Fertilization and pregnancy achieved by intracytoplasmic injection of sperm retrieved from testicular biopsies

Impact of sperm retrieval [corrected] on testis and epididymis: an experimental study using Wistar albino rats

The aim of this study was to analyze pathophysiological changes after testicular sperm aspiration (TESA) and microsurgical epididymal sperm aspiration (MESA) procedures. Twenty four mature male Wistar albino rats with a proven breeding history, weighing approximately 200-250 gm were used for the study. Animals were randomly divided into four groups (n = 6), i.e., control, sham-control, unilateral TESA, and MESA. Using a 22G needle, the aspiration procedures were done in testis or caudal epididymis. At the end of 60 days of survival, blood samples were collected and processed for antisperm antibody detection by enzyme-linked immunosorbent assay (ELISA). After euthanasia, testes and epididymides were collected and processed for paraffin embedding. Sections were stained with hematoxylin and eosin, and TUNEL technique. Serum antisperm antibody titer significantly increased in TESA (P < 0.001) when compared to MESA. Histomorphometric analysis indicated testicular alterations in TESA and MESA, with significant damage in TESA in both testes (P < 0.001). Following the MESA procedure, ipsilateral caudal and carpus epididymis showed significant alterations (P < 0.001) and no such alterations were seen in the ipsilateral caput and intact contralateral epididymis. TUNEL staining revealed an up-regulation of apoptosis in both contra- and ipsilateral testes of TESA. Needle prick had produced drastic and irreversible alterations in testis of TESA. Ensuing processes of immunological and inflammatory reaction had the potential to disrupt spermatogenesis and increase germ cell apoptosis. However, extrapolating conclusions from the experimental model to the clinic needs to be done cautiously.

Fertilization and embryonic developmental capacity of epididymal and testicular sperm and immature spermatids and spermatocytes

Spermatogenesis in mammalian species begins after birth. The gonocytes, arrested at G2 of the cell cycle in the foetus, resume mitotic proliferation after birth. As identified in the mouse, the gonocytes migrate towards the periphery of the seminiferous cords at day 4 to day 6 after birth and are located in close contact with the basal lamina. From this stage the gonocytes are referred to as primitive type A spermatogonia. These cells continue mitotic proliferation and differentiate to form type B spermatogonia. By day 10 after birth, many of the type B spermatogonia have formed preleptotene primary spermatocytes which undergo a final phase of DNA synthesis (leptotene) prior to entering meiotic prophase (zygotene).

Effects of various cryopreservation media and freezing-thawing on the morphology of rat testicular biopsies

Currently, testicular sperm extraction is successfully combined with intracytoplasmic sperm injection into the oocyte (ICSI). Several pieces of a testicular biopsy can be frozen and thawed until the ICSI attempt. In this study, the effects of freezing-thawing on the morphology of rat testicular biopsies stored in different cryopreservation media were analysed. Each cryopreservation medium contained glycerol and/or dimethyl sulfoxide (DMSO) as cryoprotectants. In general, both glycerol and DMSO, when applied at moderate concentrations (6-25%), preserved the structure of the seminiferous epithelium. The freezing-thawing procedure had no significant effect on tubular diameter; however, it caused a 'folding' of the lamina propria and notable damage to Sertoli cells, spermatogonia and spermatocytes. Round and elongated spermatids and spermatozoa displayed occasional nuclear damage, vacuolization, and shrinkage/swelling of the cytoplasm. However, the vast majority of these cells maintained their normal structure in nearly all the applied cryomedia. It is concluded that freezing-thawing of testicular biopsies, and the cryopreservation medium, have a significant impact on the structure of the seminiferous epithelium, particularly on its basal compartment.

Human pregnancies after transfer of fresh (four- to eight-cell) versus frozen-thawed blastocysts resulting from intracytoplasmic sperm injection

PURPOSE

The objective of this study was to obtain expanded blastocysts following intracytoplasmic sperm injection (ICSI) and Vero-cell co-culture, cryopreserve them at this stage, and transfer the frozen-thawed blastocysts to obtain pregnancies.

METHODS

Twenty-two couples with severe male-factor infertility or failed fertilization in a previous in vitro fertilization cycle were included in this study. ICSI was performed for all of them, and sperm-injected oocytes were immediately subjected to Vero-cell co-culture for varying intervals. Then 14 couples were treated by embryo transfer at the four- to eight-cell stage (Group I), whereas 8 couples were treated by transfer of frozen-thawed blastocysts (Group II).

