RESUMO
OBJECTIVE: To study whether severe male factor infertility (SMF), reflected by oligozoospermia, impacts embryo morphokinetic behavior in low-prognosis women as stratified by the Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria. DESIGN: Cohort study. SETTING: Private university-affiliated in vitro fertilization center. PATIENT(S): A total of 10,366 injected oocytes from 2,272 women who underwent intracytoplasmic sperm injection cycles between March 2019 and April 2022. INTERVENTION(S): Patients were divided into 8 groups according to the POSEIDON criteria (1-4) and the presence or absence of SMF. A control group of normoresponder patients was included. Kinetic markers from the point of insemination were recorded in the EmbryoScope incubator. MAIN OUTCOME MEASURE(S): Morphokinetic milestones and intracytoplasmic sperm injection clinical outcomes. RESULT(S): Embryos from patients in the POSEIDON 1 group showed significantly slower timing to pronuclear appearance, timing to pronuclear fading (tPNf), timing to 2 (t2), 3 (t3), 4 (t4), 6 (t6), and 7 (t7) cells than those from the control group. Known Implantation Diagnosis Score ranking was significantly different between the SMF and non-SMF (nSMF) subgroups in both POSEIDON 1 as well as control groups. Embryos from patients in the POSEIDON 2 group showed significantly slower timing to pronuclear appearance, t4, t6, t7, timing to 8 cells (t8), and timing to morulae than those from the control group. Embryos in the POSEIDON 2 SMF subgroup took longer than those in the POSEIDON 2 nSMF subgroup and those in both control subgroups to achieve tPNf, t2, t3, timing to 5 cells (t5), timing to start blastulation, and timing to blastulation. Known Implantation Diagnosis Score ranking was significantly different between the SMF and nSMF subgroups in both POSEIDON 2 as well as control groups. Embryos from patients in the POSEIDON 3 group showed significantly slower t8 and duration of the second cell cycle (t3-t2) than those from the control group. Known Implantation Diagnosis Score ranking was significantly different across the subgroups. Embryos derived from patients in the POSEIDON 4 group showed significantly slower tPNf, t2, t3, t4, t5, t6, t7, t8, timing to complete t4-t3 synchronous divisions, and timing to complete t8-t5 synchronous divisions than those from the control group. Known Implantation Diagnosis Score ranking was significantly different between the SMF and nSMF subgroups in both POSEIDON 4 as well as control groups. Irrespective of sperm quality, clinical outcomes significantly improved in the control subgroups compared with those in the POSEIDON 2 and 4 subgroups. CONCLUSION(S): Embryos in the SMF groups presented lower Known Implantation Diagnosis Score ranking than those in the nSMF groups in both POSEIDON 1-4 and control groups, suggesting that cumulative differences result in worse morphokinetic development when the algorithm is used.
Assuntos
Desenvolvimento Embrionário , Oligospermia , Oócitos , Injeções de Esperma Intracitoplásmicas , Humanos , Feminino , Masculino , Adulto , Oligospermia/terapia , Prognóstico , Gravidez , Estudos de Coortes , Fertilização in vitro/métodosRESUMO
In recent years, growing evidence has challenged the notion that sperm quantity and quality are not essential for the success of assisted reproductive technology. DNA fragmentation assessments on ejaculated and testicular sperm harvested from non-azoospermic infertile men have reported a remarkable decrease in DNA damage in spermatozoa directly retrieved from the seminiferous tubules. Moreover, emerging evidence using molecular genetic techniques indicates that aneuploidy rates are lower in testicular sperm than in ejaculated counterparts. The use of testicular sperm from non-azoospermic men with high sperm DNA fragmentation in semen has translated into a higher pregnancy rate and reduced risk of miscarriage. In light of these observations, the time have come for a paradigm shift concerning the use of ejaculated sperm as the preferable source of sperm for intracytoplasmic sperm injection (ICSI). Despite the need for further confirmatory research, the current evidence corroborates the safe utilization of testicular spermatozoa for ICSI in non-azoospermic men with high sperm DNA fragmentation in semen with a positive impact on chances of pregnancy.
