Sperm Defect Severity Rather Than Sperm Source Is Associated With Lower Fertilization Rates After Intracytoplasmic Sperm Injection

Main Category: Fertility
Also Included In: Urology / Nephrology;  Men's health
Article Date: 12 Jun 2008 - 12:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

UroToday.com - This study is a retrospective study of 313 ICSI cycles designed to evaluate the impact of sperm defect severity (ejaculated sperm) and the type of azoospermia on the outcomes. Two major groups according to the source of spermatozoa used for ICSI were studied. Group 1 included 220 cycles of utilizing Ejaculated sperm; group 2 included cycles utilizing testicular/Epididymal (n = 93).

Semen from group 1 was subdivided into four subgroups according to the results of the semen analysis: 1) single defect (oligo-[O] or astheno-[A] or teratozoospermia-[T], n = 41), 2) double defect (a combination of two single defects, n = 45), 3) triple defect (OAT, n = 48), and 4) control (no sperm defects; n = 86). Group 2 was subdivided according to the type of azoospermia: 1) obstructive (OA: n = 39) and 2) non-obstructive (NOA: n = 54).

Significantly lower fertilization rates were obtained when either ejaculated sperm with triple defect or testicular sperm from NOA patients were used for ICSI as compared to other groups (~73%; P < 0.05). Sperm from men with obtruction (Epididymal and testicular spermatozoa) fertilized as well as normal or mild/moderate deficient ejaculated sperm.

The authors conclude that lower fertilization rates are achieved when ICSI is performed with sperm from men with oligoasthenoteratozoospermic and non-obstructive azoospermic, and embryo development and pregnancy rates are significantly lower when testicular spermatozoa from NOA men are used.

EDITORIAL COMMENTS:

This study reemphasizes an important lesson that was not immediately appreciated when urologists and reproductive endocrinologists rapidly embraced the notion that sperm could be acquired from men with nonobstructive azoospermia and those sperm could be successfully utilized to achieve fertilization and pregnancy. As these authors and others have noted, although sperm can be achieved, fertilization can take place and pregnancies ensue - each of these "end points" are achieved at lower rate of success then achievable with better quality of sperm (ejaculated or acquired from obstructed individuals) Although, ICSI has enable patients to achieve pregnancies with poor quality sperm (ejaculated) or surgical retrieved sperm. Patients must be aware of the success rates of IVF/ICSI in the context of their diagnosis.

Reported by UroToday.com Contributing Editor Harris M. Nagler, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday