Efficacy of fresh and thawed testicular sperm using ICSI in azoospermic patients

Y.-S. Park, S.-H. Lee, H. K. Byun, J. H. Jun, M. K. Koong,
J. T. Seo. Samsung Cheil Hospital, Seoul, Republic of Korea.

OBJECTIVE: Assessed the efficacy of cryopreservation of testicular sperm
obtained from azoospermic patients and also compare the cycle outcome
following ICSI with testicular sperm from frozen-thawed seminiferous tubule.
DESIGN: Retrospective analysis.
MATERIALS AND METHODS: In 776 patients, a total 1242 cycles of
TESE was performed. Obstructive azoospermia was 680 cycles (54.8%) and
non-obstructive azoospermia was 562 (45.2%) cycles. In TESE cycle,
remained seminifeous tubules were cryopreserved after sperm preparation.
The sections of seminiferous tubules were mixed in human semen preservation
medium.

And the ampules containing sample were frozen by programmed
cell freezer (CryoMagic I, Seoul, Korea).

For thawing, frozen
samples were placed at room temperature and washed to remove cryoprotectant
and sperm were retrieved in seminiferous tubule.
RESULTS: The total fertilization rates with 2-PN were 66.1% and pregnancy
rates were 27.9% (347/1242). In obstructive azoospermia, fertilization
rates with 2-PN were 68.4% and pregnancy rates were 33.4% (227/680). The
pregnancy rates in fresh and thawed group were 35% (127/363) and 31.5%
(100/317), respectively. In non-obstructive azoospermia, fertilization rates with
2-PN were 63.8% and pregnancy rates were 21.4% (120/562). In hypospermatogenesis
(HS, n257), total pregnancy rates of fresh and thawed cycles
using patient’s own sperm were 38.6% (98/254). And pregnancy rates in fresh
group and thawed group were 25.6% (65/254) and 11.8% (30/254), respectively.
In maturation arrest (MA, n80), total pregnancy rates of fresh and
thawed cycles using patient’s own sperm were 20% (12/60). And pregnancy
rates in fresh group and thawed group were 15% (9/60) and 5% (3/60),
S266 Vol. 82, Suppl. 2, September 2004
respectively. In Sertoli cell only syndrome (SCO, n188), total pregnancy rates
of fresh cycles using patient’s own sperm were 16.7% (10/60). In Klinefelter’s
syndrome (KS, n37), total pregnancy rates of fresh cycles using patient’s own
sperm were 20% (3/20).
CONCLUSION: Optimal fertilization and pregnancy can be achieved
using fresh- and thawed testicular sperm. Thawed testicular sperm showed
reduced fertilization and pregnancy rates, cryopreservation of testicular
sperm offers a suitable chance for azoospermic patients. Especially in
non-obstructive azoospermic patients, although pregnancy rate was reduced
than obstructive azoospermia, optimum pregnancy rate can achieved. Therefore,
cryopreservation of seminiferous tubule is an effective procedure for
optimal fertilization and pregnancy rates in azoospermic patients.
Supported by: None