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Zhang D, Yao W, Zhang M, Yang L, Li L, Liu S, Jiang X, Sun Y, Hu S, Huang Y, Xue J, Zheng X, Xiong Q, Chen S, Zhu H. Safety evaluation of single-sperm cryopreservation technique applied in intracytoplasmic sperm injection. ZYGOTE 2024; 32:175-182. [PMID: 38629180 DOI: 10.1017/s0967199424000078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Intracytoplasmic sperm injection (ICSI) is a technique that directly injects a single sperm into the cytoplasm of mature oocytes. Here, we explored the safety of single-sperm cryopreservation applied in ICSI. This retrospective study enrolled 186 couples undergoing ICSI-assisted pregnancy. Subjects were allocated to the fresh sperm (group A)/single-sperm cryopreservation (group B) groups based on sperm type, with their clinical baseline/pathological data documented. We used ICSI-compliant sperm for subsequent in vitro fertilization and followed up on all subjects. The recovery rate/cryosurvival rate/sperm motility of both groups, the pregnancy/outcome of women receiving embryo transfer, and the delivery mode/neonatal-related information of women with successful deliveries were recorded. The clinical pregnancy rate, cumulative clinical pregnancy rate, abortion rate, ectopic pregnancy rate, premature delivery rate, live birth delivery rate, neonatal birth defect rate, and average birth weight were analyzed. The two groups showed no significant differences in age, body mass index, ovulation induction regimen, sex hormone [anti-Müllerian hormone (AMH)/follicle-stimulating hormone (FSH)/luteinizing hormone (LH)] levels, or oocyte retrieval cycles. The sperm recovery rate (51.72%-100.00%) and resuscitation rate (62.09% ± 16.67%) in group B were higher; the sperm motility in the two groups demonstrated no significant difference and met the ICSI requirements. Group B exhibited an increased fertilization rate, decreased abortion rate, and increased safety versus group A. Compared with fresh sperm, the application of single-sperm cryopreservation in ICSI sensibly improved the fertilization rate and reduced the abortion rate, showing higher safety.
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Affiliation(s)
- Duanjun Zhang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Wenliang Yao
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Mingliang Zhang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Lijuan Yang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Lin Li
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shujuan Liu
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Xianglong Jiang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Yingli Sun
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shuonan Hu
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Yufang Huang
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Jie Xue
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Xiaoting Zheng
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Qi Xiong
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Shenghui Chen
- Department of Reproductive Medicine, Nanchang Xinhua Hospital, Nanchang Reproductive Hospital, Reproductive Hospital Affiliated to Jiangxi University of Chinese Medicine, Nanchang City, 330001, Jiangxi Province, China
| | - Haiqin Zhu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang City, 330000, Jiangxi Province, China
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Ferlin A, Calogero AE, Krausz C, Lombardo F, Paoli D, Rago R, Scarica C, Simoni M, Foresta C, Rochira V, Sbardella E, Francavilla S, Corona G. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest 2022; 45:1085-1113. [PMID: 35075609 DOI: 10.1007/s40618-022-01741-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Infertility affects 15-20% of couples and male factors are present in about half of the cases. For many aspects related to the diagnostic and therapeutic approach of male factor infertility, there is no general consensus, and the clinical approach is not uniform. METHODS In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), endorsed by the Italian Society of Embryology, Reproduction, and Research (SIERR), we propose evidence-based recommendations for the diagnosis, treatment, and management of male factor infertility to improve patient and couple care. RESULTS Components of the initial evaluation should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, and imaging are suggested in most men and recommended when specific risk factors for infertility exist or first-step analyses showed abnormalities. Full examination including genetic tests, testicular cytology/histology, or additional tests on sperm is clinically oriented and based on the results of previous investigations. For treatment purposes, the identification of the specific cause and the pathogenetic mechanism is advisable. At least, distinguishing pre-testicular, testicular, and post-testicular forms is essential. Treatment should be couple-oriented, including lifestyle modifications, etiologic therapies, empirical treatments, and ART on the basis of best evidence and with a gradual approach. CONCLUSION These Guidelines are based on two principal aspects: they are couple-oriented and place high value in assessing, preventing, and treating risk factors for infertility. These Guidelines also highlighted that male infertility and in particular testicular function might be a mirror of general health of a man.
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Affiliation(s)
- A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy.
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - C Krausz
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - F Lombardo
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - R Rago
- Department of Gender, Parenting, Child and Adolescent Medicine, Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - C Scarica
- European Hospital, Centre for Reproductive Medicine, Rome, Italy
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Sbardella
- Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
| | - S Francavilla
- Department of Life, Health and Environmental Sciences, Unit of Andrology, University of L'Aquila, L'Aquila, Italy
| | - G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
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Amer M, Fakhry E. Fresh vs frozen testicular sperm for assisted reproductive technology in patients with non-obstructive azoospermia: A systematic review. Arab J Urol 2021; 19:247-254. [PMID: 34552776 PMCID: PMC8451649 DOI: 10.1080/2090598x.2021.1932303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective : To review the debate about the routine use of cryopreserved testicular sperm for intracytoplasmic sperm injection (ICSI) from patients with non-obstructive azoospermia (NOA), as some authors suggest repeating sperm retrieval in such cases due to poorer ICSI results when frozen–thawed testicular sperm is used compared with fresh sperm. Methods : A systematic literature review was performed in August 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science databases and the Excerpta Medica dataBASE (EMBASE), and we included 26 studies that were considered eligible for this systematic review. Results : In all, 1189 publications were screened and 26 articles were included in the systematic review. Three meta-analysis reviews were included and they all concluded that the use of fresh and frozen sperms for ICSI from patients with NOA showed comparable fertilisation and pregnancy rates. Conclusion : The use of frozen testicular sperm from men with NOA results in fertilisation and clinical pregnancy rates similar to those of fresh sperm. This may encourage fertility centres to use frozen testicular sperm samples, as this policy has certain advantages that would help with organising their workflow. Abbreviations: CPR: clinical pregnancy rate; 2PN%: two pronuclei % fertilisation rate; ICSI: intracytoplasmic sperm injection; NOA: non-obstructive azoospermia; OA, obstructive azoospermia; SCO: Sertoli cell-only syndrome; (micro-)TESE: (microsurgical) testicular sperm extraction
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Affiliation(s)
- Medhat Amer
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt.,Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Fakhry
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt
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Hervás I, Valls L, Rivera-Egea R, Juliá MG, Navarro-Gomezlechon A, Garrido N, Martínez-Jabaloyas JM. TESE-ICSI outcomes per couple in vasectomized males are negatively affected by time since the intervention, but not other comorbidities. Reprod Biomed Online 2021; 43:708-717. [PMID: 34391685 DOI: 10.1016/j.rbmo.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
RESEARCH QUESTION Does time since vasectomy (as obstructive interval) and the presence of different male comorbidities adversely affect the likelihood of achieving a newborn for vasectomized males undergoing testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI)? DESIGN This retrospective study included 364 couples with vasectomized males undergoing TESE-ICSI cycles with autologous oocytes at IVI Valencia. The main outcome was live birth rate (LBR). Subjects were divided according to the male risk factor evaluated into quartiles (obstructive interval, body mass index [BMI]) or groups (hypertension, diabetes mellitus, dyslipidaemia). The reproductive outcomes were calculated per embryo transfer, per ovarian stimulation completed, and per couple. RESULTS The average obstructive interval was 11.3 years. The LBR was 34.4% (95% CI 30.1-38.6) per embryo transfer, 27.8% (95% CI 24.1-31.5) per ovarian stimulation and 46.2% (95% CI 41.8-51.3) per couple. When considering obstructive interval, a significantly lower LBR per couple (P = 0.04) was found in the group with the longest obstruction time: Q1 42.1% (95% CI 33.5-50.7), Q2 49.1% (95% CI 36.1-62.1), Q3 56.3% (95% CI 46.7-65.9) and Q4 37.2% (95% CI 26.5-47.9) but the cumulative live birth rate (CLBR) was not affected (P = 0.63). LBR per ovarian stimulation of males with hypertension was significantly lower (P = 0.04) than healthy males: 13.5% (95% CI 2.5-24.5) and 28.6% (95% CI 24.7-32.5), respectively. The group of diabetic vasectomized males had a significantly higher CLBR (P = 0.02). The remaining risk factors assessed (smoking, dyslipidaemia and a high BMI) did not affect LBR compared with their healthy counterparts. CONCLUSION Time since vasectomy appears to negatively influence the LBR when assessed per couple. The CLBR was not affected by the obstructive interval or the presence of other male comorbidities apart from diabetes, which had a significant effect.
