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Vahidi, S., Narimani, N., Abouei, S., Sadeghi, A., Lorian, K., & Rahavian, A. (2021). Comparison of intracytoplasmic sperm injection outcomes in azoospermic men who underwent testicular sperm extraction vs. microdissection testicular sperm extraction: A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 19(9), 837-844. https://doi.org/10.18502/ijrm.v19i9.9716
https://doi.org/10.18502/ijrm.v19i9.9716
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authors
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Serajoddin Vahidi
Serajoddin Vahidi
Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
-
Nima Narimani
Nima Narimani
Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
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Saeid Abouei
Saeid Abouei
Student Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Ali Sadeghi
Ali Sadeghi
Department of Surgical Technology, Faculty of Paramedical, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Keivan Lorian
Keivan Lorian
Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Amirhossein Rahavian
Amirhossein Rahavian
Andrology Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Published Date
- Oct 10, 2021
Comparison of intracytoplasmic sperm injection outcomes in azoospermic men who underwent testicular sperm extraction vs. microdissection testicular sperm extraction: A cross-sectional study
Abstract
Background: Outcomes of intracytoplasmic sperm injection (ICSI) may be different in azoospermic men who undergo testicular sperm extraction (TESE) vs. microdissection-TESE (micro-TESE).
Objective: This study was conducted to compare the ICSI outcomes in men who underwent TESE vs. micro-TESE due to obstructive azoospermia and nonobstructive azoospermia, respectively.
Materials and Methods: A total of 310 azoospermic men who underwent ICSI from September 2016 to September 2020 were enrolled in this cross-sectional study and divided into two groups (172 cases in the TESE and 138 cases in the micro-TESE group). The paternal and maternal age, and the fertilization, biochemical pregnancy, abortion and live birth rates were compared between the two groups.
Results: Maternal mean age was significantly higher in the TESE group (34.9 ± 4.2 yr vs. 32.3 ± 5.7 yr). The fertilization and biochemical pregnancy rates were significantly higher in the TESE group, but the abortion rate was similar in the two groups. The live birth rate was higher in the TESE group, but this difference was not significant (p = 0.06). Also, the maternal and paternal age did not affect ICSI outcomes.
Conclusion: Individuals who underwent TESE had higher fertilization and biochemical pregnancy rates than those who underwent micro-TESE, but the live birth rate was not significantly different.
Keywords: Intracytoplasmic sperm injection, Azoospermia, Testicular sperm extraction, Microdissection testicular sperm extraction, Pregnancy outcome.
References
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[2] Vahidi S, Ardalan A, Mohammad K. Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pac J Public Health 2009; 21: 287-293.
[3] Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989; 142: 62-65.
[4] Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to ICSI for azoospermia. Cochrane Database Syst Rev 2008; 2008: CD002807.
[5] Ghanem M, Bakr NI, Elgayaar MA, El Mongy Sh, Fathy H, Ibrahim AHA. Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non‐obstructive azoospermia in the first cycle: A report of case series and meta‐analysis. Int J Androl 2005; 28: 16-21.
[6] Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics 2011; 66: 691-700.
[7] Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007; 13: 539-549.
[8] Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non‐obstructive azoospermia: A systematic review. Andrology 2014; 2: 20-24.
[9] Verza Jr S, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol 2008; 34: 49-56.
[10] Kanto S, Sugawara J, Masuda H, Sasano H, Arai Y, Kyono K. Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients. Fertil Steril 2008; 90: 2010 e5-e7.
[11] Vernaeve V, Tournaye H, Osmanagaoglu K, Verheyen G, Van Steirteghem A, Devroey P. Intracytoplasmic sperm injection with testicular spermatozoa is less successful in men with nonobstructive azoospermia than in men with obstructive azoospermia. Fertil Steril 2003; 79: 529-533.
[12] Esteves SC, Agarwal A. Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: Case series and systematic review. Clinics 2013; 68 (Suppl.): 141-150.
[13] Bocca S, Moussavi V, Brugh V, Morshedi M, Stadtmauer L, Oehninger S. ICSI outcomes in men undergoing TESE for azoospermia and impact of maternal age. Andrologia 2017; 49: e12617.
[14] Vahidi S, Moein MR, Yazdinejad F, Ghasemi-Esmailabad S, Narimani N. Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center. Int J Reprod BioMed 2020; 18: 1059-1064.
[15] Vahidi S, Narimani N, Ghanizadeh T, Yazdinejad F, Emami M, Mehravaran K, et al. The short abstinence may have paradoxical effects on sperms with different level of DNA integrity: A prospective study. Urol J 2021; in Press.
[16] Pandit S, Sharma R. Non invasive assessment of human oocytes and embryos in assisted reproduction: Review on present practices and future trends. Medical Journal Armed Forces India 2021; in Press.
