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P-463 CLINICAL OUTCOME OF 342 ICSI CYCLES UTILIZING SPERM RETRIEVED BY 3 SURGICAL TECHNIQUES

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Description

OBJECTIVE: The clinical management of men with azoospermia seeking fertility has been a challenge for andrologists, urologists, and reproductive endocrinologists. The surgical sperm retrieval and intracytoplasmic sperm injection have successfully transformed the treatment of male infertility so that now most of the men can father their own children. The aim of this study was to present outcome of 342 intracytoplasmic sperm injection (ICSI) cycles utilizing fresh and cryopreserved sperm retrieved from azoospermic men by 3 surgical techniques.
DESIGN: Comparison of ICSI cycles outcome utilizing sperm retrieved by 3 surgical techniques with fresh ejaculates and ejaculated cryopreserved sperm.
MATERIALS AND METHODS: The data from 1619 ICSI cycles performed during Jan to Dec 2017 were analysed. In 342 cycles, either fresh or cryopreserved sperm retrieved by fine needle aspiration (FNA), microsurgical epididymal sperm aspiration (MESA) or microsurgical testicular sperm extraction (Micro-TESE) were used. The female patients more than 40 years of age were excluded. The ovarian stimulation was initiated on day 3 of the cycle and GnRH antagonist was added later. The oocytes were collected 36 hours post hCG injection. They were denuded 2 hours after collection and ICSI was performed an hour later. The fertilization was checked 18-19 hours post ICSI. Embryo culture was performed in triple gas incubators at 37 degree C, in an atmosphere of 6% CO2, 5% O2 and balance nitrogen. The data were analysed using SPSS ver 23. The significance level was 0.05.
RESULTS: The fresh or cryopreserved sperm retrieved by all 3 surgical procedures were utilized successfully. The female age, number of oocytes retrieved and number of MII oocytes were similar in all groups (P<0.05). The fertilization rate was similar except in the group utilizing cryopreserved sperm from Micro-TESE. Pregnancy rates were higher in groups utilizing fresh sperm from Micro-TESE and MESA (Table 1).
CONCLUSIONS: Freshly collected testicular sperm provide highest pregnancy rate. Although sperm from any surgical procedure were used successfully, pregnancy rates of fresh sperm retrieved by FNA and cryopreserved sperm from Micro-TESE were lower.

Table 1: Patient age, oocyte number, number MII, fertilization and pregnancy rates
FNA-FreshMicro-TESE FreshMicro-TESE FrozenMESA FreshMESA FrozenFresh EjaculateFrozen Ejaculate
n8420215617124334
F Age35.5 ± 6.733.2 ± 4.732.4 ± 5.931 ± 7.034.5 ± 5.132.3 ± 4.933 ± 5.8 
M Age46.5 ± 16.537.4 ± 5.838 ± 9.038 ± 5.842.8 ± 13.038 ± 7.237.8 ± 6.4
Oocytes10.4 ± 5.9 14.1 ± 10.3 11.2 ± 7.3 11 ± 6.412.9 ± 7.812.2 ±  8.710.0 ± 5.4 
MII7.6 ± 4.9 10.6 ± 8.3 7.8 ± 5.59.3 ±5.98.6 ± 6.18.5  ±  6.87.1 ± 4.1
Fertilized4 ± 36.1  ± 5.13.7  ± 3.16.5  ± 4.56.6  ± 4.16.3 ± 4.9  4.5  ± 3.6
Fertilization %5051.343.4*6465.167.556.5
Pregnancy %37*6735*676444*48*