Assuntos
Injeções de Esperma Intracitoplásmicas/métodos , Recuperação Espermática , Testículo/citologia , Dano ao DNA , Fragmentação do DNA , Feminino , Humanos , Masculino , Oligospermia/terapia , Gravidez , Taxa de Gravidez , EspermatozoidesRESUMO
OBJECTIVE: To investigate the effectiveness of intracytoplasmic sperm injection (ICSI) using testicular sperm as a strategy to overcome infertility in men with high sperm DNA fragmentation (SDF). DESIGN: Prospective, observational, cohort study. SETTING: Private IVF centers. PATIENT(S): A total of 147 couples undergoing IVF-ICSI and day 3 fresh ETs whose male partner has oligozoospermia and high SDF. INTERVENTION(S): Sperm injections were carried out with ejaculated sperm (EJA-ICSI) or testicular sperm (TESTI-ICSI) retrieved by either testicular sperm extraction (TESE) or testicular sperm aspiration (TESA). SDF levels were reassessed on the day of oocyte retrieval in both ejaculated and testicular specimens. MAIN OUTCOME MEASURE(S): Percentage of testicular and ejaculated spermatozoa containing fragmented DNA (%DFI) and clinical pregnancy, miscarriage, and live-birth rates. RESULT(S): The %DFI in testicular sperm was 8.3%, compared with 40.7% in ejaculated sperm. For the TESTI-ICSI group versus the EJA-ICSI group, respectively, the clinical pregnancy rate was 51.9% and 40.2%, the miscarriage rate was 10.0% and 34.3%, and the live-birth rate was 46.7% and 26.4%. CONCLUSION(S): ICSI outcomes were significantly better in the group of men who had testicular sperm used for ICSI compared with those with ejaculated sperm. SDF was significantly lower in testicular specimens compared with ejaculated counterparts. Our results suggest that TESTI-ICSI is an effective option to overcome infertility when applied to selected men with oligozoospermia and high ejaculated SDF levels.
Assuntos
Fragmentação do DNA , Ejaculação , Fertilidade , Oligospermia/terapia , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática , Espermatozoides/patologia , Aborto Espontâneo/etiologia , Adulto , Brasil , Feminino , Humanos , Nascido Vivo , Masculino , Oligospermia/diagnóstico , Oligospermia/genética , Oligospermia/fisiopatologia , Gravidez , Taxa de Gravidez , Estudos Prospectivos , Espanha , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Recuperação Espermática/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Congenital bilateral absence of vas deferens (CBAVD) is a non-treatable cause of obstructive azoospermia (OA). However, the affected men can father children by undergoing sperm retrieval (SR) and intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: This video describes percutaneous epididymal sperm aspiration (PESA), performed on a 36 year--old male with CBAVD. In PESA the goal is to obtain epididymal fluid. A hypodermic needle attached to a 1 cc syringe is inserted through the skin into the corpus or caput epididymis. Gentle negative pressure is applied to aspirate the epididymal fluid, which is sent to the laboratory for examination. RESULTS: Total number of spermatozoa retrieved after a single puncture was 3.5 million sperm, of which 29% were motile. Motile spermatozoa with normal morphology were selected and injected into the oocyte cytoplasm, while excess retrieved sperm were cryopreserved. The operative time was 10 minutes. The patient recovered his normal activities within the next day and no complications were recorded. In a series involving 32 men with CBAVD, success rate at obtaining motile sperm by PESA was 96.8%, with a complication rate of 3.1%. ICSI carried out with spermatozoa retrieved by PESA resulted in a live birth rate of 34.4% per attempt. The short-term outcome of resulting offspring was comparable with those obtained in other categories of OA. CONCLUSION: PESA is a simple, quick, and successful procedure to retrieve sperm from men with OA due to CBAVD. Retrieved sperm can be successfully used to generate healthy offspring with the aid of ICSI.
