Overweight men with nonobstructive azoospermia have worse pregnancy outcomes after microdissection testicular sperm extraction

Capsule:
Overweight men have lower clinical pregnancy rate after microdissection testicular sperm extraction and intracytoplasmic sperm injection compared with men with normal weight. Men with body mass index >43 kg/m2 did not contribute to any pregnancies despite successful sperm retrieval.

Authors:
Ranjith Ramasamy, M.D., Campbell Bryson, B.A., Jennifer E. Reifsnyder, M.D., Queenie Neri, M.S., Gianpiero D. Palermo, M.D., Peter N. Schlegel, M.D.

Volume 99, Issue 2, Pages 372-376, February 2013

Abstract:

Objective:
To evaluate the effect of obesity on the outcome of testicular sperm extraction (TESE) and assisted reproductive technology.

Design:
Clinical retrospective study.

Setting:
Center for reproductive medicine at a tertiary university hospital.

Patient(s):
Nine hundred and seventy patients with non-obstructive azoospermia.

Intervention(s):
Microdissection testicular sperm extraction (TESE), followed by intracytoplasmic sperm injection (ICSI).

Main outcome measure(s):
Sperm retrieval rate and clinical pregnancy rate.

Results:
Testicular sperm were successfully retrieved in 55% of men overall. Of those with sperm found, clinical pregnancy rate was 51% and live birth rate was 40%. Sperm retrieval rates were similar in men with Body Mass Index < 25, 25-30, and > 30 (59%, 57%, and 54% respectively). Mean BMI of men who contributed to pregnancy (27.3 + 4.9 kg/m2) was lower (p=0.04) than for men whose sperm did not contribute to a pregnancy (28.2 + 5.4 kg/m2). No man with BMI > 43 (n=11) contributed to a successful pregnancy, even though sperm were found in men with BMI upto 57 kg/m2. On multivariable logistic regression analysis male BMI was the only predictor of successful pregnancy among the variables analyzed, including male age, female age and female BMI.

Conclusions:
Overweight men have lower clinical pregnancy rate after micro-TESE and ICSI compared to men with normal BMI. Men with BMI > 43 did not contribute to any pregnancies, despite successful sperm retrieval.

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