Samenvatting
Abstract
Introduction: Treating infertility due to non-obstructive azoospermia (NOA) by testicular sperm extraction and intracytoplasmic sperm injection (TESE-ICSI) has become a routine procedure in assisted reproduction. However, data available in the literature are merely fragmentary because they report either on sperm retrieval rates after TESE or on the outcome of ICSI once testicular spermatozoa were obtained. However, no coherent data exist to counsel NOA men about their chances to father their genetically-own child. The following retrospective analysis aimed to provide reliable information in order to counsel those couples.
Material and Methods: Between January 1994 and December 2009, NOA men with a normal karyotype and no Yq deletion having their first TESE attempt were included and studied longitudinally. Patients who had previous (multiple) testicular biopsies and patients showing hypospermatogenesis at their testicular histology were excluded. ICSI was performed with either fresh or cryopreserved testicular sperm. A maximum of 6 ICSI cycles per couple were included in our analysis. The primary outcome measure was delivery of at least one live birth. Patients were not re-enrolled after having their first delivery. Sperm retrieval rate and pregnancy rate were secondary outcome measures. A delivery obtained after frozen embryo transfer (FRET) was tallied up to the associated but unsuccessful fresh ICSI.
Results: Sperm were found at the first TESE attempt in 288 of the 714 NOA patients included (40.3%). Of these 288 men, 260 (90.3%) had ICSI treatment. Although their first TESE resulted in sperm being retrieved, consecutive TESE did not yield sperm in 26 patients. A total of 445 ICSI cycles and 48 sequential FRET cycles resulted in 130 pregnancies, 97 deliveries (11 twins, 2 triplets and 2 stillborns) and 110 children born. Pregnancy and delivery rates per ICSI cycle were 29.2% and 21.8% respectively. The delivery rate per couple starting ICSI was 37.3%: the crude total cumulative delivery rate per couple starting ICSI was 34.6% after 3 cycles and 37.7% after 6 cycles. A high drop out rate was observed after the first (33.1%) and after the second (36.4%) ICSI cycle. The live birth delivery rate for all patients included in this restrictive NOA population was 13.3% (95/714).
Conclusion: Although TESE-ICSI is a major breakthrough in the treatment of infertility in NOA men with almost 4 out of 10 couples (37.3%) having a delivery, patients should be counselled that when followed-up longitudinally, only 13 out of 100 NOA men undergoing TESE will eventually father a genetically own child.
Introduction: Treating infertility due to non-obstructive azoospermia (NOA) by testicular sperm extraction and intracytoplasmic sperm injection (TESE-ICSI) has become a routine procedure in assisted reproduction. However, data available in the literature are merely fragmentary because they report either on sperm retrieval rates after TESE or on the outcome of ICSI once testicular spermatozoa were obtained. However, no coherent data exist to counsel NOA men about their chances to father their genetically-own child. The following retrospective analysis aimed to provide reliable information in order to counsel those couples.
Material and Methods: Between January 1994 and December 2009, NOA men with a normal karyotype and no Yq deletion having their first TESE attempt were included and studied longitudinally. Patients who had previous (multiple) testicular biopsies and patients showing hypospermatogenesis at their testicular histology were excluded. ICSI was performed with either fresh or cryopreserved testicular sperm. A maximum of 6 ICSI cycles per couple were included in our analysis. The primary outcome measure was delivery of at least one live birth. Patients were not re-enrolled after having their first delivery. Sperm retrieval rate and pregnancy rate were secondary outcome measures. A delivery obtained after frozen embryo transfer (FRET) was tallied up to the associated but unsuccessful fresh ICSI.
Results: Sperm were found at the first TESE attempt in 288 of the 714 NOA patients included (40.3%). Of these 288 men, 260 (90.3%) had ICSI treatment. Although their first TESE resulted in sperm being retrieved, consecutive TESE did not yield sperm in 26 patients. A total of 445 ICSI cycles and 48 sequential FRET cycles resulted in 130 pregnancies, 97 deliveries (11 twins, 2 triplets and 2 stillborns) and 110 children born. Pregnancy and delivery rates per ICSI cycle were 29.2% and 21.8% respectively. The delivery rate per couple starting ICSI was 37.3%: the crude total cumulative delivery rate per couple starting ICSI was 34.6% after 3 cycles and 37.7% after 6 cycles. A high drop out rate was observed after the first (33.1%) and after the second (36.4%) ICSI cycle. The live birth delivery rate for all patients included in this restrictive NOA population was 13.3% (95/714).
Conclusion: Although TESE-ICSI is a major breakthrough in the treatment of infertility in NOA men with almost 4 out of 10 couples (37.3%) having a delivery, patients should be counselled that when followed-up longitudinally, only 13 out of 100 NOA men undergoing TESE will eventually father a genetically own child.
| Originele taal-2 | English |
|---|---|
| Pagina's (van-tot) | 123-123 |
| Aantal pagina's | 1 |
| Tijdschrift | Human Reproduction |
| Volume | 27 |
| Status | Published - 1 jul 2012 |
| Evenement | Unknown - Duur: 1 jul 2012 → … |