Obstet Gynecol Sci.  2019 Nov;62(6):429-437. 10.5468/ogs.2019.62.6.429.

ICSI using fresh and frozen PESA-TESA spermatozoa to examine assisted reproductive outcome retrospectively

Affiliations
  • 1Department of Biotechnology, REVA University, Bangalore, India. drkrmanjula@gmail.com
  • 2Post Graduate-Department of Biotechnology, Dayananda Sagar Institutions, Bangalore, India.

Abstract


OBJECTIVE
The male reproductive system generates, accumulates, and transports the sperm. In this study, 2 methods of surgically retrieving sperm, namely, testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA), are discussed and studied in men aged ≤38 years to achieve successful conception using assisted reproductive technology. The purpose was to assess the fertilization rate (FA), clinical pregnancy, and live birth rate (LBR) with sperm.
METHODS
A total of 287 semen samples were divided into 4 groups as follows: fresh PESA (n=73), frozen PESA (n=65), fresh TESA (n=128), and frozen TESA (n=21). The DNA fragmentation test using sperm chromatin dispersion assay was measured and reported.
RESULTS
FA was 70.3% and 65.5%, (P<0.022) for fresh and frozen epididymal sperm and 53.8% and 49.5%, (P<0.032) for fresh and frozen testicular sperm. LBR was 33.6% and 30.2% (P<0.075) for fresh and frozen epididymal sperm (PESA) and 22.7% and 18.2% (P<0.063) for fresh and frozen-thawed TESA sperm.
CONCLUSION
Exposure to tissue shearing may adversely affect sperm quality. Increased sperm DNA damage due to long-term exposure while teasing enhances reactive oxygen species production foremost to membrane damage because of the oxidation of polyunsaturated fatty acid in lipids (lipid peroxidation), oxidation of amino acid in proteins, and inactivation of specific enzymes, all leading to enzymatic dipping and possibility of less fertilization and conception as indicated by the increase in LBR with fresh/frozen PESA compared to with fresh/frozen TESA.

Keyword

Spermatozoa; Fertilization; Infertility; DNA fragmentation

MeSH Terms

Chromatin
DNA Damage
DNA Fragmentation
Fertilization
Humans
Infertility
Live Birth
Male
Membranes
Pregnancy
Reactive Oxygen Species
Reproductive Techniques, Assisted
Retrospective Studies*
Semen
Sperm Injections, Intracytoplasmic*
Sperm Retrieval
Spermatozoa*
Chromatin
Reactive Oxygen Species

Figure

  • Fig. 1 Sperm chromatin dispersion (SCD) test % on testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) sperms.Data presented as dispersed and non dispersed nuclei mean percentage for the 4 independent observations, dispersed and non-dispersed percentage for fresh PESA (63.76–36.23), dispersed and non-dispersed percentage for frozen PESA (56.99–43), dispersed and non-dispersed percentage for fresh TESA (62–38) and dispersed and non-dispersed percentage for frozen TESA (67.18–32.81) and number of observation in fresh PESA=73, frozen PESA=65, fresh TESA=128, and frozen TESA=21.

  • Fig. 2 Pregnancy outcomes: testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA). Data presented as positive B-hCG (+βhcg) and clinical pregnancy rate (CPR) mean percentage for the 4 independent observations, +βhcg and CPR & live birth rate (LBR) and miscarriage rate (MR) for fresh PESA (39.6–36.5) & (33.6–2.9), frozen PESA (36.5–34.6) & (30.2–4.4), fresh TESA (33.7–29.2) & (22.7–6.5) and frozen TESA (26.8–24.3) & (18.2–6.1).


Reference

1. Temple-Smith PD, Southwick GJ, Yates CA, Trounson AO, de Kretser DM. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert Embryo Transf. 1985; 2:119–122.
2. Corea M, Campagnone J, Sigman M. The diagnosis of azoospermia depends on the force of centrifugation. Fertil Steril. 2005; 83:920–922.
Article
3. Esteves SC, Lee W, Benjamin DJ, Seol B, Verza S Jr, Agarwal A. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol. 2013; 189:232–237.
Article
4. Glina S, Fragoso JB, Martins FG, Soares JB, Galuppo AG, Wonchockier R. Percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia. Int Braz J Urol. 2003; 29:141–145.
Article
5. Hao L, Li ZG, He HG, Zhang ZG, Zhang JJ, Dong Y, et al. Application of percutaneous epididymal sperm aspiration in azoospermia. Eur Rev Med Pharmacol Sci. 2017; 21:1032–1035.
6. Kovac JR, Lehmann KJ, Fischer MA. A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia. Urol Ann. 2014; 6:41–45.
Article
7. Gardner DK, Lane M, Watson AJ. A laboratory guide to the mammalian embryo. New York (NY): Oxford University Press;2004.
8. Gardner DK, Rizk BR, Falcone T. Human assisted reproductive technology: future trends in laboratory and clinical practice. Cambridge: Cambridge University Press;2011.
9. Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A. Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril. 1995; 63:808–815.
10. Zhu J, Tsirigotis M, Pelekanos M, Craft I. In-vitro maturation of human testicular spermatozoa. Hum Reprod. 1996; 11:231–232.
11. Smith RP, Coward RM, Lipshultz LI. The office visit. Urol Clin North Am. 2014; 41:19–37.
Article
12. McBride JA, Coward RM. Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian J Androl. 2016; 18:373–380.
Article
13. Coward RM, Mata DA, Smith RP, Kovac JR, Lipshultz LI. Vasectomy reversal outcomes in men previously on testosterone supplementation therapy. Urology. 2014; 84:1335–1341.
Article
14. Boorjian S, Lipkin M, Goldstein M. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol. 2004; 171:304–306.
Article
15. International Committee of Medical Journal Editors (ICMJE). Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals (December 16, 2014). [place unknown]: ICMJE;2014.
16. Coward RM, Mills JN. A step-by-step guide to office-based sperm retrieval for obstructive azoospermia. Transl Androl Urol. 2017; 6:730–744.
Article
17. Gorgy A, Meniru GI, Naumann N, Beski S, Bates S, Craft IL. The efficacy of local anaesthesia for percutaneous epididymal sperm aspiration and testicular sperm aspiration. Hum Reprod. 1998; 13:646–650.
Article
18. Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? A systematic review. Hum Reprod Update. 2007; 13:539–549.
Article
19. Van Peperstraten A, Proctor ML, Johnson NP, Philipson G. Techniques for surgical retrieval of sperm prior to intra-cytoplasmic sperm injection (ICSI) for azoospermia. Cochrane Database Syst Rev. 2008; 2:CD002807.
20. Bernie AM, Mata DA, Ramasamy R, Schlegel PN. Comparison of microdissection testicular sperm extraction, conventional testicular sperm extraction, and testicular sperm aspiration for nonobstructive azoospermia: a systematic review and meta-analysis. Fertil Steril. 2015; 104:1099–1103.
Article
21. Semião-Francisco L, Braga DP, Figueira Rde C, Madaschi C, Pasqualotto FF, Iaconelli A Jr, et al. Assisted reproductive technology outcomes in azoospermic men: 10 years of experience with surgical sperm retrieval. Aging Male. 2010; 13:44–50.
22. Lewin A, Weiss DB, Friedler S, Ben-Shachar I, Porat-Katz A, Meirow D, et al. Delivery following intracytoplasmic injection of mature sperm cells recovered by testicular fine needle aspiration in a case of hypergonadotropic azoospermia due to maturation arrest. Hum Reprod. 1996; 11:769–771.
Article
23. Gorgy A, Podsiadly BT, Bates S, Craft IL. Testicular sperm aspiration (TESA): the appropriate technique. Hum Reprod. 1998; 13:1111–1113.
Article
24. Jensen CF, Ohl DA, Hiner MR, Fode M, Shah T, Smith GD, et al. Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men. Andrology. 2016; 4:257–262.
Article
25. Qiu Y, Wang S, Yang D, Fan Y, Su Q, Wang Z, et al. Percutaneous vasal sperm aspiration and intrauterine insemination in the treatment of obstructive azoospermia. Fertil Steril. 1997; 68:1135–1138.
Article
26. Qiu Y, Wang SM, Yang DT, Wang LG. Percutaneous vasal sperm aspiration and intrauterine insemination for infertile males with anejaculation. Fertil Steril. 2003; 79:618–620.
Article
27. Fernández JL, Muriel L, Goyanes V, Segrelles E, Gosálvez J, Enciso M, et al. Simple determination of human sperm DNA fragmentation with an improved sperm chromatin dispersion test. Fertil Steril. 2005; 84:833–842.
28. Lewin A, Reubinoff B, Porat-Katz A, Weiss D, Eisenberg V, Arbel R, et al. Testicular fine needle aspiration: the alternative method for sperm retrieval in non-obstructive azoospermia. Hum Reprod. 1999; 14:1785–1790.
Article
29. McLachlan RI, Rajpert-De Meyts E, Hoei-Hansen CE, de Kretser DM, Skakkebaek NE. Histological evaluation of the human testis--approaches to optimizing the clinical value of the assessment: mini review. Hum Reprod. 2007; 22:2–16.
Article
30. Esteves SC, Varghese AC. Laboratory handling of epididymal and testicular spermatozoa: what can be done to improve sperm injections outcome. J Hum Reprod Sci. 2012; 5:233–243.
Article
31. Schiff JD, Palermo GD, Veeck LL, Goldstein M, Rosenwaks Z, Schlegel PN. Success of testicular sperm extraction [corrected] and intracytoplasmic sperm injection in men with Klinefelter syndrome. J Clin Endocrinol Metab. 2005; 90:6263–6267.
32. Sharpe RM, McKinnell C, Kivlin C, Fisher S. Proliferation and functional maturation of Sertoli cells, and their relevance to disorders of testis function in adulthood. Reproduction. 2003; 125:769–784.
Article
33. Pasqualotto FF, Rossi-Ferragut LM, Rocha CC, Iaconelli A Jr, Borges E Jr. Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia. J Urol. 2002; 167:1753–1756.
34. Ou L, Guo YH, Sun YP, Su YC. Outcomes of ICSI with microamount frozen-thawed sperm obtained by PESA or TESA in the treatment of azoospermia. Zhonghua Nan Ke Xue. 2010; 16:328–332.
35. Silber SJ, Van Steirteghem AC, Liu J, Nagy Z, Tournaye H, Devroey P. High fertilization and pregnancy rate after intracytoplasmic sperm injection with spermatozoa obtained from testicle biopsy. Hum Reprod. 1995; 10:148–152.
Article
36. Aamir J, Ashwini LS, Ganguly D, Murugan S, Muthiah SS, et al. Interpretation: real-time assessment on immotile but viable spermatozoa for intracytoplasmic sperm injection (ICSI): an embryologists outlook. Austin J In Vitro Fertili. 2015; 2:1021.
37. Verheyen G, Popovic-Todorovic B, Tournaye H. Processing and selection of surgically-retrieved sperm for ICSI: a review. Basic Clin Androl. 2017; 27:6.
Article
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