raised into the limitations of the study. Nevertheless, I think that investigating this point in a multi-center study will elucidate this point.

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