Factors predicting the outcome of percutaneous epididymal sperm aspiration in men with obstructive azoospermia
https://doi.org/10.4081/aiua.2022.3.323
Accepted: July 17, 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Objectives: To report on the live birth rates (LBRs) following percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia (OA) and factors affecting treatment outcome which is under reported in the literature.
Methods: This is a multicenter study that was conducted in Egypt including all couples undergoing intra cytoplasmic sperm injection (ICSI) for OA using PESA-derived sperms. Men were subdivided according to aetiology into congenital, iatrogenic and idiopathic groups. Fertilization, pregnancy and LBRs were determined and compared in each group. The longitudinal LBR, crude and expected cumulative delivery rates (CCDR, ECDR) were calculated. Multiple logistic regression analysis was used to determine significant associations between maternal, paternal and ICSI factors with successful live births.
Results: Ninety couples were included in the study. Viable sperm for ICSI was retrieved in 89 men (98.9%). A total of 155 ICSI cycles with 17 frozen embryo transfers resulted in 81 pregnan-cies and 55 live births. After 5 cycles, the longitudinal LBR, CCDR and ECDR were 30%, 57.3% and 88.6% respectively. Maternal age and number of fertilized eggs were the only fac-tors significantly affecting LBRs.
Conclusions: PESA is a minimally invasive procedure for secur-ing viable sperm for ICSI in OA men, with high cumulative delivery rates. Maternal age and number of fertilized eggs are the only factors that significantly affecting LBR. The contempo-rary longitudinal and cumulative LBRs provide objective out-come data to counsel OA patients undergoing fertility treat-ments.
Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoosper-mic patient. J Urol. 1989; 142:162. DOI: https://doi.org/10.1016/S0022-5347(17)38662-7
Tournaye H, Devroey P, Nagy J, et al. Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effec-tive approach to infertility as a result of congenital bilateral absence of the vas deferens Fertil Steril. 1994; 61:1045-105. DOI: https://doi.org/10.1016/S0015-0282(16)56754-5
Shrivastav P, Nadkarni P, Wensvoort S, Craft I. Percutaneous epi-didymal sperm aspiration for obstructive azoospermia. Hum Reprod. 1994; 9:2058-61. DOI: https://doi.org/10.1093/oxfordjournals.humrep.a138393
Kovac JR, Lehmann KJ, Fischer MA. A single-center study exam-ining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia. Urol Ann. 2014; 6:41-45. DOI: https://doi.org/10.4103/0974-7796.127026
Esteves SC, Lee W, Benjamin DJ, et al. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol. 2013; 189:232-7. DOI: https://doi.org/10.1016/j.juro.2012.08.084
Almekaty K, Abomelha S, Thum Y, et al. Reporting on longitudi-nal live birth rates and cumulative delivery rates are more realistic outcome measures than sperm retrieval rates in couples undergoing mTESE–ICSI. Hum Fertil. 2018; 22:139-144. DOI: https://doi.org/10.1080/14647273.2018.1472396
Hull M, Eddowes H, Fahy U, et al. Expectations of assisted con-ception for infertility. BMJ. 1992; 304:1465-1469. DOI: https://doi.org/10.1136/bmj.304.6840.1465
Pasqualotto FF, Rossi Ferragut LM, Rocha CC, et al. Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonob-structive azoospermia. J Urol. 2002; 167:1753-6. DOI: https://doi.org/10.1016/S0022-5347(05)65193-2
Pasqualotto F, Rossi-Ferragut L, Rocha C, et al. The efficacy of repeat percutaneous epididymal sperm aspiration procedures. J Urol. 2003; 169:1779-81. DOI: https://doi.org/10.1097/01.ju.0000066849.32466.2b
Glina S, Fragoso J, Martins F, et al. Percutaneous epididymal sperm aspiration (pesa) in men with obstructive azoospermia. Int Braz J Urol. 2003; 29:141-146. DOI: https://doi.org/10.1590/S1677-55382003000200008
Naru T, Sulaiman MN, Kidwai A, et al. Intracytoplasmic sperm injection outcome using ejaculated sperm and retrieved sperm in azoospermic men. Urol J. 2008; 5:106-10.
Elhanbly S, El-Saied MA, Fawzy M, et al. Relationship of pater-nal age with outcome of percutaneous epididymal sperm aspiration intracytoplasmic sperm injection, in cases of congenital bilateral absence of the vas deferens. Fertil Steril. 2015; 104:602-6. DOI: https://doi.org/10.1016/j.fertnstert.2015.06.020
Yafi FA, Zini A. Percutaneous epididymal sperm aspiration for men with obstructive azoospermia: predictors of sperm retrieval rates. Fertil Steril. 2013; 100:S448. DOI: https://doi.org/10.1016/j.fertnstert.2013.07.499
Krausz C, Chianese C, Swerdloff RS, Wang C. Emery and Rimoin's Principles and Practice of Medical Genetics (Sixth Edition), Chapter 33 - Genetics of Male Infertility. 2013, Pages 1-18. DOI: https://doi.org/10.1016/B978-0-12-383834-6.00041-0
Lee R, Li PS, Schlegel PN, Goldstein M. Reassessing reconstruc-tion in the management of obstructive azoospermia: Reconstruction or sperm acquisition? Urol Clin North Am. 2008; 35:289-301. DOI: https://doi.org/10.1016/j.ucl.2008.01.005
Bromage SJ, Douglas J, Falconer DA, et al. Factors affecting suc-cessful outcome from ICSI in men following previous vasectomy. World J Urol. 2007; 25:519-24. DOI: https://doi.org/10.1007/s00345-007-0182-7
Ozkavukcu S, Erdemli E, Isik A, Oztuna D, et al. Effects of cry-opreservation on sperm parameters and ultrastructural morphology of human spermatozoa. J Assist Reprod Genet. 2008; 25:403-11. DOI: https://doi.org/10.1007/s10815-008-9232-3
Kumtepe Y, Yakin K, Kahraman S, et al. Male age is not an inde-pendent factor to affect the outcome of assisted reproductive tech-niques. Int J Androl. 2003; 26:161-5. DOI: https://doi.org/10.1046/j.1365-2605.2003.00405.x
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