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Affiliation(s)
- Irene Hervás
- IVI Foundation, The Health Research Institute La Fe, Valencia 46026, Spain
| | - Lorena Valls
- Urology Unit, Hospital Clínico Universitario de Valencia, Valencia 46010, Spain
| | | | - María Gil Juliá
- IVI Foundation, The Health Research Institute La Fe, Valencia 46026, Spain
| | | | - Nicolás Garrido
- IVI Foundation, The Health Research Institute La Fe, Valencia 46026, Spain.
| | - José María Martínez-Jabaloyas
- Andrology Unit, IVIRMA Valencia, Valencia 46015, Spain; Department of Surgery, Valencia University, Valencia 46010, Spain
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5
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Zhang Z, Jing J, Luo L, Li L, Zhang H, Xi Q, Liu R. ICSI outcomes of fresh or cryopreserved spermatozoa from micro-TESE in patients with nonobstructive azoospermia: CONSORT. Medicine (Baltimore) 2021; 100:e25021. [PMID: 33761658 PMCID: PMC9282029 DOI: 10.1097/md.0000000000025021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes of fresh and cryopreserved sperm via microdissection testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA).From March 2016 to February 2020, a total of 244 men with NOA underwent micro-TESE at the Center for Reproductive Medicine, First Hospital of Jilin University, P. R. China. These cases included 40 patients who underwent 40 ICSI cycles with fresh spermatozoa from micro-TESE (Group A) and 30 patients who underwent 30 ICSI cycles with cryopreserved spermatozoa from micro-TESE (Group B). The characteristics, embryonic development, and ICSI outcomes of patients were compared between groups A and B.Our sperm retrieval rate (SRR) by micro-TESE in patients with NOA was 35.25%. No statistical differences in the patient characteristics and fertilization or quality embryo rates were observed between Groups A and B. Higher miscarriage rates and lower live births were observed in Group B than in Group A (both P < .05).Fresh testicular spermatozoa seem to produce better ICSI outcomes than cryopreserved testicular spermatozoa from patients with NOA in the micro-TESE-ICSI cycle.
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Affiliation(s)
- Zhihong Zhang
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Jili Jing
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Lili Luo
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Leilei Li
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Hongyang Zhang
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
| | - Qi Xi
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
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Cito G, Gemma L, Giachini C, Micelli E, Cocci A, Fucci R, Picone R, Sforza S, Nesi G, Santi R, Minervini A, Masieri L, Carini M, Coccia ME, Natali A. Sperm retrieval by conventional testicular sperm extraction for assisted reproduction in patients with Zinner syndrome. Clin Exp Reprod Med 2021; 48:85-90. [PMID: 33486943 PMCID: PMC7943355 DOI: 10.5653/cerm.2020.03769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/08/2020] [Indexed: 11/18/2022] Open
Abstract
We present data from three Caucasian men with Zinner syndrome who attended our center for the treatment of primary couple’s infertility. Each patient was scheduled for conventional testicular sperm extraction (cTESE) and cryopreservation. Sperm analysis confirmed absolute azoospermia. Patient 1 had right and left testis volumes of 24 mL and 23 mL, respectively; left seminal vesicle (SV) agenesis, severe right SV hypotrophy with right renal agenesis. Follicle-stimulating hormone (FSH) was 3.2 IU/L. Patient 2 exhibited right and left testis volumes of 18 mL and 16 mL, respectively; a left SV cyst of 32 × 28 mm, ipsilateral kidney absence, and right SV agenesis. FSH was 2.8 IU/L. Patient 3 showed a testicular volume of 10 mL bilaterally, a 65 × 46 mm left SV cyst, right SV enlargement, and left kidney agenesis. FSH was 32.0 IU/L. Sperm retrieval was successful in all patients. Nevertheless, cTESE should be performed on the day of oocyte retrieval.
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Affiliation(s)
| | - Luca Gemma
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Claudia Giachini
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Elisabetta Micelli
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Rossella Fucci
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi Hospital, Florence, Italy
| | - Simone Sforza
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Gabriella Nesi
- Pathology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Raffaella Santi
- Pathology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Marco Carini
- Department of Urology, Careggi Hospital, Florence, Italy
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Zhang HL, Mao JM, Liu DF, Zhao LM, Tang WH, Hong K, Zhang L, Lian Y, Lin HC, Jiang H. Clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection with fresh or cryopreserved sperm in patients with nonobstructive azoospermia. Asian J Androl 2021; 23:211-214. [PMID: 32719193 PMCID: PMC7991819 DOI: 10.4103/aja.aja_38_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We performed this study to evaluate the clinical outcomes of microdissection testicular sperm extraction-intracytoplasmic sperm injection (micro-TESE-ICSI) treatment that used fresh or cryopreserved sperm in patients with nonobstructive azoospermia (NOA). A total of 338 NOA patients with 344 consecutive cycles received treatment in the reproductive medicine center of Peking University Third Hospital in Beijing, China, from January 2014 to December 2017. Fresh oocytes and fresh sperm were used in 222 patients with 234 cycles (Group A). Fresh oocytes and cryopreserved sperm were used in 116 patients with 110 cycles (Group B). We compared patient characteristics, embryonic development, and pregnancy outcomes between Groups A and B. There was no statistical difference in the patient characteristics, and no differences were observed with fertilization or quality embryo rates between Groups A and B. The rates of clinical pregnancy and live birth were both higher for Group A than those for Group B (both P < 0.05). In conclusion, fresh testicular sperm appears to produce better ICSI outcomes than cryopreserved testicular sperm in patients with NOA.
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Affiliation(s)
- Hong-Liang Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Jia-Ming Mao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - De-Feng Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Lian-Ming Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Wen-Hao Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Kai Hong
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Li Zhang
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Ying Lian
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Hao-Cheng Lin
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
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8
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Aizer A, Dratviman-Storobinsky O, Noach-Hirsh M, Konopnicki S, Lazarovich A, Raviv G, Orvieto R. Testicular sperm retrieval: What should we expect from the fresh and subsequent cryopreserved sperm injection? Andrologia 2020; 53:e13849. [PMID: 33070352 DOI: 10.1111/and.13849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/13/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022] Open
Abstract
We sought to compare ICSI outcomes of cycle using fresh versus thawed TESE spermatozoa obtained during the previous fresh TESE. All consecutive couples undergoing ICSI cycles using fresh TESE spermatozoa, followed by ICSI cycle using cryopreserved sperm remaining from the previous fresh TESE procedure were included. Ovarian stimulation (OS)/laboratory variables and cycle outcome were assessed and compared between those utilising fresh versus thawed TESE spermatozoa. Seventy-five couples were evaluated, with no in-between groups differences in OS nor embryological variables. While implantation and LBR per embryo transfer were nonsignificantly higher in the frozen as compared to the fresh TESE, there was a trend towards higher LBRs per patient in the frozen TESE group. The cumulative miscarriage rate (4% versus 14.7%, p < .022 respectively) was significantly lower and the cumulative LBR (34.7% versus 16%, p < .007 respectively) was significantly higher using frozen TESE spermatozoa. Moreover, significantly higher proportion of frozen TESE sperm samples used pentoxifylline to enhance sperm motility. In conclusion, the results of ICSI cycles using frozen TESE spermatozoa are as good, or even better than using fresh TESE spermatozoa. Further studies are required to explore the factors responsible for the improved ICSI outcome, while using frozen versus fresh TESE sperm samples.
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Affiliation(s)
- Adva Aizer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Dratviman-Storobinsky
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Noach-Hirsh
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Sarah Konopnicki
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
| | - Alon Lazarovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Urology and Andrology Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Gil Raviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Urology and Andrology Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, at the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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9
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Liu H, Xie Y, Gao L, Sun X, Liang X, Deng C, Gao Y, Liu G. Impact on using cryopreservation of testicular or epididymal sperm upon intracytoplasmic sperm injection outcome in men with obstructive azoospermia: a systematic review and meta-analysis. J Assist Reprod Genet 2020; 37:2643-2651. [PMID: 32935172 DOI: 10.1007/s10815-020-01940-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine whether there was a significant impact on using cryopreservation of testicular or epididymal sperm upon the outcomes of intracytoplasmic sperm injection (ICSI) in patients with obstructive azoospermia (OA). METHOD Systematic review and meta-analysis of 20 retrospective studies in databases from January 1, 1995, to June 1, 2020. RESULT Twenty articles were included in this study. A total of 3602 (64.1%) of 5616 oocytes injected with fresh epididymal sperm were fertilized, compared with 2366 (61.2%) of 3862 oocytes injected with cryopreserved sperm (relative risk ratio (RR) 0.96, 95% confidence interval (CI) (0.90, 1.02), P > 0.05). A total of 303 (44.1%) of 687 ICSI cycles using fresh epididymal sperm resulted in a clinical pregnancy, compared with 150 (36.6%) of 410 ICSI cycles using cryopreserved epididymal sperm (RR 0.84, 95% CI (0.72, 0.97), P < 0.05). In the testis, a total of 2147 (68.7%) of 3125 oocytes injected with fresh sperm were fertilized, compared with 1623 (63.5%) of 2557 oocytes injected with cryopreserved sperm (RR 0.97, 95% CI (0.90, 1.06), P > 0.05). A total of 151 (47.8%) of 316 ICSI cycles using fresh testicular sperm resulted in a clinical pregnancy, compared with 113 (38.2%) of 296 ICSI cycles using cryopreserved sperm (RR 0.87, 95% CI (0.72, 1.05), P > 0.05). CONCLUSIONS In men with OA, there was a statistical lower clinical pregnancy rate (CPR) by using frozen epididymal sperm compared with fresh epididymal sperm, but showing no difference on fertilization rate (FR). Additionally, FR and CPR were not affected by whether the retrieved testicular sperm was frozen or fresh.
