Reproductive outcome after surgical sperm retrieval and intracytoplasmic sperm injection in couples with male factor sub fertility: a 10-year retrospective observational study

Authors

  • Nikhil Sebastian Department of Reproductive Medicine, Dream Flower IVF Centre, Kasaragod, Kerala, India
  • Jayalakshmi Suraj Department of Reproductive Medicine, Dream Flower IVF Centre, Kasaragod, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20250190

Keywords:

Infertility, Azoospermia, MicroTESE, Testicular sperm extraction, Intra cytoplasmic sperm injection

Abstract

Background: To evaluate surgical sperm retrieval (SSR) rate in men with obstructive azoospermia (OA) and non-obstructive azoospermia (NOA) and to compare clinical pregnancy rate (CPR) following ICSI. It was a retrospective observational study done at Dream Flower IVF Centre, Kasaragod, Kerala, India.

Methods: The 124 azoospermic men who underwent SSR along with intra cytoplasmic sperm injection (ICSI) between June 2013 to May 2024 were included in the study. OA and NOA were classified depending on the history, physical examination, ultrasonography and laboratory findings. Analysis of data on SSR rate and reproductive outcome following ICSI was done.

Results: A total of 124 male patients presented with azoospermia of which 52 patients (41.93%) had OA while 72 patients (58.06%) had NOA. The SSR rate was significantly higher in OA (100%) when compared to NOA (48.6%; p<0.05). The follicle stimulating hormone (FSH) level was significantly lower in participants with OA (5.2±2.0) when compare to NOA (25.1±15.2; p<0.05). ICSI using surgically retrieved spermatozoa was done in 90 couples. We failed to retrieve sperms in 34 (28.41%) patients, of which 27 couples opted for donor sperm (DS) for ICSI. The CPR was 55.8% and 39.5% in OA and NOA respectively. No significant difference in CPR (p=0.286), miscarriage rate (p=0.056) or live birth rate (p=0.904) were observed among the three groups.

Conclusions: Azoospermic men can be counselled about the probability of successful sperm retrieval as well as their likelihood to father their biological child following ICSI without the need of donor spermatozoa.

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References

Willot GM. Frequency of Azoospermia. For Sci Int. 1982;20(1):9-10. DOI: https://doi.org/10.1016/0379-0738(82)90099-8

Jarrow JP, Espeland MA, Lipshultz LI. Evaluation of azoospermic patient. J Uro. 1989;142(1):62-5. DOI: https://doi.org/10.1016/S0022-5347(17)38662-7

Esteves SC, Miyaoka, Agarwal A. An update on the Clinical assessment of the infertile male. Clinics (Sao Paulo). 2011;66(4):691-700. DOI: https://doi.org/10.1590/S1807-59322011000400026

Lewin J, Lukaszewski T, Sangster P. Reproductive outcomes after surgical sperm retrieval in couples with male factor sub fertility: a 10- year retrospective national cohort. Fertil Steril. 2023;119(4):589-95. DOI: https://doi.org/10.1016/j.fertnstert.2022.12.041

Hauser R, Botchan A, Amit A, Ben Yosef D, Gamzer R, Paz G, et al. Multiple Testicular Sampling in non obstructive Azoospermia- is it necessary? Hum Reprod. 1998;13(11):3081-5. DOI: https://doi.org/10.1093/humrep/13.11.3081

Chan PT, Schlegel PN. Non obstructive Azoospermia Curr Opin Urol. 2000;10(6):617-24. DOI: https://doi.org/10.1097/00042307-200011000-00015

Esteves SC, Miyaoka R, Agarwal A. Sperm Retrieval technique for assisted reproduction. Int Braz J Urol 2011;37(5):570-83. DOI: https://doi.org/10.1590/S1677-55382011000500002

Craft, I, Bennet V, Nicholson N. Fertilising ability of testicular spermatozoa. Lancet. 1993;342(8875):864. DOI: https://doi.org/10.1016/0140-6736(93)92722-6

