In-vitro culture of spermatozoa induces motility and increases implantation and pregnancy rates after testicular sperm extraction and intracytoplasmic sperm injection

For men with uncorrectable obstructive azoospermia, their only hope of fathering a child is microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilization (IVF). In 1988, proximal epididymal sperm were demonstrated to have better motility than senescent sperm in the distal epididymis, and it was thought that retrieval of motile sperm from the proximal epididymis would yield reliable fertilization and pregnancy rates after conventional IVF. However, the results to date have been poor, and although a minority of patients achieved good fertilization rates with IVF, the vast majority (81%) had consistently poor or no fertilization and the pregnancy rate averaged only 9%. Recently, intracytoplasmic sperm injection (ICSI) has been successfully used to achieve fertilization and pregnancies for patients with extreme oligoasthenozoospermia. ICSI has therefore been applied to cases of obstructive azoospermia and, in this report, 67 MESA-IVF cases are compared with 72 MESA-ICSI cases. The principle that motile sperm from the proximal segments of the epididymis should be used for ICSI was followed, although in the most severe cases in which there was an absence of the epididymis (or absence of sperm in the epididymis), testicular sperm were obtained from macerated testicular biopsies. These sperm only exhibited a weak, twitching motion. In 72 consecutive MESA cases, ICSI resulted in fertilization and normal embryos for transfer in 90% of the cases, with an overall fertilization rate of 46%, a cleavage rate of 68%, and ongoing or delivered pregnancy rates of 46% per transfer and 42% per cycle. The pregnancy and take-home baby rates increased from 9% and 4.5% with IVF to 53% and 42% with ICSI. There were no differences between the results for fresh epididymal, frozen epididymal or testicular sperm, and the number of eggs collected did not affect the outcome. The results were also unaffected by the aetiology of the obstruction such as congenital absence of the vas deferens or failed vasoepididymostomy. The only significant factor which affected the pregnancy rate was female age. It is concluded that although complex mechanisms involving epididymal transport may be beneficial for conventional fertilization of human oocytes (in vivo or in vitro), none of these mechanisms are required for fertilization after ICSI. Given the excellent results with epididymal and testicular sperm, ICSI is obligatory for all future MESA patients. Finally, the use of ICSI with testicular sperm from men with non-obstructive azoospermia is also discussed.

Download Full-text

Use of Testicular Sperm/Intracytoplasmic Sperm Injection Yields High Pregnancy Rates in Couples who Failed Multiple In Vitro Fertilization Cycles Owing to High Levels of Sperm DNA Fragmentation

Fertility and Sterility ◽

10.1016/j.fertnstert.2010.01.115 ◽

2010 ◽

Vol 93 (5) ◽

pp. S21-S22 ◽

Cited By ~ 2

Author(s):

P. Werthman ◽

R. Boostanfar ◽

W. Chang ◽

K. Chung ◽

H. Danzer ◽

...

Keyword(s):

In Vitro Fertilization ◽

Dna Fragmentation ◽

Intracytoplasmic Sperm Injection ◽

Pregnancy Rates ◽

Sperm Dna Fragmentation ◽

Testicular Sperm ◽

Vitro Fertilization ◽

Sperm Dna

Download Full-text

Greater implantation and pregnancy rates with vaginal progesterone in intracytoplasmic sperm injection but not in in vitro fertilization cycles: a retrospective study

Fertility and Sterility ◽

10.1016/j.fertnstert.2004.11.054 ◽

2005 ◽

Vol 83 (5) ◽

pp. 1391-1396 ◽

Cited By ~ 5

Author(s):

M MANNO ◽

E MARCHESAN ◽

D CICUTTO ◽

D ZADRO ◽

C FAVRETTI ◽

...

Keyword(s):

Retrospective Study ◽

In Vitro Fertilization ◽

Intracytoplasmic Sperm Injection ◽

Pregnancy Rates ◽

Vitro Fertilization ◽

Vaginal Progesterone ◽

Implantation And Pregnancy Rates

Download Full-text

Successful pregnancy in double factor infertility: Sperm in vitro culture by modified testicular fine-needle aspiration

Urologia Journal ◽

10.1177/0391560319840203 ◽

2019 ◽

Vol 86 (3) ◽

pp. 141-144

Author(s):

Gianmartin Cito ◽

Maria Elisabetta Coccia ◽

Francesco Bertocci ◽

Rita Picone ◽

Andrea Cocci ◽

...