[17] Wang F, Meng TG, Li J, Hou Y, Luo SM, Schatten H, et al. Mitochondrial Ca2+ is related to mitochondrial activity and dynamic events in mouse oocytes. Front Cell Dev Biol 2020; 8: 1110.
[18] Alkandari MH, Zini A. Medical management of non-obstructive azoospermia: A systematic review. Arab Journal of Urology 2021; 19: 1-6.
[19] Schlegel PN, Berkeley AS, Goldstein M, Cohen J, Alikani M, Adler A, et al. Epididymal micropuncture with in vitro fertilization and oocyte micromanipulation for the treatment of unreconstructable obstructive azoospermia. Fertil Steril 1994; 61: 895-901.
[20] Barroso G, Valdespin C, Vega E, Kershenovich R, Avila R, Avendaño C, et al. Developmental sperm contributions: Fertilization and beyond. Fertil Steril 2009; 92: 835-848.
[21] Oehninger S. Clinical management of male infertility in assisted reproduction: ICSI and beyond. Int J Androl 2011; 34: e319-e329.
[22] Avendaño C, Oehninger S. DNA fragmentation in morphologically normal spermatozoa: How much should we be concerned in the ICSI era? Journal of Andrology 2011; 32: 356-363.
[23] Tesarik J, Greco E, Mendoza C. Late, but not early, paternal effect on human embryo development is related to sperm DNA fragmentation. Hum Reprod 2004; 19: 611-615.
[24] Fahmy I, Mansour R, Aboulghar M, Serour G, Kamal A, Tawab NA, et al. Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non‐obstructive azoospermia. Int J Androl 1997; 20: 37-44.
[25] Palermo GD, Schlegel PN, Hariprashad JJ, Ergün B, Mielnik A, Zaninovic N, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999; 14: 741-748.
[26] Silber Sh, Escudero T, Lenahan K, Abdelhadi I, Kilani Z, Munne S. Chromosomal abnormalities in embryos derived from testicular sperm extraction. Fertil Steril 2003; 79: 30-38.
[27] Vloeberghs V, Verheyen G, Haentjens P, Goossens A, Polyzos N, Tournaye H. How successful is TESE-ICSI in couples with non-obstructive azoospermia? Hum Reprod 2015; 30: 1790-1796.
[28] Friedler S, Raziel A, Strassburger D, Schachter M, Soffer Y, Ron-El R. Factors influencing the outcome of ICSI in patients with obstructive and non-obstructive azoospermia: A comparative study. Hum Reprod 2002; 17: 3114-3121.
[29] Aboulghar MA, Mansour RT, Serour GI, Fahmy I, Kamal A, Tawab NA, et al. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil Steril 1997; 68: 108-111.
[30] Ubaldi F, Nagy ZP, Rienzi L, Tesarik J, Anniballo R, Franco G, et al. Reproductive capacity of spermatozoa from men with testicular failure. Hum Reprod 1999; 14: 2796-2800.
[31] Silber SJ, Nagy Z, Devroey P, Camus M, Van Steirteghem AC. The effect of female age and ovarian reserve on pregnancy rate in male infertility: Treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Hum Reprod 1997; 12: 2693-2700.
[2] Vahidi S, Ardalan A, Mohammad K. Prevalence of primary infertility in the Islamic Republic of Iran in 2004-2005. Asia Pac J Public Health 2009; 21: 287-293.
[3] Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient. J Urol 1989; 142: 62-65.
[4] Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to ICSI for azoospermia. Cochrane Database Syst Rev 2008; 2008: CD002807.
[5] Ghanem M, Bakr NI, Elgayaar MA, El Mongy Sh, Fathy H, Ibrahim AHA. Comparison of the outcome of intracytoplasmic sperm injection in obstructive and non‐obstructive azoospermia in the first cycle: A report of case series and meta‐analysis. Int J Androl 2005; 28: 16-21.
[6] Esteves SC, Miyaoka R, Agarwal A. An update on the clinical assessment of the infertile male. Clinics 2011; 66: 691-700.
[7] Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update 2007; 13: 539-549.
[8] Deruyver Y, Vanderschueren D, Van der Aa F. Outcome of microdissection TESE compared with conventional TESE in non‐obstructive azoospermia: A systematic review. Andrology 2014; 2: 20-24.
[9] Verza Jr S, Esteves SC. Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol 2008; 34: 49-56.
[10] Kanto S, Sugawara J, Masuda H, Sasano H, Arai Y, Kyono K. Fresh motile testicular sperm retrieved from nonobstructive azoospermic patients has the same potential to achieve fertilization and pregnancy via ICSI as sperm retrieved from obstructive azoospermic patients. Fertil Steril 2008; 90: 2010 e5-e7.
