Introduction: A subset of men with presumed azoospermia may have rare sperm in their ejaculate which can be used for intracytoplasmic sperm injection (ICSI), avoiding unnecessary surgical intervention. We routinely analyze a fresh ejaculated semen (ES) sample on the day of planned microdissection testicular sperm extraction (mTESE). If sperm are found, mTESE is deferred and the patient is requested to provide additional semen samples later that day (if the day of oocyte retrieval) or 24 hours later on the day of oocyte retrieval. We assessed the utility of this practice and outcomes after using rare fresh ejaculated sperm for ICSI.
Methods: We performed a retrospective review of men with presumed azoospermia scheduled to undergo mTESE by a single high-volume surgeon from 3/2016 to 11/2020. Of 919 scheduled procedures, 45 were canceled due to rare sperm being found in the ejaculate on the day of surgery. Patients were excluded from further analysis if no ICSI cycles were performed, frozen spermatozoa or donor sperm were used, and/or information regarding ejaculated sperm sample concentration or motility was not recorded.
Results: Our final analysis included 32 ICSI cycles performed with fresh ejaculated sperm from 31 men with presumed azoospermia. Most men had a normal karyotype and no Y-chromosome microdeletions (YCMD) (25/31, 80.6%). Of the remaining 6, 4 had an AFZc YCMD (11.8%) and 2 had a Robertsonian translocation (6.5%). For most cycles, =2 fresh ES samples were produced (30/32, 93.8%). For those cycles with =2 samples, the average number of samples produced was 3.4 ± 1.0.
A total of 24 cycles had =1 fresh ES sample produced 24 hours later on the day of oocyte retrieval. For these men, sperm were identified in 23 (96%). Of the 32 ICSI cycles performed with fresh ejaculated sperm, 28 resulted in embryo transfer (88%) and the live birth rate was 38% (12/32) (Table).
Conclusions: Providing fresh ES samples on the day of planned mTESE and on day of oocyte retrieval can avoid unnecessary surgical procedures for nearly 5% of men thought to be azoospermic with satisfactory ICSI outcomes. Over 95% of patients with sperm in the ejaculate on the day of mTESE will have sperm in the ejaculate 24 hours later. Further research is needed to delineate the optimal abstinence interval for obtaining high-quality sperm from presumed azoospermic patients.
Source of Funding: Authors JM and CK are supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
.jpg)
.jpg)