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Affiliation(s)
- Hanchao Liu
- Department of Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun Xie
- Department of Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linzhi Gao
- Reproductive Centre, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 58 Zhong shan 2nd Rd., Yuexiu District, Guangzhou, 510080, China
| | - Xiangzhou Sun
- Department of Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Liang
- Reproductive Centre, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 58 Zhong shan 2nd Rd., Yuexiu District, Guangzhou, 510080, China
| | - Chunhua Deng
- Department of Andrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Gao
- Reproductive Medicine Center, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, No. 26 Yuan cun er heng Rd., Tianhe District, Guangzhou, China.
| | - Guihua Liu
- Reproductive Centre, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 58 Zhong shan 2nd Rd., Yuexiu District, Guangzhou, 510080, China.
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10
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Klipstein S, Fallat ME, Savelli S. Fertility Preservation for Pediatric and Adolescent Patients With Cancer: Medical and Ethical Considerations. Pediatrics 2020; 145:peds.2019-3994. [PMID: 32071259 DOI: 10.1542/peds.2019-3994] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Many cancers presenting in children and adolescents are curable with surgery, chemotherapy, and/or radiotherapy. Potential adverse consequences of treatment include sterility, infertility, or subfertility as a result of gonad removal, damage to germ cells as a result of adjuvant therapy, or damage to the pituitary and hypothalamus or uterus as a result of irradiation. In recent years, treatment of solid tumors and hematologic malignancies has been modified in an attempt to reduce damage to the gonadal axis. Simultaneously, advances in assisted reproductive technology have led to new possibilities for the prevention and treatment of infertility. This clinical report reviews the medical aspects and ethical considerations that arise when considering fertility preservation in pediatric and adolescent patients with cancer.
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Affiliation(s)
- Sigal Klipstein
- Department of Obstetrics and Gynecology, Pritzker School of Medicine, University of Chicago, Chicago, Illinois; .,InVia Fertility Specialists, Chicago, Illinois
| | - Mary E Fallat
- Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky; and
| | - Stephanie Savelli
- Division of Pediatric Hematology/Oncology, Akron Children's Hospital, Akron, Ohio
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11
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Martini AE, Doyle JO. Fertility Preservation Before Deployment: Oocyte and Sperm Freezing in Members of the Active Duty Military. Semin Reprod Med 2020; 37:232-238. [DOI: 10.1055/s-0040-1701633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractActive duty military service and deployment has the potential to compromise fertility through combat-related genitourinary injury, gonadotoxic exposures, and physical separation from a partner. Despite a growing interest among the military community as well as promising efficacy and safety data, fertility preservation remains an uncovered benefit for active duty soldiers. In 2016, the Pentagon proposed a program that would cover oocyte and sperm cryopreservation for any member of the active duty military desiring its use. Regrettably, that funding was not secured and predeployment fertility preservation remains an out-of-pocket expense. Today, advocacy groups, non-for-profit organizations, and physicians remain vigilant in their attempts to drive another government initiative through Congress. While activism continues, it is important to stress the value of fertility preservation counseling in soldiers' predeployment preparation and military family planning.
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Affiliation(s)
- Anne E. Martini
- Department of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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12
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M. Falah K. Intracytoplasmic sperm injection with fresh versus cryopreserved testicular sperm in azoospermic patients. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2019. [DOI: 10.1186/s43043-019-0010-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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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13
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The management of obstructive azoospermia: a committee opinion. Fertil Steril 2019; 111:873-880. [PMID: 31029241 DOI: 10.1016/j.fertnstert.2019.02.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 01/29/2023]
Abstract
Infertility due to obstructive azoospermia may be treated effectively by surgical reconstruction or by retrieval of sperm from the epididymis or testis, followed by in vitro fertilization with intracytoplasmic sperm injection. This replaces the ASRM documents titled "Sperm retrieval for obstructive azoospermia" and "The management of infertility due to obstructive azoospermia," last published in 2008.
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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14
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Chen X, Ma Y, Zou S, Wang S, Qiu J, Xiao Q, Zhou L, Ping P. Comparison and outcomes of nonobstructive azoospermia patients with different etiology undergoing MicroTESE and ICSI treatments. Transl Androl Urol 2019; 8:366-373. [PMID: 31555560 DOI: 10.21037/tau.2019.04.08] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of the study was to compare clinical, laboratory, histological features, microdissection testicular sperm extraction (MicroTESE) and intracytoplasmic sperm injection (ICSI) treatment outcomes of nonobstructive azoospermia (NOA) patients of various etiologies, and to investigate ICSI outcomes using fresh and frozen thawed sperms from MicroTESE, so to explore an optimal MicroTESE-ICSI procedure for NOA couples. Methods A retrospective analysis was made in 595 NOA patients undergoing MicroTESE from January 2013 to December 2017. The men were classified into six groups based on etiology. Patients' age, history, hormone profile, testis volume, testicular histology, sperm retrieval, fertile and pregnancy outcomes of ICSI were included for analysis. Results A total of 595 NOA patients were included in this study, with 446 (75.0%) were idiopathic NOA, 66 (11.1%) were Klinefelter syndrome (KS), 34 (5.7%) with microdeletion of the AZFc, 33 (5.5%) cases had the history of cryptorchidism, 13 (2.2%) had a history of mumps orchitis, and 3 (0.5%) cases underwent chemotherapy. The overall sperm retrieval rate (SRR) was 40.3% (240/595), SRR of the cryptorchidism (84.8%, 28/33) and mumps orchitis (84.6%, 11/13) groups were much higher than that of other groups, the SRR of idiopathic group was the lowest (31.8%, 142/446). One hundred and ninety-eight ICSI cycles utilizing MicroTESE sperm were retrospectively analyzed, including 155 fresh MicroTESE ICSI cycles and 43 frozen-thawed MicroTESE ICSI cycles. Fertilization rate, cleavage rate, and clinical pregnancy rate of fresh sperm group were slightly higher than those in frozen thawed MicroTESE sperm group, but high qualified embryo rate of fresh sperm group was lower than frozen thawed group. The differences were of no statistical meaning. Conclusions Etiology may be an effective prognostic factor for SRR in NOA patients. NOA of definite etiology, such as cryptorchidism, has high SRR, while idiopathic NOA, the most common type of NOA, has the lowest SRR. Using of frozen thawed sperm from MicroTESE had similar pregnant outcome to that of fresh sperm, so cryopreservation of testicular sperm seems to be more suitable and of great benefit in these cases and good results can also be expected when oocyte retrieval and ICSI are not performed at the same time.
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Affiliation(s)
- Xiangfeng Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China.,Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Yi Ma
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
| | - Shasha Zou
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Siqi Wang
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Jin Qiu
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Qian Xiao
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Liang Zhou
- Northwest Women's and Children's Hospital, Xi'an 710000, China
| | - Ping Ping
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
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15
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Fayomi AP, Peters K, Sukhwani M, Valli-Pulaski H, Shetty G, Meistrich ML, Houser L, Robertson N, Roberts V, Ramsey C, Hanna C, Hennebold JD, Dobrinski I, Orwig KE. Autologous grafting of cryopreserved prepubertal rhesus testis produces sperm and offspring. Science 2019; 363:1314-1319. [PMID: 30898927 PMCID: PMC6598202 DOI: 10.1126/science.aav2914] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/13/2019] [Indexed: 12/11/2022]
Abstract
Testicular tissue cryopreservation is an experimental method to preserve the fertility of prepubertal patients before they initiate gonadotoxic therapies for cancer or other conditions. Here we provide the proof of principle that cryopreserved prepubertal testicular tissues can be autologously grafted under the back skin or scrotal skin of castrated pubertal rhesus macaques and matured to produce functional sperm. During the 8- to 12-month observation period, grafts grew and produced testosterone. Complete spermatogenesis was confirmed in all grafts at the time of recovery. Graft-derived sperm were competent to fertilize rhesus oocytes, leading to preimplantation embryo development, pregnancy, and the birth of a healthy female baby. Pending the demonstration that similar results are obtained in noncastrated recipients, testicular tissue grafting may be applied in the clinic.
