Long‐term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men

• Main Authors: Noriyuki Okuyama, Ryuichiro Obata, Nao Oka, Yusuke Nakamura, Hiromitsu Hattori, Yukiko Nakajo, Nobuya Aono, Masae Koizumi, Mayumi Toya, Koichi Nagao, Toshihiro Tai, Tomoko Hashimoto, Hideki Igarashi, Koichi Kyono
• Format: Article
• Language: English
• Published: Wiley 2018-01-01
• Series: Reproductive Medicine and Biology
• Subjects: azoospermia; fresh testicular sperm; frozen testicular sperm; intracytoplasmic sperm injection; testicular sperm extraction
• Online Access: https://doi.org/10.1002/rmb2.12073

Abstract Purpose To find the best methods to achieve the highest pregnancy and birth rates for couples needing testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI). Methods Retrospectively studied were 801 patients with male factor infertility who had undergone TESE‐ICSI between April, 1996 and July, 2016 and who had been categorized into four groups: obstructive azoospermia (OA); non‐obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). The sperm retrieval rate, hormone levels, fertilization rate (FR), pregnancy rate (PR), and birth rate (BR) after ICSI among three groups were compared: fresh testicular sperm (FS)‐fresh oocytes (FO) (Group I); frozen‐thawed testicular sperm‐FO (Group II); and FS‐vitrified‐warmed oocytes (Group III). Results The testicular sperm recovery rate was 57.8% (463/801): 89.6% in the Crypt, 97.1% in the OA, 28.9% in the NOA, and 42.2% in the KS groups. The follicle‐stimulating hormone levels were significantly higher in the NOA and KS groups and the testosterone levels were significantly lower in the KS group. The FR, PR, and BR were: 65.2%, 43.2%, and 28.5% in group I; 59.2%, 33.4%, and 18.7% in group II; and 56.4%, 33.8%, and 22.1% in group III. Conclusion Intracytoplasmic sperm injection with FS‐FO achieved the best PR and BR. It should be considered what to do in cases with no testicular sperm by TESE. The authors hope that ICSI with donor sperm will be allowed in Japan in the near future.