Outcome of ICSI with testicular spermatozoa obtained through microscopically assisted testicular sperm extraction in relation to the ovarian response
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Study question: To determine whether the outcome of ICSI with testicular spermatozoa obtained microscopically assisted testicular sperm extraction (m-TESE) is dependent on the number of MII oocytes. Summary answer: The number of the mature oocytes is an important prognostic factor in ICSI with testicular spermatozoa obtained from azoospermic men. What is known already: Retrieval of healthy oocytes is a key component of assisted reproductive treatment for infertile couples. Intracytoplasmic sperm injection (ICSI) has been commonly used for couples with male infertility since its first successful introduction in 1992 and reliable pregnancy rates were achieved by using testicular spermatozoa from patient with azoospermia. Study design, size, duration: A retrospective cohort of women 40 years old who underwent ICSI treatment with testicular spermatozoa were included from 2006 to 2013. Participants/materials, setting, methods: Women were enrolled only for one cycle. 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 between the number of MII oocytes and the live birth rate. Receiver operator characteristic (ROC) curves were formed to detect a cut-off number of MII oocytes below which live birth rate was significantly decreased. Main results and the role of chance: The live birth rate was significantly higher in ICSI-mTESE cycles with ≥7 MII oocytes than that with <7 oocytes (30.6% vs. 14.3%, respectively, r = 0.12, p = 0.02). LBRs were the lowest in cycles with one or two MII oocytes available (9% and 9%, respectively), but these rates were not statistically different than cycles with 3,4,5 and 6 MII oocytes (14.8%, 16.6%, 17.8%, 23%, respectively, p>0.05). Embryo transfer was not achieved in 37 cycles with <7 oocytes (37/167, 22.1%) and 18 cycles with ≥7 oocytes (18/173, 10.4%) because of the absence embryos available following ICSI (p < 0.01). Limitations, reasons for caution: The limitations of the present study were the retrospective design and relatively small number of ICSI cycles with testicular spermatozoa. Wider implications of the findings: Our current findings imply that obtaining low numbers of oocytes is associated with impaired pregnancy rate in ICSI with m-tese cycles. Trial registration number: Instutional Ethics committe number: 2016-012.