370 BILATERAL DIFFERENTIAL TESTICULAR BIOPSIES IMPROVE TESE AND ICSI OUTCOMES IN NON-OBSTRUCTIVE AND OBSTRUCTIVE AZOOSPERMIC INFERTILE PATIENTS

2007 ◽  
Vol 19 (1) ◽  
pp. 300
Author(s):  
S. M. Al-Ansari ◽  
M. T. Ridha-Albarzanchi ◽  
Z. A. Kanan ◽  
A. A. Al-Badri ◽  
S. K. Al-Atraqchi
Keyword(s):  
Embryo Transfer ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Seminiferous Tubules ◽  
Testicular Sperm Extraction ◽  
Sperm Retrieval ◽  
Cleavage Rate ◽  
Male Patients ◽  
Testicular Size ◽  
Icsi Outcomes

The goal of the present study was to evaluate the clinical significance of bilateral differential testicular biopsies (BDTB) to improve testicular sperm extraction (TESE) and ICSI outcomes in non-obstructive azoospermic (NOA) men. The male patients were divided into an obstructive azoospermic group (OAG, n = 40) and an NOA group (n = 50). The women in both groups had normal ovulatory cycles and reproductive hormone concentrations. BDTB were taken from upper, middle, and lower zones of the testes. At least 50 transverse histologic sections of seminiferous tubules were examined in each biopsy. The FSH, LH, and prolactin concentrations were significantly higher in the NOA group compared to the OAG (18.3 vs. 6.2 mIU mL-1, 8.5 vs. 4.1 mIU mL-1, and 9.6 vs. 6.4 ng mL-1, respectively; P < 0.01), whereas the testosterone level and testicular size were significantly lower in the NOA group vs. the OAG (3.7 vs. 5.3 ng mL-1 and 3.3 vs. 4.4 cm, respectively; P < 0.01). A new method (BDTB) for scoring testicular biopsies was used. This method is different from Johnson's method as SCO or TF or complete MA. Following positive BDTB results, TESE and ICSI were performed. The oocyte recovery rate/patient was 3.8% (154/40) and 3.6% (178/50) in the OAG and the NOA group, respectively (P > 0.05). The TESE-ICSI rates were 75.9% (117/154) in the OAG and 59.5% (106/178) in the NOA group (P < 0.005). The embryo cleavage rate was significantly higher in the OAG compared to the NOA group (98/117 = 83.8% vs. 66/106 = 62.3%, respectively; P < 0.005). The number of embryos transferred/patient in the OAG was significantly higher compared to that in the NOA group (2.5 vs. 1.3, respectively; P < 0.01). The embryo implantation rate per embryo transfer in the OAG was 52% (51/98) vs. 45.5% (30/66); P > 0.05. The clinical pregnancy rate per embryo transfer was 52.5% in the OAG and 40% in the NOA group (P > 0.05). It was concluded from the results of this study that both the BDTB and TESE were useful diagnostic and prognostic predictors of successful sperm retrieval for ICSI treatment in the non-obstructive and obstructive azoospermic male patients. The clinical embryo implantation rates were not significantly different between both groups (NOA group and OAG) which may indicate that the embryos of both groups have similar implantation potentials. Bilateral differential testicular biopsies were found to be positively correlated with the TESE and ICSI outcomes.

scholarly journals Intraoperative assessment of tubules in predicting microdissection testicular sperm extraction outcome in men with Sertoli cell-only syndrome

2018 ◽  
Vol 47 (2) ◽  
pp. 722-729 ◽  
Author(s):  
Yang Yu ◽  
Qi Xi ◽  
Ruixue Wang ◽  
Hongguo Zhang ◽  
Leilei Li ◽  
...  
Keyword(s):  
Sertoli Cell ◽  
Follicle Stimulating Hormone ◽  
Seminiferous Tubules ◽  
Testicular Sperm Extraction ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Intraoperative Assessment ◽  
Retrieval Rate ◽  
Surgical Suture ◽  
Tubule Diameter

