Abstract
Assisted reproductive technologies have dramatically advanced the opportunities for treating the most challenging cases of male infertility. In no case has this opportunity been clearer than for men with the most severe defect in spermatogenesis: nonobstructive azoospermia (NOA). In men with NOA, sperm production is so defective that no sperm reach the ejaculate. The morphology of these sperm routinely is abnormal, and our experience is that many in vitro fertilization (IVF) laboratories consider sperm obtained from these men to be unusable for assisted reproductive techniques. Sperm retrieval requires invasive techniques to identify limited foci of sperm production within the testis. Clearly, the appearance of sperm from these men is abnormal, but few data have been published on the effect of using these sperm on IVF outcomes, including embryo quality. In this chapter, we describe the outcomes of intracytoplasmic sperm injection (ICSI) using testicular sperm from men with NOA, comparing the results with those obtained with testicular sperm from men with obstructive azoospermia (controlling for testicular source) and from men with sperm in the ejaculate using donor oocytes (controlling for oocytic factors). We also present data on the use of fresh and frozen testicular sperm, as well as sperm retrieved on the day of versus the day before oocyte retrieval. The results show that use of testicular sperm from men with NOA has a substantial effect on fertilization rates (72.6 % vs. 53.3 %; P < 0.05, compared with obstructed testicular sperm) but with similar embryo development (66.2 % day 3 “good” embryos [grade 1–2] vs. 53.8 % with obstructed testicular sperm). Clinical pregnancy rates were statistically better (52.8 % vs. 41.4 %) using testicular sperm from men with obstruction versus those with NOA.
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© 2013 Springer-Verlag London
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Zaninović, N., Schlegel, P.N. (2013). MicroTESE and Embryo Development. In: Ježek, D. (eds) Atlas on the Human Testis. Springer, London. https://doi.org/10.1007/978-1-4471-2763-5_2
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DOI: https://doi.org/10.1007/978-1-4471-2763-5_2
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