Results of intracytoplasmic sperm injection performed with sperm retrieved by microscopic testicular sperm extraction in azoospermic patients.

OBJECTIVE: The absence of any sperm in the ejaculate is called azoospermia and it is detected in 1% of males and 10-15% of those with infertility complaints. Azoospermia may be due to obstructive (OA) and non-obstructive (NOA) causes. Today, healthy pregnancies can be achieved in azoospermic patients by intracytoplasmic sperm injection (ICSI) performed using sperm retrieved from microscopic testicular sperm extraction (m-TESE). In this study, we examined the sperm retrieval rates with m-TESE in azoospermic patients, the results of ICSI in OA and NOA patients with sperm and the underlying testicular pathologies in patients without sperm. MATERIAL AND METHODS: Patients who underwent m-TESE at IVF unit of our hospital between January 2005 and April 2017 were retrospectively reviewed. A total of 342 azoospermic patients (117 OA and 225 NOA cases) with regular follow-up were included in the study. In these cases, sperm retrieval and clinical pregnancy rates after ICSI were compared. RESULTS: In the m-TESE procedure, motile sperm was found in all of the OA patients and in 52.4% (118/225) of the NOA patients. Clinical pregnancy rate in the OA group was 29.9% (35/117) and live birth rate was 25.6% (30/117). In the NOA group, the clinical pregnancy rate was 27.1% (32/118) and the live birth rate was 23.7% (27/118). Histopathologic evaluation was made in 107 cases in the NOA group with no testicular sperm, revealing that 59 cases with germ-cell aplasia (sertoli-cell only syndrome), 42 cases with maturation arrest, and 6 cases with hypospermatogenesis. Postoperative hematoma developed in 3 of m-TESE cases and subsided with conservative treatment. CONCLUSION: If motile sperm is retrieved with m-TESE application in azoospermic patients, pregnancy resulting in one live birth in about 4 couples who undergo ICSI application can be achieved. In the presence of motile sperm, live birth rates are similar between OA and NOA case with very low complication rates.

Live birth rate with repeat microdissection TESE and intracytoplasmic sperm injection after a conventional testicular biopsy in men with nonobstructive azoospermia.

OBJECTIVE: To determine live birth rate via m-TESE and ICSI in men who had a previous conventional testicular biopsy. STUDY DESIGN: Retrospective study was conducted to analyze 86 m-TESE procedures for ICSI in NOA patients who had a previous conventional TESE. Only motile spermatozoa were used for ICSI and all other forms were discarded. Women under the age of 42 years and who produced at least 3 oocytes in response to controlled ovarian stimulation were included in the study. Statistical significance was tested using Student's t-test, χ(2) test and Fisher's exact test as appropriate. RESULTS: Testicular motile spermatozoa were successfully retrieved in 39 out of 47 men who had spermatozoa found in the previous biopsy (Group I), and in 6 out of 39 men with no sperm in the previous biopsy (Group II) (82.9% vs. 15.3%, respectively; p<0.01). Demographic characteristics of two groups were similar. Live birth rate per repeat m-TESE attempt via ICSI was significantly higher (23.4%, 39/47) in patients with a previous sperm-positive TESE compared to that (2.5%, 1/39) obtained in patients with a previous sperm-negative testicular biopsy (p<0.05). CONCLUSION: Repeat attempt to obtain motile spermatozoa by m-TESE following conventional TESE ensures a higher recovery and live birth rate in men who had spermatozoa found in the first recovery procedure compared to men with no spermatozoa in the first testicular biopsy. Live birth rate through ICSI is not promising after repeat m-TESE procedure in patients with a previous sperm-negative testicular biopsy.

Comparison of the transfer of equal numbers of blastocysts versus cleavage-stage embryos after repeated failure of in vitro fertilization cycles.

PURPOSE: To evaluate the efficacy of blastocyst transfer in women with at least two previously unsuccessful in vitro fertilization-embryo transfer (IVF-ET) attempts. METHODS: Retrospective analysis of 238 couples (with previous implantation failures) had equal number (two) of cleavage-stage embryos (n = 143) or blastocysts (n = 95) transferred in the same IVF center. RESULTS: The clinical pregnancy rates and live-birth rates were similar in the cleavage-stage embryo transfer group and the blastocyst group (35.6% vs. 40% and 32.1% vs. 35.7%; p > 0.05, respectively). Miscarriage rates (9.8% vs. 10.5%) and multiple pregnancy rates (15.6% vs. 23.6%) did not differ. Although implantation rate was higher with blastocyst transfer than that with day 3 transfer, it did not reach to a statistical significance (24.7% and 19%, respectively, p > 0.05). CONCLUSION: Blastocyst transfer in ICSI cycles does not yield a better outcome than that obtained with cleavage-stage embryos in women who had unsuccessful IVF attempts previously.

Effect of antithyroid antibodies on ICSI outcome in antiphospholipid antibody-negative euthyroid women.