RESULTS

Percentages of cleaved embryos and term survival rates were 57.1 and 73.3% for Group I and 50.0 and 37.5% for Group II, respectively.

CONCLUSIONS

Blastocysts obtained after ICSI and Vero-cell co-culture can retain developmental competence after cryopreservation and thawing. Transfer of frozen-thawed blastocysts derived by these means holds promise for establishment of viable pregnancies.

Testicular sperm extraction and intracytoplasmic sperm injection: a simplified method for treatment of obstructive azoospermia

OBJECTIVE

To assess the effectiveness of a simple method of testicular sperm extraction for the treatment of obstructive azoospermia.

DESIGN

Retrospective study.

SETTING

Teaching tertiary medical center.

PATIENT(S)

Seventeen men with obstructive azoospermia.

INTERVENTION(S)

The patients underwent 19 cycles of intracytoplasmic sperm injection (ICSI) using testicular sperm. In 5 cycles, testicular sperm extraction was performed after failed microepididymal sperm aspiration. In 14 cycles, testicular sperm extraction was performed in the office under local anesthesia from the outset. The outcome was compared with ICSI cycles using ejaculated sperm (95 cycles) and epididymal sperm (12 cycles fresh and 9 cycles frozen-thawed).

MAIN OUTCOME MEASURE(S)

Clinical pregnancy and implantation rates.

RESULT(S)

There were no differences in the fertilization, cleavage, implantation, or clinical pregnancy rates among ICSI cycles using testicular, epididymal (fresh or frozen-thawed), or ejaculated sperm.

CONCLUSION(S)

When used in conjunction with ICSI, testicular sperm extraction from small excisional biopsy is a simple and cost-effective method for the treatment of obstructive azoospermia.

Approaches for obtaining sperm in patients with male factor infertility

OBJECTIVE

To describe methods of sperm retrieval for intracytoplasmic sperm injection (ICSI) in patients with male factor infertility and to review the clinical results using sperm from the different sources.

DESIGN

The literature on sperm-obtaining methods and ICSI was reviewed. Studies related to this topic were identified through MEDLINE.

RESULTS(S)

This review describes the evolution of sperm retrieval methods. Sperm can be obtained by microepididymal sperm aspiration (MESA), percutaneous sperm aspiration (PESA), and testicular sperm extraction (TESE), from patients with congenital absence of the vas deferens or acquired vas obstruction. When ICSI is performed with ejaculated, epididymal, or testicular sperm, good fertilization and pregnancy rates are achieved without significant differences among the various sperm sources. The original percutaneous sperm aspiration method has been modified slightly and yields successful results.

CONCLUSION(S)

Viable pregnancies can be achieved with ICSI by using not only ejaculated sperm, but also epididymal and testicular sperm. Microepididymal sperm aspiration, percutaneous sperm aspiration, modified percutaneous sperm aspiration, and testicular sperm extraction can be considered standard procedures to treat male factor infertility.

In-vitro initiation of forward motility in testicular spermatozoa

Initiation of forward motility in vitro was investigated in goat and ram spermatozoa obtained from the rete testis. No forward motility was generated in the immotile testicular spermatozoa when they were incubated in a modified Ringer's solution containing theophylline (30 mM) and epididymal plasma (2 mg protein/ml). However, these reagents induced non-progressive flagellar movement in approximately 25% of spermatozoa. Bicarbonate (25 mM) induced forward motility in approximately 16% of the goat/ram testicular spermatozoa. Theophylline was essential for the bicarbonate-mediated activation of sperm motility, but epididymal plasma had no significant effect on this activation process. Theophylline activated progressive motility in testicular spermatozoa in a dose-dependent manner, the maximum effect occurring after incubation for 10 min with 30 mM theophylline. The initiation profile of in-vitro motility of goat/ram spermatozoa from the caput epididymis closely resembled that of testicular spermatozoa except that induction of motility in the caput spermatozoa was dependent both on bicarbonate and epididymal plasma. The data indicate that, unlike caput epididymal spermatozoa, initiation of motility in testicular spermatozoa is not dependent on motility-promoting protein(s) in epididymal plasma.