Efficacy of percutaneous needle aspiration and open biopsy for sperm retrieval in men with non-obstructive azoospermia.

OBJECTIVE: To assess the efficacy of the two most common sperm retrieval procedures, testicular sperm aspiration (TESA) and testicular sperm extraction (TESE) as part of the diagnostic work-up in men with non-obstructive azoospermia. Design. Retrospective cohort study. SETTING: Center for Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. SAMPLE: Three hundred fifty men who underwent diagnostic surgical sperm recovery between January 1997 and December 2006. METHODS: A diagnostic TESA was initially performed in 281 men with testes of >12 mm(3). If no spermatozoa or an insufficient number of spermatozoa was found, most of the men underwent a diagnostic TESE. Diagnostic TESE was performed as the only surgical procedure in 69 men who had at least one testis < or =12 mm(3). MAIN OUTCOME MEASURES: Success rates of diagnostic TESA and diagnostic TESE. RESULTS: Spermatozoa were found in 129 (45.9%) of the 281 men who underwent TESA. However, in 29 of these men too few spermatozoa were identified for the men to be accepted for IVF/ICSI. The subsequent TESE resulted in 26 additional men being accepted for IVF/ICSI. In men with testes < or =12 mm(3) a sufficient number of spermatozoa were found in 27 out of 69 men following TESE. CONCLUSIONS: The study shows that in 52% of the men with non-obstructive azoospermia spermatozoa useful for ICSI can be identified. For at least one-third of the men with testes >12 mm(3) TESA is a sufficient procedure. Sperm retrieval rate is further increased following a subsequent TESE.

Choosing fertilization method by analyzing sperm morphology or by performing swim-up preparation.

BACKGROUND: Evaluation of sperm morphology has been used as a screening method for choosing between intracytoplasmic sperm injection (ICSI) and conventional in vitro fertilization (IVF). However, sperm morphology analysis is a time-consuming and often subjective scoring method, and may lead to an unnecessarily large proportion of invasive and costly ICSI treatments. The aim of this study was to evaluate if the yield after swim-up preparation could be of advantage over sperm morphology evaluation for choosing fertilization method. MATERIAL AND METHODS: In the first part of the study 53 split cycles with less than 5% normal forms in the ejaculate were retrospectively evaluated. Part 2 is a prospective evaluation including 357 cycles where the number of sperm available after a standardized swim-up procedure was used for choosing fertilization method. In all cycles where < or = 1 million sperm were obtained after swim-up, conventional IVF was performed. RESULTS: In the first part no statistically significant difference in fertilization rates was found for IVF and ICSI respectively (59.2% versus 64.7%). Four IVF cycles ended up in total fertilization failure (TFF) while in no ICSI cycle was TFF obtained. In the second part 8.9% TFF was obtained in the poor sperm morphology group compared to 1.3% in the good morphology group. These TFF corresponded to 1% of all our treatment cycles. CONCLUSION: The present strategy reduced ICSI treatments by 10%, thereby reducing the cost and workload. It can be discussed if an increase of TFF in absolute number of eight is balanced by a reduced workload of 100 ICSI treatments.

Fallopian tube sperm perfusion: the impact of sperm count and morphology on pregnancy rates.

BACKGROUND AND OBJECTIVE: To evaluate the effect of changed criteria for sperm count and morphology when performing fallopian tube sperm perfusion (FSP) in unexplained infertility. PATIENTS AND METHODS: We report on a longitudinal study in which two periods of insemination cycles are compared. One hundred and eighty-three couples who started 361 stimulation cycles intended for FSP were included in the first period and 190 couples starting 303 cycles in the second period. The sperm requirement in the first study period was at least 7 million sperm in the prepared test sample. The FSP cycle included downregulation, controlled ovarian hyperstimulation (COH), ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 3 mL volume. To avoid high-order multiple pregnancies, cycles at risk were converted to in vitro fertilization (IVF). Based on the results from the first period, sperm requirements were lowered to a sperm count of 3 million and at least 5% normal morphology according to strict criteria. RESULTS: FSP was performed in 51% and 60% of started cycles during the two periods with similar pregnancy (24% and 23%) and birth (15% and 19%) rates. Neither sperm count nor morphology above the requirements affected pregnancy rates. IVF-converted, completed cycles reached equal pregnancy (41%) and delivery (32%) rates in both periods. Multiple pregnancy rates were higher after IVF (38%) than after FSP (24%). CONCLUSION: The lowered requirements for sperm count and morphology have not impaired pregnancy results after FSP. Patients who either completed an FSP cycle or had their cycle converted to IVF were all at high risk of multiple pregnancy.