Keyword(s):

In Vitro Culture ◽

Sperm Motility ◽

Fine Needle Aspiration ◽

Intracytoplasmic Sperm Injection ◽

Vas Deferens ◽

Needle Aspiration ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Fine Needle

Introduction: Infertility may depend up to 27% of couples on both partners. In patients with obstructive azoospermia, testicular fine-needle aspiration represents a good option to retrieve spermatozoa, in order to perform an assisted reproductive treatment. In vitro maturation of testicular spermatozoa could be the better choice of treatment in view of the increased motility, improving fertilization and pregnancy rates. Case description: A 34-year-old azoospermic man and his 33-year-old partner referred for treatment of simultaneous male and female infertility factor. The woman presented a diminished ovarian reserve, with serum follicle stimulating hormone value of 27.15 IU/L. The man underwent trans-rectal and testicular ultrasounds that detected the congenital absence of proximal vas deferens on the right side and the absence of seminal vesicle and distal vas deferens on the left side. We proposed a chance to have their own biological child. The man underwent modified testicular fine-needle aspiration using a 18-gauge butterfly needle. Sperm retrieval was successful with 0.001 × 106 spermatozoa/mL and absence of motility. Testicular sperm suspension was cultured for 24 h to identify sperm viability, achieving 10% of sperm motility. Two metaphase II oocytes were retrieved and processed with intracytoplasmic sperm injection. Clinical pregnancy with live birth was obtained. Conclusion: Performing modified testicular fine-needle aspiration increases successful sperm retrieval. Testicular sperm in vitro culture for 24 h proved to be a real and practical technique to increase sperm motility, in order to select mature and viable spermatozoa and improve successful intracytoplasmic sperm injection outcomes.

Download Full-text

Obstetrical and Neonatal Outcomes of 3,028 Singletons Born After Advanced ART Techniques: Ejaculated Sperm Intracytoplasmic Sperm Injection, Artificial Oocyte Activation, in Vitro Maturation and Testicular Sperm Extraction

Fertility & Reproduction ◽

10.1142/s2661318221500031 ◽

2021 ◽

pp. 1-10

Author(s):

Hiromitsu Hattori ◽

Yuko Atsumi ◽

Yukiko Nakajo ◽

Nobuya Aono ◽

Masae Koizumi ◽

...

Keyword(s):

Sex Ratio ◽

Intracytoplasmic Sperm Injection ◽

In Vitro Maturation ◽

The Other ◽

Neonatal Outcomes ◽

Testicular Sperm Extraction ◽

Oocyte Activation ◽

Testicular Sperm ◽

Art Techniques

Background: To evaluate obstetrical and neonatal outcomes of singletons conceived after advanced assisted reproductive technology (ART) techniques: conventional IVF pregnancies (C-IVF), ejaculated sperm intracytoplasmic sperm injection (ICSI), assisted oocyte activation (AOA), in vitro maturation (IVM), and testicular sperm extraction (TESE). Methods:The subjects were 3,028 singletons who were born after fresh or frozen embryo transfer. The subjects were separated into five groups: C-IVF (n = 855), ICSI (n = 1,869), AOA (n = 42), IVM (n = 32), and TESE (n = 230). We evaluated obstetrical and neonatal outcomes calculating the adjusted odds ratio (AOR) using multivariable logistic regression analyses for fresh and frozen embryos and for cleavage and blastocyst transfer. The C-IVF group was used as a background control for the ICSI group. Moreover, the TESE, AOA, and IVM groups were compared to the ICSI group to evaluate the effects of the ICSI procedure itself. Results: The incidence of perinatal complications was significantly lower in the ICSI-fresh group (AOR = 0.29, 95% CI: 0.10–0.83, p < 0.05). Regarding sex ratio, the IVM was significantly associated with sex ratio imbalance toward female in both fresh and frozen groups (AOR = 0.30, 95% CI: 0.10–0.96, AOR = 0.27, 95% CI: 0.07–0.98, p < 0.05). On the other hand, there were no significant differences in preterm birth rate, low birth weight rate and congenital abnormalities rate between conventional IVF, ICSI, and the other groups. Conclusions: There were no negative effects on obstetrical and neonatal outcomes between conventional IVF and ICSI. Although this was a limited sample size study, advanced ART technologies such as AOA, IVM, and TESE also seem to have a low risk of adverse impact on obstetrical and neonatal outcomes but may have a slight impact on sex ratio.

Download Full-text