MP31-13 PREGNANCY AND LIVE BIRTH RATE OUTCOMES IN INFERTILE MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA UNDERGOING HORMONE STIMULATION THERAPY

Abstract Study question Does the addition of calcium ionophores for artificial oocyte activation(AOA) help in improving Cumulative Live Birth Rate in surgically retrieved sperms for male factor infertility? Summary answer AOA significantly improved cumulative live birth rate in Micro-TESE (M-TESE), TESA for non- azoospermia (TESTICULAR) and Non-Obstructive Azoospermia(NOA)-TESA but not in Obstructive Azoospermia (OA)-TESA. What is known already The main cause of Total Fertilization Failure after ICSI is thought to be due to oocyte activation deficiency (OAD) because of oocyte-related or sperm-related factors. Studies have shown that artificial oocyte activation (AOA) is helpful in these situations, but is most effective in couples who have clear sperm-related OAD. Oocyte activation, by Phospholipase- C- Zeta (PLCζ) present in the sperm, leads to series of events resulting in calcium oscillation, oocyte activation and fertilization. AOA increases the free intracellular calcium thereby mimicking physiologic cell signaling mechanisms that result in oocyte activation and fertilization. Study design, size, duration This is a retrospective cohort study done in an academic private ART center, in which patient’s records were analyzed, from January 2016 to December 2019 (total 4 years’ duration) and all ICSI cycles with surgically retrieved sperms were included (n = 365). Study subjects were divided into 4 groups- M-TESE (n = 143), NOA-TESA (n = 38), OA-TESA (n = 62) and TESTICULAR (n = 92). Subdivision was done into cases if AOA was done and control were with conventional ICSI without AOA. Participants/materials, setting, methods Method- Immediately after ICSI, in case group (AOA), all metaphase II oocytes were treated with calcium ionophore (GM508- CultActive) for 15 minutes, then thoroughly washed and incubated under standard conditions. Primary outcome measured was cumulative live birth rate(CLBR) and Secondary outcomes were fertilization rate (Fert. rate), Cleavage rate, clinical pregnancy rate (CPR) and miscarriage rate (MA). Statistical analysis was performed with Chi-square and Mann-Whitney- U test, with significance at P < 0.05. Institutional committee clearance was obtained. Main results and the role of chance The CLBR was significantly higher with AOA- M-TESE (55.8% vs 33.3%, p- 0.008), AOA-NOA-TESA (55.55% vs 15%, p- 0.027) and AOA-TESTICULAR (62.9% vs 32.3%, p- 0.006) group. Fert. rate was significantly higher with AOA-M-TESE (81 ± 0.84 vs 64 ± 0.97, p- 0.001), AOA-NOA-TESA (86 ± 0.76 vs 64 ± 0.13, p- 0.001) and AOA-TESTICULAR (72 ± 0.12 vs 57 ± 0.11, p- 0.001). Cleavage rate, CPR also showed similar significant differences while MA was comparable. However, significant differences were not observed in any of the outcome measured in OA-TESA group between cases and controls - CBLR (51.6% vs 41.9%, p- 0.611), Fert.rate (0.77±0.14 vs 0.75±0.11, p- 0.539), CPR and MA, p- value > 0.05. It may be hypothesized that surgically retrieved sperms in cases of NOA or non- azoospermia where TESTICULAR sperms are taken have reduced or absent capacity to cause Calcium oscillations due to deficient or inadequate PLCζ or there may be some chromatin level abnormalities in these sperms, leading to lesser fertilization and lesser good quality embryos in control group in which AOA was not done. Limitations, reasons for caution This study is retrospective in nature. Sibling oocytes were not compared. The study neither looked at obstetrics complication nor the neonatal outcomes. Further studies are required for long term impact on children born from AOA cycles. Wider implications of the findings: To our knowledge, this is the first study in the literature evaluating the efficacy of calcium ionophores for NOA (M-TESE, TESA), OA (TESA) and TESTICULAR sperms. Further research is needed for use of calcium ionophores in cases of unexplained infertility and recurrent implantation failure. Trial registration number Not applicable

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Intracytoplasmic sperm injection with fresh versus cryopreserved testicular sperm in azoospermic patients

Middle East Fertility Society Journal ◽

10.1186/s43043-019-0010-1 ◽

2019 ◽

Vol 24 (1) ◽

Author(s):

Kani M. Falah

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Intracytoplasmic Sperm Injection ◽

Birth Rate ◽

Live Birth Rate ◽

Fertilization Rate ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Obstructive Azoospermia ◽