Assuntos
Infertilidade Masculina/terapia , Microcirurgia , Oligospermia/terapia , Espermatozoides , Sucção , Feminino , Humanos , Masculino , GravidezRESUMO
Azoospermia factor (AZF) microdeletion plays a key role in the genetic etiology of male infertility. The relationship between sY152 deletion in the AZFc region and clinical outcomes is still unclear. This study was to determine the effects of sY152 deletion on the sperm parameters and clinical outcomes of non-obstructive azoospermia or oligozoospermia men after intracytoplasmic sperm injection (ICSI) treatment. A total of 61 infertile men with AZFc microdeletion of the Y chromosome from January 2008 to December 2012 were recruited in the present study. They were divided into two groups, the sY152 group (n=12) and the AZFc group (n=49), based upon whether they have deleted single sY152 marker or all AZFc markers. Fifty azoospermia or oligozoospermia patients without Y chromosome microdeletion were included as the control group. The sperm quality and clinical data were compared among the three groups. Retrospective cohort-control study was performed. The sperm concentration and motility in sY152 group were better than AZFc group (P<0.05), and were comparable to the control group (P>0.05); the morphology, seminal zinc, seminal fructose and seminal carnitine were similar among the three groups (P>0.05). Patients in both sY152 and AZFc groups had lower fertilization rates (68.40% and 70.63%, respectively) than those in the control group (74.91%), and the differences were statistically significant (P<0.05). No significant differences were found in terms of MII oocyte, high-grade embryo rate, 2PN zygote, number of available embryos and transferred embryos, clinical pregnancy rate, implantation rate, miscarriage rate, multiple pregnancy rate, delivery rate, preterm rate and the male/female ratio among the three groups (P>0.05). Single sY152 deletion might cause a lower fertilization rate, but no adverse effects on sperm quality and clinical outcomes were found. Our study may provide more information for consultation in these patients.
Assuntos
Azoospermia/genética , Cromossomos Humanos Y/genética , Oligospermia/genética , Adulto , Azoospermia/terapia , Deleção Cromossômica , Feminino , Estudos de Associação Genética , Marcadores Genéticos , Predisposição Genética para Doença , Humanos , Masculino , Oligospermia/terapia , Estudos Retrospectivos , Sitios de Sequências Rotuladas , Injeções de Esperma Intracitoplásmicas , Resultado do TratamentoRESUMO
Intracytoplasmic injection with testicular spermatozoa has become a routine treatment in fertility clinics. Spermatozoa can be recovered in half of patients with nonobstructive azoospermia. The use of immature germ cells for intracytoplasmic injection has been proposed for cases in which no spermatozoa can be retrieved. However, there are low pregnancy rates following intracytoplasmic injection using round spermatids from men with no elongated spermatids or spermatozoa in their testes. The in vitro culture of immature germ cells to more mature stages has been proposed as a means to improve this poor outcome. Several years after the introduction of intracytoplasmic injection with elongating and round spermatids, uncertainty remains as to whether this approach can be considered a safe treatment option. This review outlines the clinical and scientific data regarding intracytoplasmic injection using immature germ cells and in vitro matured germ cells.
Assuntos
Oligospermia/terapia , Injeções de Esperma Intracitoplásmicas/métodos , Maturação do Esperma/fisiologia , Espermátides/fisiologia , Espermátides/transplante , Feminino , Humanos , Masculino , Gravidez , Injeções de Esperma Intracitoplásmicas/ética , EspermatogêneseRESUMO
Intracytoplasmic injection with testicular spermatozoa has become a routine treatment in fertility clinics. Spermatozoa can be recovered in half of patients with nonobstructive azoospermia. The use of immature germ cells for intracytoplasmic injection has been proposed for cases in which no spermatozoa can be retrieved. However, there are low pregnancy rates following intracytoplasmic injection using round spermatids from men with no elongated spermatids or spermatozoa in their testes. The in vitro culture of immature germ cells to more mature stages has been proposed as a means to improve this poor outcome. Several years after the introduction of intracytoplasmic injection with elongating and round spermatids, uncertainty remains as to whether this approach can be considered a safe treatment option. This review outlines the clinical and scientific data regarding intracytoplasmic injection using immature germ cells and in vitro matured germ cells.