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Affiliation(s)
- Adetunji P Fayomi
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Karen Peters
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Meena Sukhwani
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hanna Valli-Pulaski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gunapala Shetty
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marvin L Meistrich
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa Houser
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Nicola Robertson
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Victoria Roberts
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Cathy Ramsey
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Carol Hanna
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Jon D Hennebold
- Assisted Reproductive Technology Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - Ina Dobrinski
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kyle E Orwig
- Molecular Genetics and Developmental Biology Graduate Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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16
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Ukita Y, Wakimoto Y, Sugiyama Y, Fujii Y, Fukui A, Hasegawa A, Kondoh N, Yamamoto S, Shibahara H. Fertility preservation and pregnancy outcomes in adolescent and young adult male patients with cancer. Reprod Med Biol 2018; 17:449-453. [PMID: 30377398 PMCID: PMC6194234 DOI: 10.1002/rmb2.12211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Sperm cryopreservation is the gold standard for maintaining fertility in male survivors of cancer. In order to help increase the future success of fertility preservation in these patients, the present state of sperm cryopreservation was examined at the current institution and its challenges were discussed. METHODS Between January, 2004 and February, 2017, 31 male patients with cancer were introduced to the center for fertility preservation. The ages and semen characteristics of these patients were examined and compared between those whose sperm were cryopreserved before (the pretreatment group) and after (the post-treatment group) cancer treatment. RESULTS The mean sperm concentration of the pretreatment group was significantly higher than that of the post-treatment group. Normozoospermia was found in eight and three patients in the pretreatment and the post-treatment groups, respectively, albeit this difference was not significant. In contrast, the prevalence of azoospermia was higher in the post-treatment group (five patients) than in the pretreatment group (one patient). CONCLUSION As many patients possibly suffer from infertility following chemotherapy, it is necessary to provide fertility preservation opportunities to young male patients with cancer prior to the commencement of cancer treatment.
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Affiliation(s)
- Yuji Ukita
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Yu Wakimoto
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Yukiko Sugiyama
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Yuta Fujii
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Atsushi Fukui
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Akiko Hasegawa
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
| | - Nobuyuki Kondoh
- Department of UrologyHyogo College of MedicineNishinomiyaJapan
| | - Shingo Yamamoto
- Department of UrologyHyogo College of MedicineNishinomiyaJapan
| | - Hiroaki Shibahara
- Department of Obstetrics and GynecologyHyogo College of MedicineNishinomiyaJapan
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17
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Gupta C, Chinchole A, Shah R, Pathak H, Talreja D, Kayal A. Microscopic varicocelectomy as a treatment option for patients with severe oligospermia. Investig Clin Urol 2018; 59:182-186. [PMID: 29744475 PMCID: PMC5934280 DOI: 10.4111/icu.2018.59.3.182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Many studies have shown improved semen parameters after varicocele surgery; however, the benefit in terms of improved pregnancy rates and live births is still disputed in cases of severe oligoasthenozoospermia (OAS). The present study evaluated the outcome of microscopic subinguinal varicocelectomy in terms of the spontaneous pregnancy rate in patients with severe OAS. Materials and Methods This was a retrospective, observational, analytic study of 56 men with OAS who underwent microscopic varicocelectomy at our center between 2008 and 2015. The subjects were followed for a mean period of 12.4 months. Outcome was compared among groups of men with mild (sperm concentration, 10.2–19 million/mL), moderate (5.7–9.5 million/mL), and severe (<5 million/mL) OAS who were operated on during the same period. Results A total of 13 of 35 men (37.1%) with severe OAS achieved spontaneous pregnancy. Mean sperm density increased from 2.29 million/mL preoperatively to 14.09 million/mL postoperatively. The mean time to pregnancy from the date of surgery was 8.5 months. The spontaneous pregnancy rate in men with mild and moderate OAS was 62.5% and 46.2%, respectively. Conclusions Although pregnancy rates after varicocele surgery are lower preoperatively in men with severe OAS than in men with mild or moderate OAS, the spontaneous pregnancy rate of 37.1% still compares very favorably with outcomes after a single attempt at in vitro fertilization.
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Affiliation(s)
- Chirag Gupta
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Arun Chinchole
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Hemant Pathak
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Deepa Talreja
- Department of Reproductive Medicine, Lilavati Hospital and Research Centre, Mumbai, India
| | - Ankit Kayal
- Department of Urology, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
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18
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Okuyama N, Obata R, Oka N, Nakamura Y, Hattori H, Nakajo Y, Aono N, Koizumi M, Toya M, Nagao K, Tai T, Hashimoto T, Igarashi H, Kyono K. Long-term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men. Reprod Med Biol 2017; 17:82-88. [PMID: 29371826 PMCID: PMC5768980 DOI: 10.1002/rmb2.12073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/29/2017] [Accepted: 10/21/2017] [Indexed: 01/09/2023] Open
Abstract
Purpose To find the best methods to achieve the highest pregnancy and birth rates for couples needing testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI). Methods Retrospectively studied were 801 patients with male factor infertility who had undergone TESE‐ICSI between April, 1996 and July, 2016 and who had been categorized into four groups: obstructive azoospermia (OA); non‐obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). The sperm retrieval rate, hormone levels, fertilization rate (FR), pregnancy rate (PR), and birth rate (BR) after ICSI among three groups were compared: fresh testicular sperm (FS)‐fresh oocytes (FO) (Group I); frozen‐thawed testicular sperm‐FO (Group II); and FS‐vitrified‐warmed oocytes (Group III). Results The testicular sperm recovery rate was 57.8% (463/801): 89.6% in the Crypt, 97.1% in the OA, 28.9% in the NOA, and 42.2% in the KS groups. The follicle‐stimulating hormone levels were significantly higher in the NOA and KS groups and the testosterone levels were significantly lower in the KS group. The FR, PR, and BR were: 65.2%, 43.2%, and 28.5% in group I; 59.2%, 33.4%, and 18.7% in group II; and 56.4%, 33.8%, and 22.1% in group III. Conclusion Intracytoplasmic sperm injection with FS‐FO achieved the best PR and BR. It should be considered what to do in cases with no testicular sperm by TESE. The authors hope that ICSI with donor sperm will be allowed in Japan in the near future.
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Affiliation(s)
| | | | - Nao Oka
- Kyono ART Clinic Takanawa Tokyo Japan
| | | | | | | | - Nobuya Aono
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART Clinic Sendai Japan
| | | | | | - Koichi Nagao
- First Department of Urology Toho University School of Medicine Tokyo Japan
| | - Toshihiro Tai
- First Department of Urology Toho University School of Medicine Tokyo Japan
| | | | | | - Koichi Kyono
- Kyono ART Clinic Takanawa Tokyo Japan.,Kyono ART Clinic Sendai Japan
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19
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Palermo GD, O'Neill CL, Chow S, Cheung S, Parrella A, Pereira N, Rosenwaks Z. Intracytoplasmic sperm injection: state of the art in humans. Reproduction 2017; 154:F93-F110. [PMID: 29158352 PMCID: PMC5719728 DOI: 10.1530/rep-17-0374] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022]
Abstract
Among infertile couples, 25% involve both male and female factors, while male factor alone accounts for another 25% due to oligo-, astheno-, teratozoospermia, a combination of the three, or even a complete absence of sperm cells in the ejaculate and can lead to a poor prognosis even with the help of assisted reproductive technology (ART). Intracytoplasmic sperm injection (ICSI) has been with us now for a quarter of a century and in spite of the controversy generated since its inception, it remains in the forefront of the techniques utilized in ART. The development of ICSI in 1992 has drastically decreased the impact of male factor, resulting in millions of pregnancies worldwide for couples who, without ICSI, would have had little chance of having their own biological child. This review focuses on the state of the art of ICSI regarding utility of bioassays that evaluate male factor infertility beyond the standard semen analysis and describes the current application and advances in regard to ICSI, particularly the genetic and epigenetic characteristics of spermatozoa and their impact on reproductive outcome.
