Controversy exists around the use of epididymal sperm for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) for couples with obstructive azoospermia (OA), and the ability to reliably predict IVF/ICSI outcomes with surgically extracted epididymal sperm remains limited. To provide additional clinical context we sought to compare IVF/ICSI outcomes of epididymal sperm from couples with OA to outcomes of couples using normal, ejaculated sperm.
We performed a case-control analysis of 40 couples who underwent office-based epididymal sperm retrieval for OA followed by IVF/ICSI, compared with a control group of 38 female age-matched couples with no evidence of female factor infertility who underwent IVF/ICSI with normal, ejaculated sperm. Primary outcome was live birth on the initial embryo transfer.
Epididymal samples yielded a median total motile sperm count of 9.1 million, compared to 81 million for ejaculated sperm. On the primary embryo transfer, fertilization rate (71% vs 77%, p=0.2), blastulation rate (48% vs 59%, p=0.09), clinical pregnancy rate (70% vs 58%, p=0.4), and live birth rate (58% vs 47%, p=0.4) did not differ between epididymal and ejaculated sperm groups.
For couples with a male partner with OA, epididymal sperm IVF/ICSI outcomes compare similarly with age-matched controls undergoing IVF/ICSI using normal, ejaculated sperm. These results may help reproductive surgeons provide reassurance about the use of obstructed epididymal sperm as well as help guide discussions about anticipated outcomes of IVF/ICSI.
The Journal of urology. 2020 Oct 07 [Epub ahead of print]
Solomon Hayon, Sarah Moustafa, Caitlin Boylan, Taylor P Kohn, Mary Peavey, R Matthew Coward
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA., Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA., UNC Fertility, Raleigh, NC, USA., The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.