Successful Cryptozoospermia Management with Multiple Semen Specimen Collection.
Academic Article
Overview
abstract
OBJECTIVE: To determine the prevalence of sperm suitable for intracytoplasmic sperm injection (ICSI) in fresh ejaculated semen samples provided by men scheduled for a microdissection testicular sperm extraction (mTESE) procedure. Secondary objectives included evaluation of the effect of a short abstinence period on semen quality and ICSI outcomes for cryptozoospermic men. DESIGN: Retrospective cohort study SUBJECTS: All men scheduled to undergo a mTESE procedure by a single, high-volume surgeon at an academic center from 9/1/2015 - 5/1/2021. EXPOSURE: Presence of sperm suitable for ICSI in the ejaculate on the day of scheduled mTESE. MAIN OUTCOME MEASURES: Prevalence of sperm suitable for ICSI in the ejaculate among previously azoospermic men. Secondary outcomes included changes in semen parameters, clinical pregnancy rate, and live birth rate. RESULTS: Of 727 planned mTESE procedures, 69 (9.5%) were canceled due to sperm suitable for ICSI being identified in a fresh ejaculated sample produced on the day of scheduled surgery (typically one day prior to oocyte retrieval). Overall, 50 men (50/727, 6.9%) used these rare, ejaculated sperm for ICSI. Semen samples obtained with <24 hours of abstinence were more likely to have better motility than the sample initially provided on day of planned mTESE (p<0.001). The live birth rate per ICSI attempt using these rare, ejaculated sperm was 36% (19/53). CONCLUSION: Providing a fresh ejaculated semen sample on the day of mTESE allows nearly 10% of azoospermic men to avoid surgery with satisfactory ICSI outcomes. Providing multiple ejaculated samples over a short period does not adversely affect sperm concentration and may enhance sperm motility for cryptozoospermic men.