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Affiliation(s)
- G D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - C L O'Neill
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Chow
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - A Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - N Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
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20
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Schachter-Safrai N, Karavani G, Levitas E, Friger M, Zeadna A, Lunenfeld E, Har-Vardi I. Does cryopreservation of sperm affect fertilization in nonobstructive azoospermia or cryptozoospermia? Fertil Steril 2017; 107:1148-1152. [PMID: 28392002 DOI: 10.1016/j.fertnstert.2017.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/16/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare intracytoplasmic sperm injection (ICSI) outcomes with the use of fresh or frozen-thawed ejaculated or testicular sperm in patients with cryptozoospermia or nonobstructive azoospermia. DESIGN Retrospective cohort study. SETTING Tertiary medical center IVF unit. PATIENT(S) A total of 274 patients evaluated from 1999 to 2011. INTERVENTION(S) A total of 103 patients underwent testicular sperm extraction (TESE) because of nonobstructive azoospermia, and 171 patients were diagnosed with cryptozoospermia. MAIN OUTCOME MEASURE(S) ICSI outcomes during the first cycle in each technique performed according to the sperm origin (testicular vs. ejaculated) and processing (frozen vs. fresh). RESULT(S) Forty-eight cycles with the use of frozen testicular sperm, 22 cycles with fresh testicular sperm, 66 cycles with frozen ejaculated sperm, and 138 cycles with fresh ejaculated sperm were examined. Significantly more motile sperm were found in the fresh ejaculate group compared with the frozen-thawed ejaculate group (96% vs. 88%, respectively). Furthermore, fresh ejaculated sperm were found to have better fertilization rates than frozen ejaculated sperm (64% vs. 56%, respectively). No significant difference was found between fresh and frozen-thawed testicular sperm, either in motile sperm available for ICSI or in fertilization rate (64% vs. 62% and 52% vs. 49%, respectively). CONCLUSION(S) In cases of cryptozoospermia, frozen-thawed ejaculated sperm is inferior to fresh ejaculated sperm in fertilization rates. However, in nonobstructive azoospermia, no major differences were found between fresh and frozen-thawed testicular sperm. Therefore, uncoupled TESE/oocyte pick-up (OPU) should be considered in NOA cases to prevent possible unnecessary ovarian stimulation and OPU when no sperm cells are detected.
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Affiliation(s)
- Natali Schachter-Safrai
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
| | - Eliahu Levitas
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Epidemiology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Atif Zeadna
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eitan Lunenfeld
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Iris Har-Vardi
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Science, Ben Gurion University of the Negev, Beer Sheva, Israel
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21
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Schiewe MC, Rothman C, Spitz A, Werthman PE, Zeitlin SI, Anderson RE. Validation-verification of a highly effective, practical human testicular tissue in vitro culture-cryopreservation procedure aimed to optimize pre-freeze and post-thaw motility. J Assist Reprod Genet 2016; 33:519-28. [PMID: 26847133 PMCID: PMC4818637 DOI: 10.1007/s10815-016-0659-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/07/2016] [Indexed: 10/31/2022] Open
Abstract
PURPOSE The aim of our paper was to validate a testicular biopsy procedure that simplifies handling, processing, and cryopreservation, while at the same time optimizes sperm motility before freezing and after thawing. METHODS Two prospective studies were conducted to verify, optimize, and understand the virtues of pre-freeze testicular tissue IVC at different temperatures (21, 30, or 37 °C). Testicular tissue was obtained from clinical specimens designated for whole tissue cryopreservation (i.e., intact mass of tubules) and/or for fresh use in IVF-ICSI cycles. Whole testicular biopsy pieces (1-3 mm(3)) were diluted in glycerol containing freeze solutions, slow cooled to 4 °C and then rapidly frozen in LN2 vapor. Fresh and post-thaw testicular biopsy tissue were evaluated for changes in the quantity (%) and pattern of motility (I-IV: twitching to rapid progression, respectively) over a 1 week duration. The clinical effectiveness of IVC-cryopreserved whole testicular biopsy tissue was also validated analyzing fresh embryo transfers. RESULTS More reliable recovery of motile testicular sperm was achieved using whole tissue freeze preservation combined with IVC (24-96 h) post-acquisition at an incubation temperature of 30 °C compared to ambient temperature (21 °C) or 37 °C. Up to 85 % of the pre-freeze motility was conserved post-thaw (+3 h) for easy ICSI selection. Sperm longevity was optimized to fresh tissue levels by implementing testicular biopsy sucrose dilution post-thaw. Favorable clinical outcomes were proven using frozen-thawed testicular biopsy sperm for ICSI. CONCLUSIONS By employing minimal tissue manipulation, integrating pre-freeze IVC processing at 30 °C and the freezing of whole testicular biopsy tissue, we have reduced the labor and improved the efficacy of processing testicular tissue for freeze-preservation and subsequent ICSI use.
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Affiliation(s)
- M C Schiewe
- Ovagen Fertility/Southern California Institute for Reproductive Sciences (SCIRS), Newport Beach, CA, USA. .,California Cryobank (CCB), Los Angeles, CA, USA.
| | - C Rothman
- California Cryobank (CCB), Los Angeles, CA, USA.,Center for Male Reproduction and Vasectomy Reversal, Los Angeles, CA, USA
| | - A Spitz
- Department of Urology, University of California, Irvine (UCI), CA, USA
| | - P E Werthman
- Center for Male Reproduction and Vasectomy Reversal, Los Angeles, CA, USA
| | - S I Zeitlin
- Department of Urology, University of California, Los Angeles (UCLA), CA, USA
| | - R E Anderson
- Southern California Center for Reproductive Medicine (SCCRM), Newport Beach, CA, USA
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Hessel M, Robben JC, D'Hauwers KW, Braat DD, Ramos L. The influence of sperm motility and cryopreservation on the treatment outcome after intracytoplasmic sperm injection following testicular sperm extraction. Acta Obstet Gynecol Scand 2015; 94:1313-21. [DOI: 10.1111/aogs.12769] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Marloes Hessel
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Johanna C.M. Robben
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Didi D.M. Braat
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Liliana Ramos
- Department of Obstetrics and Gynecology; Radboud University Medical Center; Nijmegen The Netherlands
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Meijerink AM, Oomen RE, Fleischer K, IntHout J, Woldringh GH, Braat DDM. Effect of maternal and treatment-related factors on the prevalence of birth defects after PESA-ICSI and TESE-ICSI: a retrospective cohort study. Acta Obstet Gynecol Scand 2015; 94:1245-53. [PMID: 26265143 DOI: 10.1111/aogs.12728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We performed a retrospective cohort study with the aim to evaluate the effect of maternal and treatment-related factors on the prevalence of birth defects after intracytoplasmic sperm injection (ICSI) using percutaneous epididymal sperm aspiration (PESA) and testicular sperm extraction (TESE). MATERIAL AND METHODS 643 newborns born after PESA-ICSI (n = 406) and TESE-ICSI (n = 237) in Radboud University Medical Center, after a gestational age of 12 weeks, 1 January 2002-1 January 2011 and 1 March-1 November 2014, respectively, were included in this study. Three sources of data were used for analysis: questionnaires, national obstetrics registration forms, and a lab-database of all ICSI treatments. Data were analyzed using generalized estimating equations and logistic regression analysis. RESULTS The prevalence of major birth defects in newborns born after PESA-ICSI was 6.9% and after TESE-ICSI was 5.9% (odds ratio 0.89, 95% confidence interval 0.46-1.75). No significant association was found between maternal or treatment-related factors and the prevalence of birth defects. CONCLUSIONS We found a similar overall prevalence of birth defects in newborns born after PESA-ICSI and TESE-ICSI. The maternal and treatment-related factors investigated did not show a significantly increased cumulative risk of birth defects.
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Affiliation(s)
- Aukje M Meijerink
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinoud E Oomen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kathrin Fleischer
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gwendolyn H Woldringh
- Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
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Roque M, Valle M, Marques F, Sampaio M, Geber S. Intracytoplasmic sperm injection outcomes with cryopreserved testicular sperm aspiration samples. Andrologia 2015; 48:252-6. [PMID: 25998234 DOI: 10.1111/and.12439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/28/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) may be performed with testicular frozen-thawed spermatozoa in patients with nonobstructive azoospermia (NOA). Sperm retrieval can be performed in advance of oocyte aspiration, as it may avoid the possibility of no recovery of spermatozoa on the day of oocyte pickup. There are few studies available in the literature concerning the use of frozen-thawed spermatozoa obtained from testicular sperm aspiration (TESA). To evaluate the effects and the outcomes of ICSI with frozen-thawed spermatozoa obtained by TESA, we performed a retrospective analysis of 43 ICSI cycles using frozen-thawed TESA. We obtained acceptable results with a fertilisation rate of 67.9%, an implantation rate (IR) of 17.1%, and clinical and ongoing pregnancy rates of 41.9% and 37.2% respectively. The results of this study suggest that performing ICSI using cryopreserved frozen-thawed testicular spermatozoa with TESA as a first option is a viable, safe, economic and effective method for patients with NOA.