Assuntos
Feminino , Humanos , Masculino , Gravidez , Oligospermia/terapia , Injeções de Esperma Intracitoplásmicas/métodos , Maturação do Esperma/fisiologia , Espermátides/fisiologia , Espermátides/transplante , Espermatogênese , Injeções de Esperma IntracitoplásmicasRESUMO
OBJECTIVE: To compare the changes that occurs in the spermatic parameters when a second ejaculate is obtained in the first 60 minutes in patients with a different seminal quality. MATERIAL AND METHOD: Infertile patient from andrology service were asked to provide a second sample within 1 hours of the first. All the patients had poor semen characteristics in volumen, density, motility or total motile cells. RESULTS: The patients were divided in subgroup; hipospermia (n = 75), oligospermic (n = 46), asthenospermic (n = 111) and teratospermic (n = 157). A benefic effect from a second ejaculate sample was observed in patients with asthenosperia, oligospermic and a total motile sperm count less than 10 million (p < 0.05). CONCLUSIONS: The second ejaculate must be considered as an alternative in some infertile patients that are looking for an spontaneous pregnancy or in patients that will require an assisted reproductive techniques and have poor seminal parameters.
Assuntos
Ejaculação , Infertilidade Masculina/terapia , Inseminação Artificial Homóloga , Sêmen/citologia , Adulto , Astenozoospermia/fisiopatologia , Astenozoospermia/terapia , Distinções e Prêmios , Ejaculação/fisiologia , Ginecologia , Humanos , Infertilidade Masculina/fisiopatologia , Masculino , México , Obstetrícia , Oligospermia/fisiopatologia , Oligospermia/terapia , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Espermatozoides/anormalidades , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the effect of male age on clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles, according to sperm concentration. DESIGN: Retrospective, observational study. SETTING: Assisted reproduction center. PATIENT(S): The study included 1,024 couples undergoing ICSI cycles with fresh spermatozoa. INTERVENTION(S): The influence of paternal age on ICSI outcomes of oligozoospermic and normozoospermic patients was evaluated. MAIN OUTCOME MEASURE(S): Rates of high-quality embryos, pregnancy, implantation, and miscarriage were evaluated through linear logistic regression analyses. RESULT(S): When the sperm concentration was abnormal, paternal age influenced implantation (regression coefficient value = -0.7009) and pregnancy rates (odds ratio = 0.95, 95% confidence interval 0.91-0.99). However, in normozoospermic patients, no influence of paternal age was observed on implantation (regression coefficient value = 0.0566) or pregnancy rates (odds ratio = 1.00, 95% confidence interval 0.97-1.03). CONCLUSION(S): For couples in which the men are oligozoospermic, the implantation rate could be impaired by increased paternal age. In these couples, the chance of pregnancy decreased 5% for each year of paternal age. When men are normozoospermic, this effect is not observed.
Assuntos
Oligospermia/terapia , Idade Paterna , Injeções de Esperma Intracitoplásmicas , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Adulto , Blastocisto/citologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oligospermia/diagnóstico , Gravidez , Taxa de Gravidez , Prognóstico , Controle de Qualidade , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Resultado do TratamentoRESUMO
A patient with a unilateral testis tumour who had been treated with radical orchiectomy was referred to our centre. He was oligospermic before orchiectomy and needed chemotherapy because of abnormal tumour markers after the aforementioned operation. He did not have any sperm suitable for freezing. Because of a lack of information about the spermatogenic abilities in the other testis, it is advisable to freeze sperm prior to orchiectomy at least in patients with semen analysis disorders.