[11] Vernaeve V, Tournaye H, Osmanagaoglu K, Verheyen G, Van Steirteghem A, Devroey P. Intracytoplasmic sperm injection with testicular spermatozoa is less successful in men with nonobstructive azoospermia than in men with obstructive azoospermia. Fertil Steril 2003; 79: 529-533.
[12] Esteves SC, Agarwal A. Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: Case series and systematic review. Clinics 2013; 68 (Suppl.): 141-150.
[13] Bocca S, Moussavi V, Brugh V, Morshedi M, Stadtmauer L, Oehninger S. ICSI outcomes in men undergoing TESE for azoospermia and impact of maternal age. Andrologia 2017; 49: e12617.
[14] Vahidi S, Moein MR, Yazdinejad F, Ghasemi-Esmailabad S, Narimani N. Iranian temporal changes in semen quality during the past 22 years: A report from an infertility center. Int J Reprod BioMed 2020; 18: 1059-1064.
[15] Vahidi S, Narimani N, Ghanizadeh T, Yazdinejad F, Emami M, Mehravaran K, et al. The short abstinence may have paradoxical effects on sperms with different level of DNA integrity: A prospective study. Urol J 2021; in Press.
[16] Pandit S, Sharma R. Non invasive assessment of human oocytes and embryos in assisted reproduction: Review on present practices and future trends. Medical Journal Armed Forces India 2021; in Press.
[17] Wang F, Meng TG, Li J, Hou Y, Luo SM, Schatten H, et al. Mitochondrial Ca2+ is related to mitochondrial activity and dynamic events in mouse oocytes. Front Cell Dev Biol 2020; 8: 1110.
[18] Alkandari MH, Zini A. Medical management of non-obstructive azoospermia: A systematic review. Arab Journal of Urology 2021; 19: 1-6.
[19] Schlegel PN, Berkeley AS, Goldstein M, Cohen J, Alikani M, Adler A, et al. Epididymal micropuncture with in vitro fertilization and oocyte micromanipulation for the treatment of unreconstructable obstructive azoospermia. Fertil Steril 1994; 61: 895-901.
[20] Barroso G, Valdespin C, Vega E, Kershenovich R, Avila R, Avendaño C, et al. Developmental sperm contributions: Fertilization and beyond. Fertil Steril 2009; 92: 835-848.
[21] Oehninger S. Clinical management of male infertility in assisted reproduction: ICSI and beyond. Int J Androl 2011; 34: e319-e329.
[22] Avendaño C, Oehninger S. DNA fragmentation in morphologically normal spermatozoa: How much should we be concerned in the ICSI era? Journal of Andrology 2011; 32: 356-363.
[23] Tesarik J, Greco E, Mendoza C. Late, but not early, paternal effect on human embryo development is related to sperm DNA fragmentation. Hum Reprod 2004; 19: 611-615.
[24] Fahmy I, Mansour R, Aboulghar M, Serour G, Kamal A, Tawab NA, et al. Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non‐obstructive azoospermia. Int J Androl 1997; 20: 37-44.
[25] Palermo GD, Schlegel PN, Hariprashad JJ, Ergün B, Mielnik A, Zaninovic N, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod 1999; 14: 741-748.
[26] Silber Sh, Escudero T, Lenahan K, Abdelhadi I, Kilani Z, Munne S. Chromosomal abnormalities in embryos derived from testicular sperm extraction. Fertil Steril 2003; 79: 30-38.
[27] Vloeberghs V, Verheyen G, Haentjens P, Goossens A, Polyzos N, Tournaye H. How successful is TESE-ICSI in couples with non-obstructive azoospermia? Hum Reprod 2015; 30: 1790-1796.
[28] Friedler S, Raziel A, Strassburger D, Schachter M, Soffer Y, Ron-El R. Factors influencing the outcome of ICSI in patients with obstructive and non-obstructive azoospermia: A comparative study. Hum Reprod 2002; 17: 3114-3121.
[29] Aboulghar MA, Mansour RT, Serour GI, Fahmy I, Kamal A, Tawab NA, et al. Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil Steril 1997; 68: 108-111.
[30] Ubaldi F, Nagy ZP, Rienzi L, Tesarik J, Anniballo R, Franco G, et al. Reproductive capacity of spermatozoa from men with testicular failure. Hum Reprod 1999; 14: 2796-2800.
[31] Silber SJ, Nagy Z, Devroey P, Camus M, Van Steirteghem AC. The effect of female age and ovarian reserve on pregnancy rate in male infertility: Treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Hum Reprod 1997; 12: 2693-2700.