Haydarpasa Numune Med J. 2019; 59(1): 31-34 | DOI: 10.14744/hnhj.2018.98698

Comparison of the ICSI Results From Sperm Obtained by m-TESE at Three Different Periods in Patients with Azoospermia: Retrospective Study

Erkan Erdem¹, Aytac Sahin², Selin Demirer³, Meryem Hocaoðlu⁴, Akin Usta⁵, Ziya Çebi⁶, Meric Karacan^7
1Department of Urology, Ota-jinemed Hospital, Istanbul, Turkey
²Department of Urology, Fatih Sultan Mehmet Training and Researh Hospital, Istanbul, Turkey
³Department of Genetics, Istanbul University Aziz Sancar Experimental Medicine Research Institute, Istanbul, Turkey
⁴Department of Gynecology and Obstetrics, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey
⁵Department of Gynecology and Obstetrics, Balýkesir University Faculty of Medicine, Balýkesir, Turkey
⁶Department of Gynecology and Obstetrics, Ota-jinemed Hospital, Istanbul, Turkey
⁷Department of Gynecology and Obstetrics, Yeni Yüzyýl University Faculty of Medicine, Istanbul, Turkey

INTRODUCTION: The absence of any spermatozoa in the ejaculate is called azoospermia, and it is seen in 1% of males, resulting in 10%–15% of infertility problems. Azoospermia may be due to obstructive (OA) and non-obstructive (NOA) causes. Microscopic testicular sperm extraction (m-TESE) is often applied today to obtain sperm from patients with azoospermia, and healthy pregnancies can be obtained by performing intracytoplasmic sperm injection (ICSI) with the testicular sperm obtained. In this study, we aimed to compare the ICSI cycle results from fresh sperm obtained by m-TESE on the day of oocyte collection or the day before, and frozen m-TESE sperm.
METHODS: Between January 2008 and April 2017, patients who underwent m-TESE in the In Vitro Fertilization Unit of our hospital were retrospectively analyzed. A total of 342 patients with azoospermia (117 OA and 225 NOA cases) with regular follow-up were included in the study. The first group underwent m-TESE on the same day, the second group underwent m-TESE 24 hours before, and in the third group, the sperm was frozen after m-TESE.
RESULTS: A total of 235 patients, 117 patients with OA (%100) and 118 NOA patients (52.4%), had motile spermatozoa. In 150 patients (85 OA, 65 NOA), the sperm were used the same day, and in 51 patients (24 OA, 27 NOA), one day later. Sperm in 34 patients (8 OA, 26 NOA) was frozen for later use. When ICSI results were evaluated in these groups, the number and rates of fertilization in the OA group were 56 (65.8%), 16 (66.6%), and 5 (62.5%); clinical pregnancy numbers and rates were 30 (35.2%), 9 (37.5%), and 3 (37.5%); and the live birth numbers and rates were 26 (30.5%), 7 (29.1%), and 2 (25.0%), respectively. In the NOA group, fertilization numbers and rates were 46 (70.7%), 19 (70.3%), and 18 (69.2%); clinical pregnancy numbers and rates were 24 (36.9%), 10 (37.0%), and 10 (38.4%); and the live birth numbers and rates were 20 (30.7%), 8 (29.6%), and 8 (30.7%), respectively.
DISCUSSION AND CONCLUSION: In the IVF-ICSI applications, there was no difference in terms of fertilization, pregnancy, and live birth rates between the use of frozen sperm or m-TESE on the oocyte collection day or 1 day before.

Keywords: Azoospermia, infertility; m-TESE; pregnancy; spermatozoa.