Objective This study aimed to assess the value of measuring the tubule diameter during microdissection testicular sperm extraction (micro-TESE) in predicting outcomes in patients with Sertoli cell-only syndrome (SCOS). Methods Fifty-six consecutive patients with SCOS were included. Patients were classified into two groups on the basis of the diameter of seminiferous tubules measured against 5/0 surgical suture (≥100 µm or <100 µm). Results The sperm retrieval rate (SRR) in men with a tubule diameter ≥100 µm was significantly lower than that in those with <100 µm (3.1% vs. 25.0%). The SRR from the contralateral testis in men with a tubule diameter ≥100 µm was lower than that in those with <100 µm (0% vs. 14.3%). Men with a tubule diameter ≥100 µm had a significantly larger testis and lower follicle-stimulating hormone levels than did men with <100 µm (8.1 ± 2.4 vs. 5.3±1.8 mL, 19.9 ± 9.7 vs. 25.9 ± 7.1 mIU/mL, respectively). Conclusions The diameter of tubules is a useful predictor for a successful SRR in men with SCOS. Intraoperative assessment of homogeneous large tubules allows some men to perform a limited (superficial) contralateral micro-TESE after no spermatozoa are initially identified.

scholarly journals Efficiency Comparison Between Dry And Humid Cultures For Clinical Outcome of The In Vitro Fertilization-Embryo Transfer

2021 ◽  
Author(s):  
Weihai Xu ◽  
Lin Zhang ◽  
Ling Zhang ◽  
Shishi Li ◽  
Jing Shu
Keyword(s):  
In Vitro Fertilization ◽  
Embryo Transfer ◽  
Implantation Rate ◽  
Fertilization Rate ◽  
Cleavage Rate ◽  
High Quality ◽  
Vitro Fertilization ◽  
Efficiency Comparison ◽  
Ivf Et

Abstract Background: In this study, we compared the in vitro embryo development, embryo transfer outcome and the offspring outcome in the in vitro fertilization-embryo transfer (IVF-ET) between dry culture (DC) and humid culture (HC). Methods: Our study was divided into two parts. Firstly, we determined the fertilization rate, cleavage rate and high-quality embryo rate from 21 cycles in the DC group (N=262 oocytes) and HC group (N=263 oocytes). Secondly, we determined the embryo transfer outcome and the offspring outcome in DC group (N=184 cycles) and HC group (N=136 cycles). Results: Compared with the HC group, significant increase was observed in the high-quality embryo rate (66.1.2% vs. 55.3%, p=0.037) and implantation rate (49.8% vs. 40.6%, p=0.027) in the DC group. No statistical differences were observed in the pregnant outcome and birth defect of the offspring (p>0.05). Compared with HC, DC was associated with a higher high-quality embryo rate and a higher implantation rate after embryo transfer. Conclusions: No statistical differences were noticed in the offspring conditions between the two culture modes. Taken together, DC may serve as a promising method for IVF-ET.

P–002 Prediction model for salvage microdissection testicular sperm extraction in patients with failed conventional testicular sperm extraction

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Caroppo ◽  
F Castiglioni ◽  
C Campagna ◽  
E M Colpi ◽  
E Piatti ◽  
...  
Keyword(s):  
Prediction Model ◽  
Internal Validity ◽  
Prediction Equation ◽  
Seminiferous Tubules ◽  
Testicular Sperm Extraction ◽  
High Magnification ◽  
Testicular Sperm ◽  
Sperm Retrieval ◽  
Discrimination Ability ◽  
The Individual

