ICSI Using Fresh and Frozen PESA-TESA Spermatozoa to Examine Assisted Reproductive Outcome Retrospectively

Objective: The male reproductive system generates, accumulates, and transports the sperm. In this study, 2 methods of surgically retrieving sperm, namely, testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA), are discussed and studied in men aged ≤38 years to achieve successful conception using assisted reproductive technology. The purpose was to assess the fertilization rate (FA), clinical pregnancy, and live birth rate (LBR) with sperm.

Methods: A total of 287 semen samples were divided into 4 groups as follows: fresh PESA (n=73), frozen PESA (n=65), fresh TESA (n=128), and frozen TESA (n=21). The DNA fragmentation test using sperm chromatin dispersion assay was measured and reported.

Results: FA was 70.3% and 65.5%, (<0.022) for fresh and frozen epididymal sperm and 53.8% and 49.5%, (<0.032) for fresh and frozen testicular sperm. LBR was 33.6% and 30.2% (<0.075) for fresh and frozen epididymal sperm (PESA) and 22.7% and 18.2% (<0.063) for fresh and frozen-thawed TESA sperm.

Conclusion: Exposure to tissue shearing may adversely affect sperm quality. Increased sperm DNA damage due to long-term exposure while teasing enhances reactive oxygen species production foremost to membrane damage because of the oxidation of polyunsaturated fatty acid in lipids (lipid peroxidation), oxidation of amino acid in proteins, and inactivation of specific enzymes, all leading to enzymatic dipping and possibility of less fertilization and conception as indicated by the increase in LBR with fresh/frozen PESA compared to with fresh/frozen TESA.