The impact of surgical sperm retrieval on the in vitro fertilization outcomes of infertile patients with a temporary ejaculation failure on their oocyte retrieval day

Capsule:
For patients with temporary ejaculation failure, surgical sperm retrieval compromised the outcomes of fresh embryo transfers, whereas it did not affect the outcomes of thawed embryo transfers.

Authors:
Li Junsheng, M.S., Bai Quan, M.D., Lian Ying, M.S., Zheng Xiaoying, Ph.D., Li Ming, M.S., Zhao Ping, Ph.D., Liu Ping M.D., Qiao Jie, M.D.

Volume 99, Issue 2, Pages 362-366, February 2013

Abstract:

Objective:
To evaluate the impact of testicular sperm aspiration on the clinical outcomes of the in vitro fertilization (IVF) patients with temporary ejaculation failure (TEF) on the day of oocyte retrieval.

Design:
A case-control study.

Setting:
University-affiliated IVF center.

Patient(s):
One hundred and eight infertile couples encountering TEF on the day of oocyte retrieval.

Intervention(s):
Testicular sperm aspiration and intracytoplasmic sperm injection (TESA-ICSI) were employed to help the TEF couples to complete their IVF treatments. A group of obstructive azoospermia (OA) patients was chosen as a control group to evaluate the efficiency and safety of this intervention.

Main outcome measure(s):
Fertilization rates, transferable embryo rates and clinical pregnancy rates.

Result(s):
Through the TESA-ICSI, TEF couples achieved a 38.83% (40/103) clinical pregnancy rate (PR) per IVF cycle. Compared with the OA group, the TEF group showed a comparable fertilization rate (66.43% vs. 65.25%), transferable embryo rate (60.76% vs. 60.85%) and PR (51.61% vs. 50.00%) in thawed embryo transfer cycles but a relatively low PR (25.49% vs. 44.64%) in fresh embryo transfer cycles.

Conclusion(s):
TESA-ICSI is a relatively efficient and safe way to help the patients encountering temporary ejaculation failure.

  • One important finding worth pointing out. The similar outcomes for frozen cycles but not fresh cycles is very interesting. The authors hypothesis that the stress of an urgent TESA causes for the whole couple seems plausible.

  • The authors are to be commended for their important study. The one comment I have would be the appropriateness of the control group – namely obstructive azoospermic men. While both groups underwent surgical sperm retrieval, the obstructed men should have normal spermatogenesis. In contrast, the unable to ejaculate group contained many men with impaired spermatogenesis which may impact IVF outcomes. As the authors point out in the discussion, stress may explain the lower pregnancy rate but it may also be due to the infertility itself.

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