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Affiliation(s)
- M Roque
- Origen - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - M Valle
- Origen - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - F Marques
- Origen - Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - M Sampaio
- Origen - Center for Reproductive Medicine, Belo Horizonte, Brazil
| | - S Geber
- Origen - Center for Reproductive Medicine, Belo Horizonte, Brazil.,Medical School - Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Wöber M, Ebner T, Steiner SL, Strohmer H, Oppelt P, Plas E, Obruca A. A new method to process testicular sperm: combining enzymatic digestion, accumulation of spermatozoa, and stimulation of motility. Arch Gynecol Obstet 2014; 291:689-94. [DOI: 10.1007/s00404-014-3458-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/29/2014] [Indexed: 12/01/2022]
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Park YS, Kim MK, Lim CK, Lee SH, Park DW, Seo JT, Yang KM. Efficacy of cryopreservation of embryos generated by intracytoplasmic sperm injection with spermatozoa from frozen testicular tissue. J Assist Reprod Genet 2014; 31:1331-6. [PMID: 25141840 DOI: 10.1007/s10815-014-0304-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/17/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the viability of frozen embryos generated by intracytoplasmic sperm injection (ICSI) with frozen testicular spermatozoa. METHODS A total of 68 fresh embryo transfer (ET) cycles and 85 subsequent frozen-thawed ET (FET) cycles were grouped according to the source of spermatozoa: fresh testicular spermatozoa (TESE) or frozen-thawed testicular spermatozoa (t-TESE). RESULTS There were no significant differences in the age of female patients, number of oocytes, or fertilization rates in fresh ET cycles with TESE (TESE-fresh ET) versus t-TESE (t-TESE-fresh ET). The rate of embryo survival after thawing (95.7 % vs. 94.0 %) was similar in frozen ET cycles (FET) with TESE (TESE-FET) and with t-TESE (t-TESE-FET). While there were significant differences in the proportion of good quality embryos, no statistical differences were found in the pregnancy or clinical abortion rates between the two groups. Moreover, delivery rates were not significantly different. CONCLUSIONS Although the proportion of good quality embryos was affected by cryopreservation of testicular tissue, embryo survival rate was not. As well, subsequent pregnancy could be achieved successfully via t-TESE-FET cycles. Therefore, FET is not affected by the cryopreservation of testicular tissue, and avoids further oocyte retrieval and TESE procedures.
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Affiliation(s)
- Yong-Seog Park
- Laboratory of Reproductive Medicine, Department of Urology, Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, 100-380, Republic of Korea,
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Ronn R, Holzer HEG. Oncofertility in Canada: cryopreservation and alternative options for future parenthood. CURRENT ONCOLOGY (TORONTO, ONT.) 2014; 21:e137-46. [PMID: 24523611 DOI: 10.3747/co.20.1360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cancer can be a devastating diagnosis. In particular, malignancy and its indicated treatments have profoundly negative effects on the fertility of young cancer patients. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer therapies and to facilitate fertility preservation. In Canada, these fertility issues are often inadequately addressed despite the availability of resources. The goal of this four-part series is to facilitate systemic improvements in fertility preservation for adolescent and young adult Canadians with a new diagnosis of cancer. METHODS This article reviews fertility preservation options that use cryopreservation techniques. It also outlines some of the alternative options for future parenthood. RESULTS Cryopreservation of a woman's gametes and gonadal tissue may involve embryo, oocyte, and ovarian tissue cryopreservation with or without ovarian stimulation. Similarly, male gametes and gonadal tissue may be cryopreserved. Techniques and success rates continue to improve. Third-party assistance through gamete donation, gestational carriers, and adoption are also alternative options for parenthood. CONCLUSIONS Cryopreservation techniques are especially feasible options for fertility preservation in the newly diagnosed cancer patient.
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Affiliation(s)
- R Ronn
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - H E G Holzer
- McGill University Health Centre, Reproductive Centre, and Department of Obstetrics and Gynecology, McGill University, Montreal, QC
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Ohlander S, Hotaling J, Kirshenbaum E, Niederberger C, Eisenberg ML. Impact of fresh versus cryopreserved testicular sperm upon intracytoplasmic sperm injection pregnancy outcomes in men with azoospermia due to spermatogenic dysfunction: a meta-analysis. Fertil Steril 2014; 101:344-9. [PMID: 24345355 DOI: 10.1016/j.fertnstert.2013.10.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/17/2013] [Accepted: 10/05/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if clinical pregnancy rates and fertilization rates with the use of cryopreserved sperm for intracytoplasmic sperm injection (ICSI) in patients with azoospermia due to spermatogenic dysfunction (i.e., nonobstructive azoospermia) are similar to those with fresh sperm. DESIGN Systematic review and meta-analysis. SETTING Academic medical center. PATIENT(S) Azoospermic men secondary to spermatogenic dysfunction. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate, fertilization rate. RESULT(S) Eleven studies met criteria for the outcome of clinical pregnancy rate. Seventy-nine (28.7%) of 275 intracytoplasmic sperm injection cycles using fresh testicular sperm resulted in a clinical pregnancy, compared with 84 (28.1%) of 299 intracytoplasmic sperm injection cycles using cryopreserved sperm (relative risk [RR] 1.00, 95% confidence interval [CI] 0.75-1.33). Ten studies met criteria for the outcome of fertilization rate. A total of 1,422 (52.9%) of 2,687 oocytes injected with fresh testicular sperm were fertilized, compared with 1,490 (54.0%) of 2,757 oocytes injected with cryopreserved sperm (RR 0.97, 95% CI 0.92-1.02). CONCLUSION(S) In men with azoospermia due to spermatogenic dysfunction, there is no statistical difference between the use of fresh versus cryopreserved-thawed testicular sperm when assessing clinical pregnancy or fertilization rates in couples undergoing ICSI.
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Karacan M, Alwaeely F, Erkan S, Çebi Z, Berberoğlugil M, Batukan M, Uluğ M, Arvas A, Çamlıbel T. Outcome of intracytoplasmic sperm injection cycles with fresh testicular spermatozoa obtained on the day of or the day before oocyte collection and with cryopreserved testicular sperm in patients with azoospermia. Fertil Steril 2013; 100:975-80. [DOI: 10.1016/j.fertnstert.2013.06.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 06/18/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Omurtag K, Cooper A, Bullock A, Naughton C, Ratts V, Odem R, Lanzendorf SE. Sperm recovery and IVF after testicular sperm extraction (TESE): effect of male diagnosis and use of off-site surgical centers on sperm recovery and IVF. PLoS One 2013; 8:e69838. [PMID: 23922817 PMCID: PMC3726782 DOI: 10.1371/journal.pone.0069838] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/13/2013] [Indexed: 12/02/2022] Open
Abstract
Objective Determine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation. Patients One hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm. Outcome Measures Successful sperm recovery defined as 1–2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n = 60), non-obstructive azoospermia (n = 39), cancer (n = 14), paralysis (n = 7) and other (n = 10). Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n = 22), vasectomy or failed vasectomy reversal (n = 37) and “other”(n = 1). Sperm recovery was also evaluated by surgical site including infertility clinic (n = 54), hospital operating room (n = 67) and physician’s office (n = 11). Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm. Results Testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p = <0.0001) compared to other male diagnoses (66%, p = <0.0001, 59% p = 0.015). No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p = 0.0371) compared to diagnoses of cancer, paralysis or other (16.7%). Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p = 0.007) compared to those with other diagnoses (44%). Conclusion Testicular sperm extraction is a safe and effective option regardless of the etiology of the azoospermia. The type of surgical center and/or its distance from the laboratory was not related to success. Men with non-obstructive azoospermia have a lower chance of successful sperm retrieval and fertilization.
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Affiliation(s)
- Kenan Omurtag
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Washington University, St Louis, Missouri, United States of America.
