A retrospective study of the effect of testicular biopsy extracted spermatozoa in intracytoplasmic sperm injection (ICSI) on reproductive outcomes in assisted reproductive treatment (ART)

Date
2023-03
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Background: Azoospermia, a possible cause of male infertility, is responsible for 10–15 percent of infertility cases. Azoospermia is characterized by the absence of spermatozoa following microscopic analysis and centrifugation of the complete sperm specimen. Azoospermia patients can be divided into two categories, obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). The effects of testicular spermatozoa compared to ejaculated spermatozoa on ART outcomes still remain controversial. Spermatozoa from different sources or diagnostic groups result in significantly different treatment outcomes in some studies but not in others. There are differences in the quality of sperm from patients diagnosed with OA and NOA. Due to ongoing controversy, this study was therefore conducted to establish ICSI outcomes with ejaculated spermatozoa and testicular retrieved spermatozoa under specific laboratory conditions. Aims: The primary aim was to retrospectively investigate the effect of testicular biopsy spermatozoa (TB group) compared to the effect of ejaculated spermatozoa (ES group) on ART outcomes. The secondary aim was to retrospectively evaluate whether the reason for azoospermia (NOA or OA) affects the IR, CPR, LBR, and MR. Materials and Methods: This study was retrospectively conducted on the data obtained from medical and laboratory records between 2017 and 2020 at Drs. Aevitas Fertility Clinic, Pinelands, South Africa and Tygerberg Fertility Clinic for the period of 2015 – 2020. Data was categorized and filtered based on predetermined inclusion and exclusion criteria. Data was submitted for statistical analysis (statistical significance: P < 0.05). Results: The FR (84.66% vs 82.47%), Cleavage Rate (97.15% vs 98.76%), Blastulation Rate (54.73% vs 53.82%), CPR (44.86% vs 35.94%) and MR (29.17% vs 36.28%) were not significantly different between the TB group and the ES group respectively (p>0.05). The IR (30.69% vs 23.06%) and the LBR (33.64% vs 23.96%) was significantly different between the TB group and the ES group respectively (p<0.05). The FR (86.30% vs 79.29%), Cleavage Rate (96.79% vs 98.39%), Blastulation Rate (57.19% vs 45.43%), IR (29.27% vs 35.33%), CPR (43.90% vs 48%), MR (36.11% vs 8.33%) and LBR (29.27% vs 44%) were not significantly different between the OA group and the NOA group respectively (p>0.05). Conclusion: The present study primarily compared the results of ICSI with testicular spermatozoa with those of ICSI with ejaculated spermatozoa. Sub analysis were done on the two different azoospermic groups (NOA and OA). This retrospective study indicated similar FR, Cleavage Rates, Blastulation Rates, PR and MR for the ES group and the TB group. The current study found a significant difference in the IR and LBR between these two groups. By comparing the OA and the NOA group no significant difference in the FR, Cleavage Rates, Blastulation Rates, IR, CPR, MR and LBR was found. The present study, as well as available literature, confirms that the use of testicular spermatozoa does not have a negative effect on ICSI treatment outcomes. This study can therefore provide valuable information during consultation for ICSI treatment in these patients and provide them with assurance that it is possible to achieve normal FR as well as good quality embryos, IR, CPR and lower MR with ICSI.
AFRIKAANSE OPSOMMING: Agtergrond: Azoospermie, 'n moontlike oorsaak van infertiliteit by mans, is verantwoordelik vir 10-15 persent van infertiliteitsgevalle (Schlegel, 2004). Azoospermie word gekenmerk deur die afwesigheid van spermatozoa na mikroskopiese analise en sentrifugering van die volledige semen monster (Schlegel, 2004). Azoospermie pasiente kan in twee kategoriee verdeel word, obstruktiewe azoospermie (OA) en nieobstruktiewe azoospermie (NOA). Die uitwerking van testikulere spermatozoa teenoor geejakuleerde spermatozoa op ART-uitkoms is steeds kontroversieel. Spermatozoa vanaf verskillende diagnostiese groepe lei tot aansienlik kontrasterende ART-uitkomste in sommige studies, maar nie in ander nie. Daar is ‘n verskil in die kwaliteit van sperms van pasiente wat met OA en NOA gediagnoseer is. As gevolg van voortdurende omstredenheid, is hierdie studie dus uitgevoer om ICSI-uitkomste te bestudeer vir geejakuleerde spermatozoa teenor testikulere spermatozoa onder spesifieke laboratoriumtoestande. Doelwitte: Die primere doel was om die effek van testikulere biopsie spermatozoa (TB-groep) retrospektief te ondersoek en dit te vergelyk met die effek van geejakuleerde spermatozoa (ES-groep). Die sekondere doel was om te bepaal of die oorsaak vir azoospermie (NOA of OA) die Inplantingskoers (IR), Kliniese Swangerskapkoers (CPR), Geboortekoers (LBR) en miskraamkoers (MR) affekteer. Materiale en Metodes: Hierdie studie is retrospektief uitgevoer op die anonieme data verkry uit mediese en laboratoriumrekords vanaf 2017 tot. 2020 by Dr. Aevitas Fertiliteitskliniek, Pinelands, South Africa en Tygerberg Fertiliteitskliniek vir die tydperk van 2015 – 2020. Data is ingedeel op grond van voorafbepaalde insluiting- en uitsluitingskriteria. Data is ingedien vir statistiese analise (statistiese betekenisvolheid: P <0,05). Resultate: Die FR (84,66% vs 82,47%), delingskoers (97,15% vs 98,76%), Blastulasiekoers (54,73% vs 53,82%), CPR (44,86% vs 35,94% vs 29.31) en MR (29.31% vs. %) was nie betekenisvol verskillend tussen die TB-groep en ES-groep onderskeidelik nie (p>0.05). Die IR (30.69% vs 23.06%) en die LBR (33.64% vs 23.96%) was betekenisvol verskillend tussen die TB-groep en die ES-groep onderskeidelik (p<0.05). Die FR (86,30% vs 79,29%), delingskoers (96,79% vs 98,39%), blastulasiekoers (57,19% vs 45,43%), IR (29.27% vs 35.33%), CPR (43,90% vs 48%), MR (36,11% vs 8,33%) en die LBR (29.27% vs 44%) was nie betekenisvol verskillend tussen die OA-groep en die NOA-groep onderskeidelik nie (p. > 0,05). Gevolgtrekking: Die huidige studie het hoofsaaklik die resultate van ICSI met testikulere spermatozoa vergelyk met die van geejakuleerde spermatosoa. Sub-analise is op die twee verskillende azoospermiese groepe (NOA en OA) gedoen. Hierdie retrospektiewe studie het soortgelyke FR, delingskoers, blastulasiekoers, CPR en MR tussen die ES-groep en die TB-groep aangedui. Die huidige studie het 'n beduidende verskil in die IR en LBR tussen hierdie twee groepe gevind. Deur die OA en die NOA-groep te vergelyk, is geen beduidende verskil uitgewys in die FR, delingskoers, Blastulasietempo's, IR, CPR, MR en die LBR nie. Die huidige studie, sowel as beskikbare literatuur, bevestig dat die gebruik van testikulere spermatozoa nie 'n negatiewe invloed op ICSI behandelingsuitkomste het nie. Hierdie huidige studie kan dus nuttige inligting verskaf tydens konsultasie van hierdie pasiente en aan hulle versekering verskaf dat dit moontlik is hoe normale FR sowel as goeie kwaliteit embrio's, IR, PR en laer MR via ICSI te bereik.
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Thesis (MSc)--Stellenbosch University, 2023.
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