Abstract Study question Is there any intra-surgical parameter able to predict the outcome of salvage microdissection testicular sperm extraction (mTESE) in patients with previous failed TESE? Summary answer Among all the variables under consideration, only the seminiferous tubules (ST) caliber pattern found at high magnification was able to significantly predict the mTESE outcome... What is known already Several studies have demonstrated that no clinical or hormonal parameters are able to predict the outcome of a salvage mTESE performed in patients with previous sperm retrieval failure (SRF). It has been previously demonstrated that a prediction model with the combination of two intra-surgical parameters such as the STs caliber, defined as dilated tubule (DT), slightly dilated tubules (SDT) and not dilated tubules (NDT), and testis histology had an excellent discrimination ability (AUC 0.93) to distinguish between cases with and without the outcome, but such prediction model has not been tested in patients undergoing salvage mTESE. Study design, size, duration A prediction model was built on a dataset of 63 patients, 29–50 years old, undergoing unilateral (15 ) or bilateral (48) salvage mTESE after failed TESE from 2015 through 2019, with a resulting N = 111 testes under consideration. Two models were compared, one with STs and histology as covariates, the other with STs alone: the second model was chosen due to better discrimination... Participants/materials, setting, methods we assessed internal validity with a bootstrapping procedure for a realistic estimate of the performance of the prediction model in similar future patients with NOA undergoing salvage mTESE. We repeated the entire modeling process in 259 samples drawn with replacement from the original sample, and determined the performances (AUC, sensitivity, specificity) of the selected prediction model. Calibration (correspondence between the predicted and observed probabilities) was visually assessed by inspecting the calibration belt... Main results and the role of chance Sperm retrieval was successful in 24 out of 63 patients (38%): age, testis volume and hormonal parameters did not vary among patients with successful sperm retrieval (SSR) or SRF. The prevalent histological pattern was Sertoli cell only syndrome (69.6%), while hypospermatogenesis, maturation arrest and hyalinosis were found in 4.5%, 23% and 1.8% of cases. The STs pattern was heterogeneous, with DTs being found only in 23.4% of testes. Sperm were found in 69% of DTs, 29% of SDTs, and 5% of NDTs. The prediction model correctly classified 82.88% of patients and explained the 26.5% variability of the outcome. The STs pattern significantly predicted the mTESE outcome with a sensitivity of 62% and a specificity of 90.2%, PPV 69.2%, NPV 87%. Both SDT (OR 0.105, 95% CI 0.034–0.317, p &lt; 0.0001) and NDT (OR 0.024, 95% CI 0.004–0.128, p &lt; 0.0001) were negatively associated with the chance of retrieving sperm, the resulting prediction equation being Log (SSR)= 0.81 – 2.2 SDT – 3.7 NDT. The model had a clearly useful discrimination (AUC 0.813). The optimism corrected AUC was 0.7977, and the model was well calibrated (p = 1.00) with both the 80% and 95% calibration belts encompassing the bisector over the whole range of the predicted probabilities Limitations, reasons for caution The STs caliber pattern was subjectively evaluated at high magnification (24–36x) by comparing the individual ST appearance with the surrounding ones, however such evaluation was performed by the same experienced urologist with more than 1000 mTESE procedures performed to date. Wider implications of the findings: No clinical data but the STs appearance at high magnification could discriminate between patients with and without chances of SSR. These results reinforce the evidence supporting the superiority of mTESE compared to conventional TESE in retrieving sperm, particularly in lower prognosis patients with NOA such as those with previous SR. Trial registration number Not applicable

scholarly journals Granulocyte Colony-Stimulating Factor Combined With Transcutaneous Electrical Acupoint Stimulation in Treatment of Unresponsive Thin Endometrium in Frozen Embryo Transfer Cycles

2021 ◽  
Vol 3 ◽  
Author(s):  
Linjiang Song ◽  
Qinxiu Zhang ◽  
Shaomi Zhu ◽  
Xudong Shan
Keyword(s):  
Embryo Transfer ◽  
Endometrial Thickness ◽  
Embryo Implantation ◽  
Implantation Rate ◽  
Granulocyte Colony Stimulating Factor ◽  
Thin Endometrium ◽  
Treatment Groups ◽  
Stimulating Factor ◽  
Embryo Implantation Rate ◽  
Acupoint Stimulation

Objective: This trial was designed to assess the treatment effects of granulocyte colony-stimulating factor (G-CSF) and transcutaneous electrical acupoint stimulation (TEAS) on thin endometrium in frozen-thawed embryo transfer (FET) cycles.Methods: Ninety-nine patients with previous cancellations of embryo transfer were included, 56 of whom were prospectively treated with intrauterine perfusion of G-CSF in subsequent FET cycles. The selected patients were randomized into the G-CSF perfusion only group and the G-CSF perfusion combined with TEAS group. The other 43 patients were retrospectively included as controls.Results: Compared to previous cycles, endometrial thickness was statistically significantly increased in the two treatment groups (5.97 ± 0.60, 7.52 ± 0.56, 6.14 ± 0.52, and 7.66 ± 0.44; P = 0.00 and 0.00, respectively). The increases in endometrial thickness suggested that no statistically significant difference was found between the two treatment groups. The G-CSF with TEAS group suggested a higher embryo implantation rate than the G-CSF perfusion only and control groups (33.33 and 29.1% and 33.33 and 17.39%; P = 0.412 and 0.091, respectively). The G-CSF combined with TEAS group demonstrated nominally higher clinical and ongoing pregnancy rates than the G-CSF perfusion-only group and controls, though, the difference was not statistically significant.Conclusion: G-CSF has a potential role in improving endometrium thickness in patients with thin unresponsive endometrium in FET treatment cycles. In addition, when combined with TEAS, G-CSF perfusion treatment also improves the embryo implantation rate; however, randomized controlled trials are highly demanded to provide high-grade evidence regarding clinical pregnancy rate after G-CSF perfusion treatment.