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Prins GS, Bremner W. The 25th Volume: President's Message: Andrology in the 20th Century: A Commentary on Our Progress During the Past 25 Years. ACTA ACUST UNITED AC 2013; 25:435-40. [PMID: 15223830 DOI: 10.1002/j.1939-4640.2004.tb02812.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Gail S Prins
- Department of Urology, University of Illinois, Chicago, USA
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Gangrade BK. Cryopreservation of testicular and epididymal sperm: techniques and clinical outcomes of assisted conception. Clinics (Sao Paulo) 2013; 68 Suppl 1:131-40. [PMID: 23503963 PMCID: PMC3583152 DOI: 10.6061/clinics/2013(sup01)15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 07/28/2012] [Indexed: 11/18/2022] Open
Abstract
The introduction of the technique of intracytoplasmic sperm injection to achieve fertilization, especially using surgically retrieved testicular or epididymal sperm from men with obstructive or non-obstructive azoospermia, has revolutionized the field of assisted reproduction. The techniques for the retrieval of spermatozoa vary from relatively simple percutaneous sperm aspiration to open excision (testicular biopsy) and the more invasive Micro-TESE. The probability of retrieving spermatozoa can be as high as 100% in men with obstructive azoospermia (congenital bilateral absence of the vas deferens, status post-vasectomy). However, in nonobstructive azoospermia, successful sperm retrieval has been reported in 10-100% of cases by various investigators. The surgical retrieval and cryopreservation of sperm, especially in men with non-obstructive azoospermia, to some extent ensures the availability of sperm at the time of intracytoplasmic sperm injection. In addition, this strategy can avoid unnecessary ovarian stimulation in those patients intending to undergo in vitro fertilization-intracytoplasmic sperm injection with freshly retrieved testicular sperm when an absolute absence of sperm in the testis is identified. Several different methods for the cryopreservation of testicular and epididymal sperm are available. The choice of the container or carrier may be an important consideration and should take into account the number or concentration of the sperm in the final preparation. When the number of sperm in a testicular biopsy sample is extremely low (e.g., 1-20 total sperm available), the use of an evacuated zona pellucida to store the cryopreserved sperm has been shown to be an effective approach.
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Popal W, Nagy ZP. Laboratory processing and intracytoplasmic sperm injection using epididymal and testicular spermatozoa: what can be done to improve outcomes? Clinics (Sao Paulo) 2013; 68 Suppl 1:125-30. [PMID: 23503962 PMCID: PMC3583163 DOI: 10.6061/clinics/2013(sup01)14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022] Open
Abstract
There are two main reasons why sperm may be absent from semen. Obstructive azoospermia is the result of a blockage in the male reproductive tract; in this case, sperm are produced in the testicle but are trapped in the epididymis. Non-obstructive azoospermia is the result of severely impaired or non-existent sperm production. There are three different sperm-harvesting procedures that obstructive azoospermic males can undergo, namely MESA (microsurgical epididymal sperm aspiration), PESA (percutaneous epididymal sperm aspiration), and TESA (testicular sperm aspiration). These three procedures are performed by fine-gauge needle aspiration of epididymal fluid that is examined by an embryologist. Additionally, one technique, called TESE (testicular sperm extraction), is offered for males with non-obstructive azoospermia. In this procedure, a urologist extracts a piece of tissue from the testis. Then, an embryologist minces the tissue and uses a microscope to locate sperm. Finding sperm in the testicular tissue can be a laborious 2- to 3-hour process depending on the degree of sperm production and the etiology of testicular failure. Sperm are freed from within the seminiferous tubules and then dissected from the surrounding testicular tissue. It is specifically these situations that require advanced reproductive techniques, such as ICSI, to establish a pregnancy. This review describes eight different lab processing techniques that an embryologist can use to harvest sperm. Additionally, sperm cryopreservation, which allows patients to undergo multiple ICSI cycles without the need for additional surgeries, will also be discussed.
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Affiliation(s)
- Wana Popal
- Reproductive Biology Associates, Atlanta, GA, USA.
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Botelho F, Figueiredo L, Leite R, Carvalho A, Tomada N, Vendeira P. Predictive factors of a successful testicular biopsy and subsequent clinical pregnancy. Andrologia 2012; 44:237-42. [PMID: 22272771 DOI: 10.1111/j.1439-0272.2012.01276.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2011] [Indexed: 11/27/2022] Open
Abstract
Forecast of success with testicular sperm extraction and intracytoplasmic sperm injection (ICSI) remains unknown, as predictive factors have rarely been studied. We evaluated the association among possible predictive factors and a successful biopsy and clinical pregnancy. A consecutive sample of men submitted to a testicular open biopsy in S. João Hospital was used. Patient's age, medical history, testicular volume, spermogram, genetic testing, endocrinologic results, biopsy results and clinical pregnancy information were collected. From the 113 men included, it was possible to retrieve spermatozoa in 79.6% of the cases, which resulted in 58 fertilisations and 22 clinical pregnancies. Retrieving viable spermatozoa on biopsy was associated with the identification of spermatozoa in the spermogram (100.0% versus 74.4%; P = 0.010), diseases causing obstructive infertility (100.0% versus 79.2%; P = 0.036) and no genetic causes detected (82.4% versus 54.5%; P = 0.030). Successful clinical pregnancy was only associated with lower female partner age (31.7 versus 36.0 year; P = 0.001) but not the quality of the spermatozoa or the time until the reproduction cycle. Identification of spermatozoa in the spermogram, diseases causing obstructive infertility and lack of genetic causes for infertility were associated with higher probability of viable spermatozoa retrieval but the female partner age remained the principal determinant of a successful pregnancy.
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Affiliation(s)
- F Botelho
- Department of Urology, S. João Hospital, Porto, Portugal.
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Nuñez-Calonge R, Cortes S, Gago M, López P, Caballero-Peregrin P. Increased fertilization rates after in vitro culture of frozen-thawed testicular immotile sperm in nonobstructive azoospermic patients. ISRN UROLOGY 2012; 2012:108576. [PMID: 22567413 PMCID: PMC3329651 DOI: 10.5402/2012/108576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/19/2011] [Indexed: 04/13/2023]
Abstract
Objective. To optimise the use of freeze/thaw testicular immotile spermatozoa from nonobstructive azoospermia patients and to analyse the outcome of intracytoplasmic sperm injection (ICSI) of such spermatozoa. Methods. Testicular specimens were retrieved and cryopreserved from forty patients with nonobstructive azoospermia and underwent one cycle with thawed spermatozoa (Group I) that led to pregnancy in sixteen cases. Twenty-four patients of group I underwent treatment with the same batch of thawed spermatozoa (Group II). For the first ICSI attempt, injection was performed when motile spermatozoa were found. In group II, injection was performed when maximum motility was reached. We compared mean of fertilization rate, embryo quality, clinical pregnancy rate and embryo implantation rate. Results. The mean percentage of motility was significantly higher in the group II than in the group I (18, 6 versus 8, 2). Group I showed a significant decrease in fertilization rates when compared with cryopreserved testicular spermatozoa in group II (54% versus 72%, P < 0.05). No difference was noted between the cleavage rate, embryo quality, clinical pregnancy rates and implantation rates among group II and I. Conclusion. Fecundation rate can be significantly improved after in-vitro culture and sperm selection of frozen-thawed immotile testicular spermatozoa in patients with nonobstructive azoospermia.
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Affiliation(s)
- R. Nuñez-Calonge
- Reproduction Unit, CLTNTCA Tambre, Calle Tambre no. 8, 28002 Madrid, Spain
- *R. Nuñez-Calonge:
| | - S. Cortes
- Reproduction Unit, CLTNTCA Tambre, Calle Tambre no. 8, 28002 Madrid, Spain
| | - M. Gago
- Reproduction Unit, CLTNTCA Tambre, Calle Tambre no. 8, 28002 Madrid, Spain
| | - P. López
- Reproduction Unit, CLTNTCA Tambre, Calle Tambre no. 8, 28002 Madrid, Spain
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Human Sperm Cryopreservation: Update on Techniques, Effect on DNA Integrity, and Implications for ART. Adv Urol 2011; 2012:854837. [PMID: 22194740 PMCID: PMC3238352 DOI: 10.1155/2012/854837] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/22/2011] [Accepted: 09/27/2011] [Indexed: 11/18/2022] Open
Abstract
Cryopreservation of human spermatozoa-introduced in the 1960's-has been recognized as an efficient procedure for management of male fertility before therapy for malignant diseases, vasectomy or surgical infertility treatments, to store donor and partner spermatozoa before assisted reproduction treatments and to ensure the recovery of a small number of spermatozoa in severe male factor infertility. Despite the usefulness of it, cryopreservation may lead to deleterious changes of sperm structure and function: while the effects of cryopreservation on cells are well documented, to date there is no agreement in the literature on whether or not cryopreservation affects sperm chromatin integrity or on the use of a unique and functional protocol for the freezing-thawing procedure. Therefore, sperm cryopreservation is an important component of fertility management and much of its successful application seems to affect the reproductive outcome of assisted reproduction technologies (ART): appropriate use of cryoprotectants before and sperm selection technologies after cryopreservation seem to have the greatest impact on preventing DNA fragmentation, thus improving sperm cryosurvival rates.
