TESE-ICSI outcomes per couple in vasectomized males are negatively affected by time since the intervention, but not other comorbidities

Embryological, clinical, and newborn outcomes from 583 treatment cycles with fresh and frozen testicular spermatozoa

BACKGROUND

Besides non-obstructive azoospermia, other conditions also benefit from the use of testicular sperm extraction, but their clinical outcomes remain to be explored in detail.

OBJECTIVE

To compare the use of fresh and frozen testicular spermatozoa in patients submitted to testicular sperm extraction because of idiopathic or secondary non-obstructive azoospermia, and after recurrent failed intracytoplasmic sperm injection attempts using ejaculated or aspirated testicular spermatozoa.

MATERIALS AND METHODS

We retrospectively evaluated 325 patients with normal karyotypes and absence of Y-chromosome microdeletions that used testicular sperm extraction for fertility treatments. Comparisons included detailed embryological, clinical, and newborn outcomes.

RESULTS

Patients underwent 503 treatment cycles, 269 with fresh and 234 with frozen testicular spermatozoa. No significant differences were observed between fresh and frozen spermatozoa regarding clinical pregnancy (38.0%/43.2%), live birth delivery (32.2%/34.0%), and newborn (40.1%/43.2%) rates, the same being observed in cumulative clinical pregnancy (47.9%/48.5%), live birth delivery (41.7%/38.3%), and newborn (50.4%/48.5%) rates. Also, no significant differences were observed between fresh and frozen spermatozoa per pathology (idiopathic or secondary non-obstructive azoospermia, cryptorchidism, abnormal semen parameters, cryptozoospermia, obstructive azoospermia, and anejaculation). However, in idiopathic non-obstructive azoospermia, frozen embryo transfer cycles from fresh sperm cycles evidenced significantly higher rates of live birth delivery and newborn. As cycles with frozen spermatozoa evidenced significantly higher female age, time of infertility, and basal follicle stimulating hormone, and significantly lower number of follicles, female characteristics were thereafter individualized. The presence of mixed factors did not affect outcomes. Good ovarian response cases exhibited significantly higher rates of implantation and newborn, whereas younger women cases showed significantly higher rates of implantation, clinical pregnancy, and newborn; however, when fresh spermatozoa were compared to frozen spermatozoa, these differences were no longer present.

DISCUSSION AND CONCLUSION

Data provide detailed embryological, clinical, and newborn outcomes associated with specific conditions in which testicular sperm extraction was required. It also highlights no detrimental effects on outcomes when frozen testicular spermatozoa is used.

Effect of time since vasectomy on live birth rate of TESE‒ICSI egg donation cycles and male-related prognostic factors

BACKGROUND

Vasectomy is a widely used method of contraception. However, some men may have the desire to become biological fathers again after a period.

OBJECTIVE

To explore the effect of time since vasectomy and different male comorbidities on live birth rates from intracytoplasmic sperm injection cycles using donated oocytes by using testicular spermatozoa obtained by testicular sperm extraction.

MATERIALS AND METHODS

This was a retrospective study of 123 couples who underwent a testicular sperm extraction‒intracytoplasmic sperm injection cycle after vasectomy using donated oocytes. Subjects were divided into groups according to time since vasectomy and the male risk factor evaluated. The main outcomes measured were live birth rate per embryo transfer, per oocyte donation cycle, and per couple. We assessed the cumulative live birth rate according to the time since vasectomy and considered male comorbidities: body mass index, hypertension, diabetes mellitus, dyslipidemia, and smoking.

RESULTS

The overall live birth rate per couple was 59.3% (50.6-68.0). Considering the number of embryo transfer and oocyte donation cycle, the live birth rates were 34.1% (27.8-40.4) and 44.5% (36.9-52.1), respectively. The live birth rate according to time since vasectomy was not statistically different between groups. Consequently, the cumulative live birth rate was similar between the different interval times when considering one to eight embryo transfers (p = 0.74). No statistical differences in live birth rate and cumulative live birth rate were found between groups clustered according to male body mass index, smoking, hypertension, and dyslipidemia. However, diabetic male patients had a significantly lower rate of live birth rate per couple (22.2% [4.94-49.4]) than non-diabetic patients did (62.7% [53.7-71.8]) (p = 0.03), but not in their cumulative live birth rate.

CONCLUSIONS

The time since vasectomy seems to have no detrimental effects on the live birth rate and cumulative live birth rate in testicular sperm extraction‒intracytoplasmic sperm injection cycles with donated oocytes. Male diabetes negatively affects the overall live birth rate per couple, but not the cumulative live birth rate. These results could be useful for multidisciplinary patient-tailored counseling, regarding the chance of having a pregnancy and facilitating the decision-making process of the fertility specialists.

Frequency, morbidity and equity - the case for increased research on male fertility

Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.

Sperm deoxyribonucleic acid fragmentation (by terminal deoxynucleotidyl transferase biotin dUTP nick end labeling assay) does not impair reproductive success measured as cumulative live birth rates per donor metaphase II oocyte used

OBJECTIVE

To better study the effect of sperm deoxyribonucleic acid fragmentation (SDF) on intracytoplasmic sperm injection (ICSI) outcomes from an ovum donation program by assessing the cumulative live birth rates (CLBRs) per number of embryo transfers (ETs), embryos replaced (EmbR), and metaphase II (MII) oocytes required in consecutive treatments to achieve the first newborn.

DESIGN

A multicenter retrospective cohort study was conducted, and the Kaplan-Meier survival curves were generated to calculate the CLBR with regard to the SDF degree.

SETTING

Private university-affiliated in vitro fertilization centers.

PATIENT(S)

Data from 864 couples using donated eggs and undergoing ICSI from 2000 to 2019 were analyzed. Sperm deoxyribonucleic acid fragmentation was measured using terminal deoxynucleotidyl transferase biotin dUTP nick end labeling assay on their ejaculated sperm.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Live birth rate (LBR) per first ET and per all consecutive ETs within the same patient and CLBR per ET, per EmbR, and per MII oocyte used considering the SDF level.

RESULT(S)

A total of 1,903 ICSI cycles were considered, encompassing 6,340 donated oocytes, 2,543 embryos, and 1,145 ETs. Comparing ≤15% SDF (low) with >15% SDF (high) or by 10% SDF ranges, the LBRs per first ET and per all ETs did not significantly differ. The Kaplan-Meier curves of the CLBR per ET, per EmbR, and per donor oocyte consumed were similar between the SDF groups evaluated.

CONCLUSION(S)

Elevated SDF does not reduce the LBR or cumulative probability to obtain a child when calculated per ET, per EmbR, and per donated MII oocyte used in couples undergoing ICSI cycles.