Schoysman R, Vanderzwalmen P, Nijis M, Segal I, Segal Bertin, Geerts L, et al. Pregnancy after fertilisation with human testicular spermatozoa. Lancet. 1993;342(8881):1237. DOI: https://doi.org/10.1016/0140-6736(93)92217-H

Devroey P, Nagy P, Tournaye H, Liu J, Silber S, Van Steirteghem A. Outcome of Intracytoplasmic sperm injection with testicular spermatozoa in obstructive and non-obstructive azoospermia. Hum Reprod 1996;11(5):1015-8. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a019288

Windt ML, Coetzee K, Kruger TF, Menkveld R, Van der Merwe JP. Intracytoplasmic sperm injection with testicular spermatozoa in men with azoospermia. J Assist Reprod Genet. 2002;19(2):53-9. DOI: https://doi.org/10.1023/A:1014487412975

Pasqualotto FF, Rossi-Ferragut LM, Rocha CC, Iaconelli A. Outcome of in vitro fertilization and Intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia. J Urol. 2002;167(4):1753-6. DOI: https://doi.org/10.1016/S0022-5347(05)65193-2

Vernaeve V, Tournaye H, Osmanagaoglu K, Verheyen G, Van Steurteghem A, Devroey P. Intracytoplasmic sperm injection with testicular spermatozoa is less successful in men with nonobstructive azoospermia than in men with obstructive azoospermia. Fertil Steril. 2003;79:529-33. DOI: https://doi.org/10.1016/S0015-0282(02)04809-4

De Croo I, Van der Elst J, Everaert K, De Sutter P, Dhont M. Fertilization, pregnancy and embryo implantation rates after ICSI in cases of obstructive and non- obstructive azoospermia. Hum Reprod. 2000;15(6):1383-8. DOI: https://doi.org/10.1093/humrep/15.6.1383

Sousa M, Cremades N, Oliveira C, Ferraz L, Teixeura da Silva J, et al. Predictive value of testicular histology in secretory azoospermic subgroups and clinical outcome after microinjection of fresh and frozen-thawed sperm and spermatids. Hum Reprod. 2002;17(7):1800-10. DOI: https://doi.org/10.1093/humrep/17.7.1800

Fraietta R, Zylberstejn DS, Esteves SC. Hypogonadotropic hypogonadism revisited. Clinics (Sao Paulo). 2013;1(1)81-8. DOI: https://doi.org/10.6061/clinics/2013(Sup01)09

Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue extraction. Hum Reprod. 1999;14(1):131-5. DOI: https://doi.org/10.1093/humrep/14.1.131

Dabaja AA, Schlegel PN. Microdissection testicular sperm extraction: an update. Asian J Androl. 2013;15(1):35-9. DOI: https://doi.org/10.1038/aja.2012.141

Esteves SC, Miyaoka, Orosz JE, Agarwal A. An update on sperm retrieval techniques for azoospermic males. Clinics (Sao Paulo). 2013;68:99-110. DOI: https://doi.org/10.6061/clinics/2013(Sup01)11

De Kretser DM, Burger HG, Hudson B. The relationship between germinal cells and serum FSH levels in males with infertility. J Clin Endocrinol Metab. 1974;38(5):78-93. DOI: https://doi.org/10.1210/jcem-38-5-787

Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systemic review. Hum Reprod Update. 2007;13(6):539-49. DOI: https://doi.org/10.1093/humupd/dmm029

Esteves SC. Microdissection testicular sperm extraction (micro-TESE) as sperm acquisition method for men with nonobstructive azoospermia seeking fertility: operative and laboratory aspects. Int Braz J Urol. 2013;39(3):440-1. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2013.03.21

Reifsnyder JE, Ramasamy R, Husseini J, Schlegel PN. Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol. 2012;188(2):532-6. DOI: https://doi.org/10.1016/j.juro.2012.04.002

