Higher pregnancy rates using testicular sperm in men with severe oligospermia

Capsule:
Use of testicular sperm for intracytoplasmic sperm injection (ICSI) is associated with a 50% pregnancy and live-birth rate for couples with 1 previous IVF–ICSI cycle failure with ejaculated sperm.

Authors:
Akanksha Mehta, M.D., Alexander Bolyakov, M.S., Peter N. Schlegel, M.D., Darius A. Paduch, M.D., Ph.D.

Volume 104, Issue 6, Pages 1382-1387

Abstract:

Objective:
To evaluate assisted reproductive technology (ART) outcomes using testicular sperm in oligospermic men who previously failed to achieve paternity using TUNEL-positive ejaculated sperm.

Design:
Retrospective cohort.

Setting:
Academic medical center.

Patient(s):
Twenty-four oligospermic men who failed one or more ART cycles using ejaculated sperm with TUNEL-positive proportion >7%, and subsequently underwent microsurgical testicular sperm extraction (TESE).

Intervention(s):
TESE followed by intracytoplasmic sperm injection (ICSI).

Main Outcome Measure(s):
TUNEL-positive level in ejaculated and testicular sperm; clinical pregnancy.

Result(s):
The mean TUNEL-positive level was 24.5% for ejaculated sperm, and 4.6% for testicular sperm. Clinical pregnancy was achieved in the first ART cycle with testicular sperm in 12 (50%) out of 24 couples. There was no statistically significant difference in maternal and paternal age, maternal gravity and parity, number of previous ART attempts, concentration or motility of retrieved sperm, number of oocytes retrieved, fertilization rate, or number of embryos transferred between couples who did and did not achieve pregnancy. No miscarriages occurred. All 12 pregnancies resulted in the delivery of healthy children.

Conclusion(s):
The percentage of TUNEL-positive cells is lower in testicular sperm for oligospermic men who have abnormal ejaculated sperm DNA fragmentation. The use of testicular sperm for ICSI was associated with a 50% pregnancy and live-birth rate for couples who had previously failed one or more IVF–ICSI cycles with ejaculated sperm. No other clinical predictors of successful pregnancies after the use of surgically retrieved sperm could be identified. In men with elevated TUNEL-positive ejaculated sperm and failed ART, TESE may be considered.

  • Jason M. Franasiak

    A interesting study on the use of TESE/ICSI in those with prior failed cycles and high sDFI. In the methods it states that males who had failed one or more IVF or ICSI cycles were included and then all underwent TESE/ICSI. What percentage of men had previously failed conventional insemination only before moving to TESE/ICSI? Is it possible that simply moving to ICSI with traditional specimen collection in the subset who had failed conventional insemination might have improved outcomes for these men?

  • This article provides additional evidence to the body of literature that improving DNA fragmentation can improve fertility outcomes. As to how to do that is another matter. Something happens in the epididymis after the sperm leaves the testicle that impacts the sperm DNA resulting in a higher DFI and thereby lower pregnancy success rates. For those with oligospermia and elevated DFI, MicroTESE obtained sperm should be strongly considered. As Dr. Hsieh alluded to, it would be interesting to see what the outcomes with cryopreserved sperm obtained at time of MicroTESE that was not used for the fresh ICSI cycle.

  • while the role sDFI for male infertility evaluation is unclear, this article adds to growing evidence that treatment can lead to improved fertility outcome. authors reported improved fresh cycle outcomes which I have also observed in my own practice. there is always a question on what to do with extra testicular sperm from the retrieval. do the authors have experience with frozen testicular sperm outcomes in the subsequent cycles in the 50% of the couples who didn’t achieve pregnancy during the fresh cycle?

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