Antithyroid antibodies (ATA) are found in 5-15% of women at reproductive age and are not necessarily accompanied with thyroid dysfunction. ATA are associated with adverse effects such as spontaneous miscarriage, recurrent miscarriages, preterm delivery and maternal post-partum thyroiditis in women with normal thyroid hormone concentrations. The role of ATA on the outcome of IVF cycles remains to be investigated. This study evaluated the impact of ATA on the outcome of intracytoplasmic sperm injection (ICSI)-embryo transfer cycles in euthyroid women. A total of 253 women undergoing ICSI-embryo transfer cycles were prospectively enrolled in this study. Women positive for at least one of the thyroid antibodies, with normal thyroid-stimulating hormone (TSH) and free T4 concentrations and negative for anticardiolipin antibodies and lupus anticoagulant were included. ICSI was performed for fertilization in all cycles. Of 253 women, 219 were ATA negative and 34 ATA positive. Implantation rates (19.1% versus 18.4%), miscarriage rates (9.0% versus 8.3%) and ongoing pregnancy rates (37.0% versus 32.4%) did not differ significantly between the ATA-positive group and the ATA-negative group, respectively. The presence of antithyroid antibodies in euthyroid and antiphospholipid antibody-negative women was not found to significantly affect the outcome of ICSI-embryo transfer cycles. Antithyroid antibodies (ATA) can interact with thyroid hormone receptors located on the human oocyte and impair the chance of fertilization and healthy pregnancy. They are found in 5-15% of women at reproductive age and are not necessarily accompanied with thyroid dysfunction. ATA have been reported to be associated with adverse effects such as spontaneous miscarriage, recurrent miscarriages, preterm delivery and maternal post-partum thyroiditis in women with normal thyroid hormone concentrations. The role of ATA on the outcome of IVF cycles remains to be investigated. The objective of our study was to evaluate the impact of ATA on the outcome of intracytoplasmic sperm injection (ICSI)-embryo transfer cycles in euthyroid women. A total of 253 women undergoing ICSI-embryo transfer cycles were prospectively enrolled in this study. Women with at least one of the thyroid antibodies positive and normal TSH and free T4 concentrations were included in the study. Since other immunological disorders might affect the results, antiphospholipid antibodies (APA), which are the markers of antiphospholipid antibody syndrome, were also screened in all women prior to study. Women with positive for APA were excluded in the final analysis. Of 253 women, 219 (86.6%) were ATA negative and 34 (13.4%) ATA positive. Implantation rates (19.1% versus 18.4%), biochemical pregnancy rates (9.2% versus 14.3%), miscarriage rates (9.0% versus 8.3%) and ongoing pregnancy rates (37.0% versus 32.4%) did not differ significantly between the ATA-positive group and the ATA-negative group, respectively. In conclusion, presence of antithyroid antibodies in euthyroid and antiphospholipid antibody-negative women does not affect the outcome of ICSI-embryo transfer cycles.

Outcome of intracytoplasmic sperm injection cycles with fresh testicular spermatozoa obtained on the day of or the day before oocyte collection and with cryopreserved testicular sperm in patients with azoospermia.

OBJECTIVE: To compare the outcome of intracytoplasmic sperm injection (ICSI)-ET cycles with fresh testicular spermatozoa obtained on the same day or the day before oocyte retrieval with frozen-thawed spermatozoa. DESIGN: Retrospective cohort study. SETTING: Fertility center. PATIENT(S): The first ICSI-ET cycle of 337 couples with motile testicular spermatozoa of azoospermic patients. INTERVENTION(S): Microdissection testicular sperm extraction (TESE), sperm cryopreservation, ICSI-ET. MAIN OUTCOME MEASURE(S): Fertilization, implantation, clinical pregnancy rates (PRs) and delivery rates. RESULT(S): Testicular sperm retrieval was performed on the day of oocyte retrieval in 166 cycles (group A), the day before oocyte retrieval in 42 cycles (group B), and the frozen-thawed testicular spermatozoa were used in 129 cycles (group C). The groups were comparable in terms of the ages of male and female patients, ovarian response to stimulation, as well as the number of oocytes injected. The number of cycles with nonobstructive azoospermia and obstructive azoospermia was evenly distributed in each group. Fertilization rates were 70.7%, 68.7%, and 67.3%, clinical PRs 31.3%, 30.9%, and 25.5%, and delivery rates 28.9%, 28.5%, and 23.2% for groups A, B, and C, respectively. The outcomes of patients with nonobstructive azoospermia did not differ from those of patients with obstructive azoospermia within and among the groups. CONCLUSION(S): Neither the timing of TESE (on the day of or the day before oocyte retrieval) nor the use of frozen-thawed testicular sperm affects the outcome of ICSI-ET cycle when motile spermatozoa are obtained in azoospermic men. In addition, etiology of azoospermia does not have any influence on the outcome with different timing of microdissection TESE procedure for ICSI.

Vitrification of human laser treated blastocysts within cut standard straws (CSS): novel aseptic packaging and reduced concentrations of cryoprotectants.

Vitrification of laser treated human blastocysts using reduced concentrations of permeable cryoprotectants was carried out by submerging cut standard straws (CSS) into liquid nitrogen. The CSS were made by cutting a standard 0.25 ml straw at an angle of approximately 45 degrees . After laser assisted hatching, 6 day blastocysts (n=250) were loaded into droplets of approximately 0.75 microl in the CSS and were either plunged directly into liquid nitrogen or first encased in a standard 0.5 ml straw (aseptic technique) before being vitrified. Permeable cryoprotectants (ethylene glycol+Me(2)SO) at concentrations of 15% and 20% v:v were tested for their effect on post warming re-expansion and post transfer pregnancy rates. Our results indicate that the use of reduced concentrations of cryoprotectants and aseptic packaging of blastocysts did not have any statistically significant impact on the study outcomes.