Okada H, Dobashi M, Yamazaki T, Hara I, Fujisawa M, Soichi A, et al. Conventional versus microdissection testicular sperm extraction for nonobstructive azoospermia. J Urol. 2002;168(3):1063-7. DOI: https://doi.org/10.1016/S0022-5347(05)64575-2

Nicopoullos JD, Gilling-Smith C, Almeida PA, Norman-Taylor J, Grace I, Ian G, et al. Use of surgical sperm retrieval in azoospermic men: a meta-analysis. Fertil Steril. 2004;82(3):691-701. DOI: https://doi.org/10.1016/j.fertnstert.2004.02.116

Talas H, Yaman O, Aydos K. Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia. Asian J Androl. 2007;9(5):668-73. DOI: https://doi.org/10.1111/j.1745-7262.2007.00273.x

Practice Committee of the American Society for Reproductive Medicine. Sperm retrieval for obstructive azoospermia. Fertil Steril. 2008;90(5):S213-8. DOI: https://doi.org/10.1016/j.fertnstert.2008.08.047

Baker K, Sabanegh Jr E. Obstructive azoospermia: reconstructive techniques and results. Clinics (Sao Paulo). 2013;68(1):61-73. DOI: https://doi.org/10.6061/clinics/2013(Sup01)07

Esteves SC, Lee W, Benjamin DJ, Seol B, Verza S Jr, Ashok A. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and Intracytoplasmic sperm injection according to the cause of obstruction. J Urol. 2013;189(1):232-7. DOI: https://doi.org/10.1016/j.juro.2012.08.084

Miyaoka R, Esteves SC. Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval technique and gamete source play a role? Clinics (Sao Paulo). 2013;68(1):111-9. DOI: https://doi.org/10.6061/clinics/2013(Sup01)12

Palermo GD, Schlegel PN, Haripradhad JJ, Ergun B, Mielnik A, Zaninovic N, et al. Fertilization and pregnancy outcome with Intracytoplasmic sperm injection for azoospermic men. Hum Reprod. 1999;14(3):741-8. DOI: https://doi.org/10.1093/humrep/14.3.741

He X, Cao Y, Zhang Z, Zhao J, Wei Z, Ping Z, et al. Spermatogenesis affects the outcome of ICSI for azoospermic patients rather than sperm retrieval method. Syst Biol Reprod Med. 2010;56(6):457-64. DOI: https://doi.org/10.3109/19396368.2010.513078

Van Loendersloot LL, Van Wely M, Limpens J, Bossuyt PM, Repping S, Van der Veen F et al. Predictive factors in in vitro fertilization (IVF): a systemic review and meta-analysis. Hum Reprod Update. 2010;16(6):577-89. DOI: https://doi.org/10.1093/humupd/dmq015

Ghanem M, Bakr NI, Elgayaar MA, El Mongy S, Fathy H, Ibrahi AHA. Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non-obstructive azoospermia in the first cycle: a report of case series and meta-analysis. Int J Androl. 2005;28(1):16-21. DOI: https://doi.org/10.1111/j.1365-2605.2005.00491.x

Mateizel I, Verheyen G, Van Assche E, Tournaye H, Liebaers I, Van Steirteghem A. FISH analysis of chromosome X, Y and 18 abnormalities in testicular sperm from azoospermic patients. Hum Reprod. 2002;17(9):2249-57. DOI: https://doi.org/10.1093/humrep/17.9.2249

Vialard F, Bailly M, Bouazzi H, Albert M, Pont JC, Vanda M, et al. The high frequency of sperm aneuploidy in Klinefelter patients and in nonobstructive azoospermia is due to meiotic errors in euploid spermatocytes. J Androl. 2012;33(6):1352-9. DOI: https://doi.org/10.2164/jandrol.111.016329

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Published

2025-01-29

How to Cite

Sebastian, N., & Suraj, J. (2025). Reproductive outcome after surgical sperm retrieval and intracytoplasmic sperm injection in couples with male factor sub fertility: a 10-year retrospective observational study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(2), 539–544. https://doi.org/10.18203/2320-1770.ijrcog20250190

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Original Research Articles