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Use of Surgical Sperm Retrieval in Azoospermic Men: a Meta-analysis

Overview
Journal Fertil Steril
Date 2004 Sep 18
PMID 15374716
Citations 44
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Abstract

Objective: To compare the outcome of intracytoplasmic sperm injection (ICSI) cycles [1] using epididymal and testicular sperm in patients with obstructive azoospermia (OA); [2] using surgically retrieved sperm in patients with OA and nonobstructive azoospermia (NOA); and [3] using fresh and frozen-thawed sperm.

Design: Meta-analysis of published data.

Setting: Assisted conception unit.

Patient(s): Ten reports (734 cycles: 677 transfers) were identified as suitable to assess source of sperm; 9 reports (1,103 cycles: 998 transfers) to assess etiology; and 17 reports (1,476 cycles: 1,377 transfers) to assess the effect of cryopreservation.

Intervention(s): Surgical sperm retrieval/ICSI.

Main Outcome Measure(s): Fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR), and ongoing pregnancy rate (OPR) per embryo transfer.

Result(s): Meta-analysis demonstrated no significant difference in any outcome measure between the use of epididymal or testicular sperm in men with OA. Meta-analysis showed a significantly improved FR (relative risk [RR] 1.18; 95% confidence interval [CI]: 1.13-1.23) and CPR (RR 1.36; 95% CI: 1.10-1.69) in men with OA as compared to NOA with a nonsignificant increase in OPR. There was no difference in either IR or miscarriage rate between the two groups. Comparing fresh with frozen-thawed epididymal sperm there was no difference in FR or IR, a significantly higher CPR (RR 1.20; 95% CI: 1.0-1.42), and no difference in OPR. No difference in fertilization or pregnancy outcome was noted when the testicular cycles were analyzed separately, but IR was significantly impaired using frozen-thawed sperm (RR 1.75; 95% CI: 1.10-2.80).

Conclusion(s): Meta-analysis of published data confirms that etiology of azoospermia and cryopreservation of surgically retrieved sperm impacts on ICSI outcome, and allows us to make several recommendations for clinical practice. Origin of sperm, in men with similar etiology, does not affect outcome.

Citing Articles

Effect of freezing and thawing on ejaculated sperm and subsequent pregnancy and neonatal outcomes in IVF.

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Pregnancy outcomes in patients with non-obstructive azoospermia undergoing micro-TESE: comparison of fresh vs. frozen-thawed testicular sperm.

Suleymanova L, Bayram H, Donmez Cakil Y, Selam B, Cincik M J Assist Reprod Genet. 2024; 41(12):3399-3404.

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Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring.

Majzoub A, Viana M, Achermann A, Ferreira I, Laursen R, Humaidan P J Clin Med. 2024; 13(16).

PMID: 39201081 PMC: 11355217. DOI: 10.3390/jcm13164939.


Idiopathic secondary azoospermia occurrence in men with oligospermia over time.

Karavani G, Kattan M, Lau S, Lo K, Grober E, Mehra V J Assist Reprod Genet. 2024; 41(8):2163-2171.

PMID: 38941005 PMC: 11339189. DOI: 10.1007/s10815-024-03179-6.


Cryptozoospermia: Should we use ejaculated sperm or surgically retrieved sperm for assisted reproductive technology?.

Hibi H, Tokoro M, Sonohara M, Ihara K, Fukunaga N, Asada Y Reprod Med Biol. 2023; 22(1):e12546.

PMID: 37900700 PMC: 10601583. DOI: 10.1002/rmb2.12546.