Abstract: PD68-03
Sources of Funding: Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.

Introduction

Microdissection testicular sperm extraction (microTESE) with intracytoplasmic sperm injection (ICSI) is an important treatment option for men with non-obstructive azoospermia (NOA). Although men with NOA have 0% normal forms, laboratory staff will commonly avoid ICSI of individual sperm because of subjective considerations of sperm &[Prime]quality&[Prime] based on morphologic evaluation. We report the effect of injected sperm characteristics on fertilization and pregnancy rates in ICSI following microTESE in men with NOA.

Methods

We conducted a retrospective review of all men at a single institution who had successful sperm retrieval at microTESE and then proceeded to ICSI between 05/13 and 06/16. Information was collected on demographics, injected sperm characteristics at ICSI, fertilization, and pregnancy rates. Comparisons were done using Fisher&[prime]s test, gamma test, one-way ANOVA, and multivariable analysis (MVA), with significance set at p<0.05.

Results

A total of 198 men (mean age 35±8 years) were included. Fertilization and pregnancy rates were 44% and 38%, respectively. On univariable analysis, sperm motility and the lack of acrosome defects were associated with higher fertilization and pregnancy rates while an increasing number of total sperm abnormalities was negatively associated with fertilization, but not pregnancy, rates (Table). On MVA, only sperm motility was associated with fertilization rates (p<0.001) while both sperm motility (p=0.004) and the lack of acrosome abnormalities (p=0.018) were associated with pregnancy rates. Female age (mean age 31±5 years) was not associated with fertilization or pregnancy rates on MVA.

Conclusions

This study is the first to assess the relationship between injected testicular sperm characteristics and reproductive outcomes in ICSI. All men with NOA have abnormal sperm morphology and our experience suggests that no specific sperm abnormality, including injection of non-motile sperm, precludes the chance of pregnancy. Further study of sperm characteristics may influence how aggressively surgeons should seek better sperm quality during microTESE procedures. Use of elongating spermatids (blunt-tailed sperm) did not adversely affect the chance of pregnancy despite concerns for lower fertilization with severely blunt-tailed sperm.

Funding

Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.