Can we predict the chance of successful epididymal or testicular sperm aspiration following vasectomy?

Purpose of this retrospective study was to investigate if serum markers, men’s age, interval since vasectomy, BMI, testicular size and smoking could predict the success of epididymal or testicular sperm aspiration (PESA/TESA) in vasectomized men. Forty-four consecutively performed PESA/TESA procedures were reviewed retrospectively. Motile sperm was retrieved from 77.3% of PESA/TESA procedures. Mean serum Inhibin-B (Inh-B) level tended to be higher in men who had motile sperm retrieved compared to those who had not (180.3 versus 126.2?pg/ml, p?=?0.05). Univariate analysis identified serum Inh-B to be the only predictor of PESA/TESA success (r?=?0.32, CI: 0.006–0.584, p?=?0.046). Serum FSH, LH, T levels, age, BMI, smoking status and interval since vasectomy did not correlate with the PESA/TESA outcome. Inh-B could modestly discriminate between successful and unsuccessful PESA/TESA (AUC=?0.70) with high positive (89.5%) but low negative prediction (36.8%); 58.6% sensitivity and 77.7% specificity at the optimum cut-off level of 166?pg/ml. Positive outcome was only 50% when the Inh-B level was below 100?pg/ml. It is concluded that a high serum Inh-B might reliably predict successful PESA/TESA in vasectomized men. More invasive sperm retrieval procedures could be reserved for men with very low Inh-B or failed PESA/TESA. Future studies with adequate power may confirm our findings.     

Approaches for obtaining sperm in patients with male factor infertility

Objective: To describe methods of sperm retrieval for intracytoplasmic sperm injection (ICSI) in patients with male factor infertility and to review the clinical results using sperm from the different sources.

Design: The literature on sperm-obtaining methods and ICSI was reviewed. Studies related to this topic were identified through MEDLINE.

Result(s): This review describes the evolution of sperm retrieval methods. Sperm can be obtained by microepididymal sperm aspiration (MESA), percutaneous sperm aspiration (PESA), and testicular sperm extraction (TESE),from patients with congenital absence of the vas deferens or acquired vas obstruction. When ICSI is performed with ejaculated, epididymal, or testicular sperm, good fertilization and pregnancy rates are achieved without significant differences among the various sperm sources. The original percutaneous sperm aspiration method has been modified slightly and yields successful results.

Conclusion(s): Viable pregnancies can be achieved with ICSI by using not only ejaculated sperm, but also epididymal and testicular sperm. Microepididymal sperm aspiration, percutaneous sperm aspiration, modified percutaneous sperm aspiration, and testicular sperm extraction can be considered standard procedures to treat male factor infertility.     

不同来源的精子ICSI治疗周期妊娠结局分析

目的:比较不同来源的精子进行ICSI治疗后受精率、胚胎种植率、临床妊娠率等临床指标有无差异。方法:回顾性分析2006年1月~2008年12月本院生殖中心进行的431个ICSI治疗周期,按精子来源分为A组(重度少弱精子症组)287个周期、B组(梗阻性无精子症附睾穿刺组)109个周期、C组(梗阻性无精子症睾丸穿刺组)35个周期,比较各组女方平均年龄、男方平均年龄、不孕病史、平均MII卵数、受精率、卵裂率、胚胎利用率、平均移植胚胎数量、种植率、妊娠率、流产率等指标的差异。结果:A组与B、C两组在种植率、妊娠率方面差异有统计学意义(18.46%vs25.23%、28.76%;31.23%vs42.16%、39.39%,P<0.05);B、C两组之间各数据差异无统计学意义(P>0.05),受精率、卵裂率、流产率3组之间差异无统计学意义。结论:重度少弱精子症患者射出精子进行ICSI治疗后胚胎种植率、临床妊娠率低于梗阻性无精子症患者。     

Update on surgical sperm recovery – The European view

Surgical sperm recovery has become a well-established procedure to obtain spermatozoa for intra-cytoplasmic sperm injection (ICSI). Although a tendency exists to treat all azoospermic patients by ICSI using surgically retrieved sperm, vasovasostomy remains the gold standard for post-vasectomy azoospermia. In men with obstructive azoospermia in whom vasovasostomy is not indicated, sperm can be easily obtained by either aspiration from epididymis or testis, or a testicular biopsy. In about half of men with non-obstructive azoospermia, sperm may be obtained by testicular biopsy but unfortunately no accurate tests are currently available to predict successful recovery. In these patients, not only recovery rates are limited but also the chance to establish an ongoing pregnancy is decreased compared to men with normal spermatogenesis. When no spermatozoa are recovered after testicular sperm extraction (TESE), the use of donor sperm or adoption is indicated. Given the extremely low pregnancy rates, ICSI using round spermatids is not an option and remains unlawful in some countries.     

Epididymal distension as a predictor of the success of PESA procedures

Purpose : To evaluate the value of epididymal distension in predicting the success of percutaneous epididymal sperm aspiration (PESA) procedure. Methods : Physical examination of epididymis to detect epididymal distension and PESA were performed in 49 obstructive azoospermic patients divided into two groups according to its causes (Group I: previous vasectomy, n = 27 and Group II: other causes, n = 22). Results : Epididymal distension was found in 42 cases (85.7%). PESA was successful in 42 out of the 49 patients, giving a sperm retrieval rate of 85.7%. The success rate of PESA in Groups I and II is 92.6 and 77.3%, respectively. The accuracy, sensitivity, specificity, and positive and negative predictive value of epididymal distension for the overall patients were 86.7, 90.5, 64.2, 93.8, and 52.9%, respectively. The success rate of PESA procedure in patients with epididymal distension was significantly higher than in patients without epididymal distension (p < 0.05). Conclusions : The presence of epididymal distension in obstructive azoospermic men was predictive of PESA success.