Testicular Sperm

Abstract Background The purpose of this study is to compare the outcome of intracytoplasmic sperm injection (ICSI) using fresh sperm versus frozen-thawed sperm in both obstructed and non-obstructed azoospermias. This retrospective study included 159 ICSI cycles from 126 couples. In 91 obstructed azoospermia cases, 66 cycles were treated with fresh testicular sperm and 25 cycles were treated with frozen-thawed testicular samples. In 68 non-obstructed azoospermia cases, 32 cycles were treated with fresh testicular sperm and 36 cycles were treated with frozen-thawed testicular sperm, and the main measure and outcomes calculated are fertilization rate, clinical pregnancy, and live birth rate. Results In case of obstructed azoospermia, there were no statistically significant differences between fresh sperm and frozen-thawed testicular sperm used for ICSI regarding fertilization rate, clinical pregnancy rate, and live birth rate as shown (57%, 47%, 0.093 p value; 23.7%, 17.4%, 0.54 p value; and 11.9%, 8.7%, 0.68 p value, respectively). Non-obstructed azoospermia cases also show no significant differences in fertilization rate (37%, 36%, 0.91 p value), clinical pregnancy rate (20%, 14.3%, 0.58 p value), and live birth rate (4%, 3.6%, 0.93 p value). Conclusion Cryopreservation of testicular sperm is reliable if carried out before ovulation induction especially in cases with non-obstructive azoospermia

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Role of microsurgical varicocelectomy in the management of non-obstructive azoospermia with varicocele: our tertiary care centre experience

African Journal of Urology ◽

10.1186/s12301-020-00064-3 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Avinash P. S. Thakur ◽

Darsan Sadasivan ◽

Vivek Sharma ◽

Vasantharaja Ramasamy ◽

Subeesh Parol ◽

...

Keyword(s):

Live Birth ◽

Intracytoplasmic Sperm Injection ◽

Birth Rate ◽

Live Birth Rate ◽

Testicular Sperm Extraction ◽

Obstructive Azoospermia ◽

Sperm Retrieval ◽

Modest Improvement ◽

Retrieval Rate

Abstract Background Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele. Methods This was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele. Results A total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%). Conclusions In NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.

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Clinical Outcomes and Live Birth Rate (LBR) of Micro-TESE With ICSI-IVF in 968 Non-obstructive Azoospermia Patients From One Reproductive Medicine Center: a Retrospective Cohort Study

10.21203/rs.3.rs-806130/v1 ◽

2021 ◽

Author(s):

Yu Lan ◽

Haiyan Zheng ◽

Xin Fu ◽

Tianwen Peng ◽

Chen Liao ◽

...

Keyword(s):

Live Birth ◽

Birth Rate ◽

Sperm Count ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Obstructive Azoospermia ◽

Testicular Sperm ◽

Sperm Retrieval ◽

Significant Difference ◽

Intent To Treat

Abstract Background: Most of data available in the literature reported the sperm retrieval rate (SRR) and ICSI results of microdissection testicular sperm extraction (micro-TESE) in non-obstructive azoospermia (NOA) patients with different etiologies. Unfortunately, there is currently a lack of comprehensive Intent-to-treat (ITT) data to guide clinicians in conducting comprehensive consultations with NOA patients. The aim of current study was to obtain more comprehensive evidence-based data and clinical outcomes for better consultation of NOA patients who opted to undergo micro-TESE combined with ICSI-IVF.Materials and methods: A retrospective study involved 968 NOA patients underwent micro-TESE during the period between January 2015 and December 2019. Those who had successful sperm retrieval and performed ICSI-IVF cycles were included in intent-to-treat (ITT) analysis. The primary outcome measure was the live birth rate (LBR). The cumulative pregnancy or live birth was defined as clinical pregnancy or at least one live-born baby resulting from an ICSI initiated cycle. Two kinds of stratification analyses were performed based on different etiologies of NOA and various amounts of sperm retrieved. The 'Student's t-test was used for comparison of continuous variables. One-way ANOVA was used to assess outcomes among more than two groups. Chi-squared (χ2) or Fisher's exact test was used for proportions.Results: The SRR of all 968 NOA patients undergoing micro-TESE was 44.6% (n=432). ITT analysis was performed in 424 patients, and ICSI-IVF was applied in 362 couples, leading to 171 clinical pregnancies (40.3%) and 161 live-birth deliveries (38.0%) in the first embryo transfer cycle. No significant difference was observed for per-protocol analysis between the groups of frozen sperm and fresh sperm in cumulative clinical pregnancy rate (CPR, 51.0% vs. 45.2%) and live-birth rate (LBR, 47.5% vs. 42.9%). NOA patients with Y chromosome azoospermia factor c (AZFc) microdeletions had the lowest rate of the high-score embryo on day 3 (4.4%, P<0.05) and the lowest cumulative CPR (22.2%, P<0.05). NOA patients with lower sperm count had significantly lower cumulative LBR than those with higher sperm count (25.0% vs. 49.2%, P<0.05).Conclusions: Micro-TESE is an effective sperm retrieval technique for NOA patients. Our data indicated no significant difference in the LBR between ICSI-IVF cycles using frozen or fresh testicular sperm.

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