scholarly journals Prognostic Factors for Successful Microdissection Testicular Sperm Extraction (Micro-TESE)

2021 ◽  
pp. 30-35
Author(s):  
Mohamed Hamdy Mashaly ◽  
Tarek Ahmed Gamil ◽  
Maged Moustafa Ragab ◽  
Mohamed Abo El-Enen Ghalwash
Keyword(s):  
Semen Analysis ◽  
Testicular Volume ◽  
Seminiferous Tubules ◽  
Testicular Sperm Extraction ◽  
Obstructive Azoospermia ◽  
Testicular Sperm ◽  
University Hospitals ◽  
Sperm Retrieval ◽  
Significant Difference ◽  
Detailed Medical History

Background: There are some men suffer from infertility, non-obstructive azoospermia is one of the causes of infertility, these men need sperm retrieval from testes like microdissection testicular sperm extraction (Micro-TESE). This work aims to assess the different preoperative and intraoperative factors that predict successful sperm retrieval with Microdissection Testicular Sperm Extraction (Micro-TESE) in men with non-obstructive azoospermia. Methods: Our study is a cohort prospective one, conducted on 52 male patients with non-obstructive azoospermia who attended to the outpatient andrology and infertility clinic of Urology Department, Tanta University Hospitals during the period between December2018 to November2019. All patients were subjected to detailed medical history, physical examination, two semen analysis on two different laboratories. Microdissection Testicular Sperm Extraction is performed to all patients after Estimation of serum FSH, LH, testosterone, prolactin, estradiol and scrotal Doppler ultrasonography Results: From 52 patients who have done, Patients were divided in to 2 groups according to the result of Micro-TESE procedure: negative SSR group (28 patients) and positive SSR group (24 patients).In comparison between the two groups according to preoperative factors as age, FSH, LH, estradiol, testosterone, prolactin and testicular volume, there was no significant difference between these groups. On comparison of intraoperative size of seminiferous tubules in relation to results of Micro-TESE, we found that presence of large convoluted seminiferous tubules was statistically significant in prediction of successful sperm retrieval with Micro-TESE Conclusions: The chances of sperm retrieval in men with NOA by Micro-TESE are not related to preoperatively age, FSH, LH, testosterone, estradiol, prolactin and testicular volume. The detection of large seminiferous tubules intraoperatively is a good predictor for successful sperm retrieval with Micro-TESE as it was statistically significant.

186 COMPARISON OF IVF AND ICSI TREATMENTS ON THE FERTILIZATION, EMBRYO CLEAVAGE, EMBRYO TRANSFER, PREGNANCY, AND EMBRYO IMPLANTATION RATES IN IMMUNOLOGICALLY INFERTILE PATIENTS

2006 ◽  
Vol 18 (2) ◽  
pp. 201
Author(s):  
S. Al-Anssari ◽  
M. Ridha-Barzanchi ◽  
N. Hawa ◽  
S. Mahmood ◽  
S. Khunda
Keyword(s):  
Embryo Transfer ◽  
Group Treatment ◽  
Embryo Implantation ◽  
Reproductive Hormones ◽  
Human Menopausal Gonadotropin ◽  
Female Patients ◽  
Male Patients ◽  
Implantation Rates ◽  
Embryo Cleavage

