Outcome of ICSI with motile testicular spermatozoa obtained through microscopically assisted testicular sperm extraction in relation to the ovarian response
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"Introduction. - To determine the relationship between AFC, basal FSH level, woman's age, the number of oocytes retrieved and the outcome of ICSI with testicular spermatozoa obtained with microscopically assisted testicular sperm extraction. Material and methods. - In this retrospective cohort study, a total of 340 couples who underwent ICSI treatment with testicular sperm were enrolled. Women aged <= 40 years and the first cycles of couples were included. ICSI was performed with motile testicular spermatozoa obtained from 89 men with obstructive azoospermia and 251 men with nonobstructive azoospermia. GnRH-antagonist protocol was used for ovulation induction. Simple linear regression was carried out to analyze relationship between the AFC, basal FSH, woman's age, the number of oocytes, and the live birth rate (LBR). Receiver operator characteristic curves (ROC) were formed to detect cut-off values below which LBR was significantly decreased. ROC curve analysis demonstrated that the cut-off level of the number of oocytes retrieved to predict the LBR was 7. According to this cut-off level, all patients were divided into two groups. Women with retrieved < 7 oocytes were included in Group 1 and women with retrieved >= 7 oocytes were included in Group 2. Results. - The mean age of men was 35.1 +/- 4.9 years. The mean age, mean FSH level and mean AFC of women were 32.1 +/- 4.9 years, 6.9 +/- 2.7 IU/L, 7.6 +/- 3.4, respectively. Significant correlations were found between AFC, the number of oocytes retrieved, and the LBR per ICSI cycle with testicular spermatozoa. The LBR was significantly lower in women with AFC < 8 than those with AFC >= 8. Independently, the LBR was significantly lower in cycles with < 7 oocytes retrieved compared to those with >= 7. Embryo transfer was not achieved in 37 cycles with < 7 oocytes (37/167, 22.1%) and 18 cycles with >= 7 (18/173,10.4%) because of the absence of transfer-quality embryos (P = 0.005). The LBRs were the lowest in cycles with one or two oocytes available (8.3 and 8.3%, respectively), but these rates were not statistically different than those in cycles with 3, 4, 5 and 6 oocytes (14.2, 17.2, 18.5, 17.6%, respectively, P = 0.810). Conclusions. - AFC and the number of oocytes retrieved are important prognostic factors in an ICSI cycle with testicular sperm in women < 40 years, yielding significantly diminished LBRs with < 8 antral follicles and/or < 7 oocytes retrieved.