---

Azospermik Hastalarda Mikro TESE Ýle Üç Farklý Zamanda Elde Edilen Spermlerle Yapýlan ICSI Sonuçlarýnýn Karþýlaþtýrýlmasý: Retrospektif Analiz

Erkan Erdem¹, Aytac Sahin², Selin Demirer³, Meryem Hocaoðlu⁴, Akin Usta⁵, Ziya Çebi⁶, Meric Karacan^7
1Ota-jinemed Hastanesi, Üroloji Klinigi, Ýstanbul
²Fatih Sultan Mehmet Eðtim ve Araþtýrma Hastanesi, Uroloji Kliniði, Istanbul
³Ýstanbul Üniversitesi Aziz Sancar Deneysel týp Araþtýrma Enstitüsü, Genetik anabilim dalý, Istanbul
⁴Ýstanbul Medeniyet Üniversitesi, Göztepe Eðitim ve Araþtýrma Hastanesi, Kadýn hastalýklarý ve Doðum Kliniði, Istanbul
⁵Balýkesir Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Ana Bilim Dali, Balýkesir
⁶Ota-jinemed Hastanesi, Kadýn Hastalýklarý ve Doðum Kliniði, Ýstanbul
⁷Yeni Yüzyýl Üniversitesi Týp Fakültesi, Kadýn Hastalýklarý ve Doðum Ana Bilim Dali, Ýstanbul

GÝRÝÞ ve AMAÇ: Ejakülatta hiç sperm bulunmamasý azoospermi olarak adlandýrýlmakta ve erkeklerin %1’inde, infertilite yakýnmasý olanlarýn ise %10-15’inde saptanmaktadýr. Azospermi, obstruktif (OA) ve non-obstruktif (NOA) nedenlere baðlý olabilir. Azospermik hastalardan sperm elde etmek için günümüzde sýklýkla mikroskopik testiküler sperm ekstraksiyonu (m-TESE) uygulanmakta, elde edilen testiküler sperm ile intrasitoplazmik sperm Ýnjeksiyonu (ICSI) yapýlarak saðlýklý gebelikler elde edilebilmektedir. Bu çalýþmada, oosit toplama günü veya önceki gün m-TESE yapýlarak elde edilen taze spermler ve daha önce elde edilmiþ dondurulmuþ spermler ile yapýlan ICSI sikluslarýnýn sonuçlarýný karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2008 - Nisan 2017 tarihleri arasýnda hastanemiz ÝVF Ünitesinde m-TESE yapýlan hastalar retrospektif olarak incelendi. Kayýtlarýna ulaþýlan, düzenli takipleri yapýlmýþ 342 azospermik hasta (117 OA ve 225 NOA olgusu) çalýþmaya dahil edildi. Ayný gün m-TESE yapýlanlar 1. grup, 24 saat önce m-TESE yapýlanlar 2. grup, daha önce m-TESE yapýlýp spermlerin dondurulduðu hastalar ise 3. grup olarak sýnýflandýrýldý.
BULGULAR: Motil spermatozoa, 117 OA’lý hastalarýn tamamýndan (%100) ve NOA hastalarýnýn ise 118’inde (%52,4) olmak üzere toplam 235 hastada elde edildi. 150 hastada (85 OA, 65 NOA) spermler ayný gün, 51 hastada (24 OA, 27 NOA) bir gün sonra kullanýldý. 34 hastada ise (8 OA, 26 NOA) bulunan spermler daha sonra kullanýlmak üzere donduruldu.
Bu gruplarda yapýlan ICSI sonuçlarý deðerlendirildiðinde OA grubunda fertilizasyon sayý ve oranlarý sýrasýyla 56 (%65,8), 16 (%66,6) ve 5 (%62,5), klinik gebelik sayý ve oranlarý 30 (%35,2), 9 (%37,5) ve 3 (%37,5), canlý doðum sayý ve oranlarý 26 (%30,5), 7 (%29,1) ve 2 (%25,0) olarak bulundu. NOA grubunda ise fertilizasyon sayý ve oranlarý 46 (%70,7), 19 (%70,3) ve 18 (%69,2), klinik gebelik sayý ve oranlarý 24 (%36,9), 10 (%37,0) ve 10 (%38,4), canlý doðum sayý ve oranlarý 20 (%30,7), 8 (%29,6) ve 8 (%30,7) olarak bulundu

TARTIÞMA ve SONUÇ: ÝVF-ICSI uygulamalarýnda dondurulmuþ spermlerin kullanýmý ya da m-TESE iþleminin oosit toplama günü veya 1 gün önce yapýlmasý arasýnda fertilizasyon, gebelik ve canlý doðum oranlarý açýsýndan fark yoktur.

Anahtar Kelimeler: Ýnfertilite, azospermi, m-TESE, spermatozoa, gebelik

---

CITE