The objective of the present work was to study the response to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) techniques in regard to fertilization, embryo cleavage, embryo transfer (ET), pregnancy, and embryo implantation rates using semen from immunologically infertile men. Ninety-four men with antisperm antibodies (ASA) detected in their semen and serum by slide agglutination and tray microagglutination tests were involved in IVF (IVF group) or ICSI (ICSI group) treatment. All male patients underwent sperm penetration assay (SPA) using zona-free hamster oocytes. Men with positive SPA were admitted to the IVF protocol (n = 46) and men with negative SPA were involved in the ICSI protocol (n = 48). The female patients had normal ovulatory cycles and normal reproductive hormone concentrations (FSH, LH, prolactin, estradiol and progesterone). They received human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG) for the induction of ovulation. Follicular growth was monitored by serial vaginal sonography and measurement of estradiol concentrations. Sperm viability was assayed by a hypo-osmotic swelling test (HOST) prior to oocyte insemination. Student t-test and Chi-Square test were used for statistical analysis of the data. The clinical data of the female patients (including age, body mass index (kg/m2), infertility duration, total number of hMG ampoules, estradiol concentration on cycle Day 3 and at day of hCG injection, and endometerial thickness) in the IVF and ICSI groups were not significantly different between the groups (P > 0.05). The oocyte recovery rate per patient was 6.34 (292/46) in the IVF group and 6.87 (330/48) in the ICSI group. The fertilization and embryo cleavage rates were similar (P > 0.05) in the IVF and ICSI groups (61.86% (133/215) vs. 56.50% (139/246) and 78.95% (105/133) vs. 72.66% (101/139), respectively). The percentage of embryos of transferable quality (ET rate) and the number of transferred embryos per patient were significantly higher (P < 0.05) in the IVF group compared to the ICSI group (73.33% (77/105) vs. 58.42% (59/101) and 1.67 vs. 1.22, respectively). The pregnancy rate per patient and embryo implantation rate were similar (P > 0.05) in both IVF and ICSI groups (28.26% vs. 25% and 21.74% vs. 18.75%, respectively). It was concluded from the results of the present study that the higher ET rate and the number of the transferred embryos per patient in the IVF group may be due to the superior quality of IVF sperm compared to ICSI sperm. Both IVF and ICSI embryos showed no significant differences in their pregnancy and embryo implantation rates; this may indicate that both types of embryos are viable and have similar pregnancy and embryo implantation potentials following ET, provided that the female patients have normal ovulatory cycles and normal concentrations of reproductive hormones. SPA and HOST were found to be useful tests for the selection of spermatozoa in ASA positive male patients for involvement in IVF or ICSI procedures.

P–085 Sperm retrieval after microdissection testicular sperm extraction (micro-TESE) and pregnancy outcomes of intracytoplasmic sperm injection (ICSI) in men with Klinefelter syndrome

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
V H Dinh ◽  
T H H Nguye ◽  
B H. Nguye ◽  
A T. Nguye ◽  
K C. Trin ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Klinefelter Syndrome ◽  
Testicular Tissue ◽  
Testicular Sperm Extraction ◽  
Ongoing Pregnancy ◽  
Sperm Retrieval ◽  
Ongoing Pregnancy Rate ◽  
Live Births ◽  
Retrieval Rate ◽  
Icsi Outcomes

Abstract Study question What are the sperm retrieval rate and ICSI outcomes in azoospermic men with Klinefelter syndrome (KS)? Summary answer In men with KS, a sperm retrieval rate of 51.3% after the first attempt micro-TESE, and 4 live births after ICSI were observed. What is known already: Klinefelter syndrome (KS) is encountered in 10% of men with azoospermia. Micro-TESE is presently used to treat infertility for KS patients with nonobstructive azoospermia. The retrieved sperms can be used for ICSI. Study design, size, duration: From June 2019 to July 2020, 39 azoospermic patients with KS were examined for the presence of testicular spermatozoa. Participants/materials, setting, methods: Participants were recruited from couples attending the Andrology and Fertility Hospital of Hanoi Vietnam, for infertility treatment. Micro-TESE was performed to extract testicular tissue. After retrieval, ICSI was used with fresh sperm. Main results and the role of chance: The sperm retrieval rate of first attempt micro-TESE in KS men was 51.3% (20/39). Logistic regression analysis showed patient age did not affect the sperm retrieval rate of micro-TESE (OR 0.99, 95% CI 0.88 - 1.11). Similarly, no association was observed between serum FSH, LH, testosterone level, and testicular volume with the success of sperm retrieval. The fertilization rate after ISCI in patients with retrieved sperm was 60% (12/20). Clinical pregnancy and ongoing pregnancy rates were 50% (10/20) and 40% (8/20). There were 4 live births. No sufficient data were available to test the effect of clinical or biological parameters on ICSI outcomes. Limitations, reasons for caution Our data rely on a cohort of KS patients attending a single fertility clinic. The sample size did not allow regression analysis for any ICSI outcome. Wider implications of the findings: Micro-TESE is helpful in retrieving sperm in azoospermia KS patients with sperm retrieval rate reaching 50%. ICSI following micro-TESE can lead to an ongoing pregnancy rate of 40% with some result in live births. The outcome of micro-TESE is independent of any clinical or biochemical parameters tested. Trial registration number Not applicable

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