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Esteves SC, Miyaoka R, Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011; 37:570-83. [DOI: 10.1590/s1677-55382011000500002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
| | - Ricardo Miyaoka
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
| | - Ashok Agarwal
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
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39
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Current options for preservation of fertility in the male. Fertil Steril 2011; 96:286-90. [DOI: 10.1016/j.fertnstert.2011.06.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/10/2011] [Indexed: 12/26/2022]
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Merchant R, Gandhi G, Allahbadia GN. In vitro fertilization/intracytoplasmic sperm injection for male infertility. Indian J Urol 2011; 27:121-32. [PMID: 21716935 PMCID: PMC3114573 DOI: 10.4103/0970-1591.78430] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Progress in the field of assisted reproduction, and particularly micromanipulation, now heralds a new era in the management of severe male factor infertility, not amenable to medical or surgical correction. By overcoming natural barriers to conception, in vitro fertilization and embryo transfer (IVF-ET), subzonal sperm insemination, partial zona dissection, and intracytoplasmatic injection of sperm (ICSI) now offer couples considered irreversibly infertile, the option of parenting a genetically related child. However, unlike IVF, which necessitates an optimal sperm number and function to successfully complete the sequence of events leading to fertilization, micromanipulation techniques, such as ICSI, involving the direct injection of a spermatozoon into the oocyte, obviate all these requirements and may be used to alleviate severe male factor infertility due to the lack of sperm in the ejaculate due to severely impaired spermatogenesis (non-obstructive azoospermia) or non-reconstructable reproductive tract obstruction (obstructive azoospermia). ICSI may be performed with fresh or cryopreserved ejaculate sperm where available, microsurgically extracted epididymal or testicular sperm with satisfactory fertilization, clinical pregnancy, and ongoing pregnancy rates. However, despite a lack of consensus regarding the genetic implications of ICSI or the application and efficacy of preimplantation genetic diagnosis prior to assisted reproductive technology (ART), the widespread use of ICSI, increasing evidence of the involvement of genetic factors in male infertility and the potential risk of transmission of genetic disorders to the offspring, generate major concerns with regard to the safety of the technique, necessitating a thorough genetic evaluation of the couple, classification of infertility and adequate counseling of the implications and associated risks prior to embarking on the procedure. The objective of this review is to highlight the indications, advantages, limitations, outcomes, implications and safety of using IVF/ICSI for male factor infertility to enable a more judicious use of these techniques and maximize their potential benefits while minimizing foreseen complications.
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Affiliation(s)
- Rubina Merchant
- Deccan Fertility Clinic, Rotunda - Center for Human Reproduction, Mumbai, India
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Peng QP, Cao SF, Lyu QF, Xue SG, Jin W, Liu XY, Zhang WJ, Nielsen HI, Kuang YP. A novel method for cryopreservation of individual human spermatozoa. In Vitro Cell Dev Biol Anim 2011; 47:565-72. [PMID: 21638160 DOI: 10.1007/s11626-011-9428-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 05/15/2011] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to develop a novel method for the cryopreservation and efficient post-thaw recovery of individual or small numbers of human spermatozoa. Spermatozoa equilibrated in cryoprotectant buffer were injected with an intracytoplasmic sperm injection (ICSI) needle into a droplet of cryoprotectant on a homemade cryoleaf. The droplet was of cryoprotectant and seminal plasma at a ratio of 1:1. The sperm-loaded cryoleaf was slowly lowered over and stored in liquid nitrogen. Spermatozoa were thawed in a 37°C oil bath without dilution and centrifugation. To test the fertilizing ability of these spermatozoa, the recovered spermatozoa were injected by ICSI into 1-d-old or in vitro-matured human oocytes. Fresh spermatozoa from the same semen samples served as controls. The trials were performed in two separate experiments. In the first set of experiments, 92 spermatozoa were thawed and carefully investigated. The spermatozoa from percutaneous epididymal sperm aspiration had a motility recovery of 92.9% (13/14); ejaculated spermatozoa had a motility recovery of 61.5% (48/78), and only 1.3% (1/78) was lost. Together in the first and second set of experiments, the fertilization rates for the fresh and frozen-thawed spermatozoa were 67.6% (25/37) and 60.6% (40/66), respectively (P = 0.052). The mean embryo cleavage rates in the fresh and frozen-thawed groups were 88% (22/25) and 85% (34/40), respectively (P = 0.990). This cryopreservation method for individual or small numbers of human spermatozoa was efficient and simple. These findings make this method a promising technique for the clinical application of ejaculated sperm from oligozoospermic patients.
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Affiliation(s)
- Qiu-Ping Peng
- Department of Assisted Reproduction, Shanghai 9th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 ZhiZaoJu Road, 200011, Shanghai, China.
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Kalsi J, Thum MY, Muneer A, Pryor J, Abdullah H, Minhas S. Analysis of the outcome of intracytoplasmic sperm injection using fresh or frozen sperm. BJU Int 2010; 107:1124-8. [DOI: 10.1111/j.1464-410x.2010.09545.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Woldringh GH, Besselink DE, Tillema AHJ, Hendriks JCM, Kremer JAM. Karyotyping, congenital anomalies and follow-up of children after intracytoplasmic sperm injection with non-ejaculated sperm: a systematic review. Hum Reprod Update 2010; 16:12-9. [PMID: 19700489 DOI: 10.1093/humupd/dmp030] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For men with azoospermia, it is possible to father their own progeny by intracytoplasmic sperm injection (ICSI) with epididymal or testicular sperm. Some studies show that children born after assisted reproductive technology (ART) are at increased risk of birth defects, other studies suggest that there is no extra concern about ICSI children conceived with epididymal or testicular sperm. METHODS Studies about the karyotypes of fetuses, congenital anomalies and the follow-up of the children born after ICSI with non-ejaculated sperm were identified by means of a systematic literature search. RESULTS Eight relevant studies were identified; two studies reported karyotype, five reported malformations and one reported follow-up of children after ICSI. In total, there were 55 out of 1973 (2.8%) abnormal karyotypes in the ICSI with ejaculated sperm group, 0 out of 31 in the ICSI with epididymal sperm group and 5 out of 191 (2.6%) in the ICSI with testicular sperm group. Major malformations were found in 543 out of 12 377 (4.4%) in the ICSI with ejaculated sperm group, 17 out of 533 (3.2%) in the ICSI with epididymal sperm group and 31 out of 670 (4.6%) in the ICSI with testicular sperm group. CONCLUSIONS Although there were no statistical differences, the study groups were small and heterogenic, with a number of potential biases. We therefore recommend a standardized methodology of follow-up studies after ART, with well-defined groups of ICSI with ejaculated sperm, ICSI with epididymal sperm and ICSI with testicular sperm, and a control group of naturally conceived children.
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Affiliation(s)
- G H Woldringh
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, The Netherlands.
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Carpi A, Sabanegh E, Mechanick J. Controversies in the management of nonobstructive azoospermia. Fertil Steril 2009; 91:963-70. [DOI: 10.1016/j.fertnstert.2009.01.083] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 01/12/2009] [Accepted: 01/16/2009] [Indexed: 02/06/2023]
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Pires I, Figueiredo H, Ferraz L, Pinelo S, Serra H, Barbosa A, Felgueira E, Tavares A. Resultados da ICSI-TESE em azoospermia: influência da etiologia e criopreservação. Rev Int Androl 2009. [DOI: 10.1016/s1698-031x(09)70258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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Lee J, Binsaleh S, Lo KC, Jarvi K. Varicocelectomy May Benefit Men With a Sertoli Cell-Only Pattern on Microsurgical Testicular Sperm Extraction: A Case Report. Urology 2008; 71:1226.e17-8. [DOI: 10.1016/j.urology.2007.11.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 10/23/2007] [Accepted: 11/20/2007] [Indexed: 11/15/2022]
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48
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49
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Núñez Calonge R, Cortés Gallego S, Gago García M, García Segovia Á, Peramo Moya B, Caballero Peregrín P. Optimización de los resultados de microinyección intracitoplasmática con espermatozoides congelados y descongelados procedentes de biopsia de testículo. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Pires I, Figueiredo H, Ferraz L, Serra H, Barbosa A, Felgueira E, Tavares A. Criopreservação e biópsia testicular: análise de resultados. Rev Int Androl 2007. [DOI: 10.1016/s1698-031x(07)74046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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