The influence of sperm motility and cryopreservation on the treatment outcome after intracytoplasmic sperm injection following testicular sperm extraction.

INTRODUCTION: It is already known that embryo quality is a major contributing factor to the outcome of assisted reproduction techniques. This study focuses on treatment variables that might be of importance to the outcome of intracytoplasmic sperm injection following testicular sperm extraction (TESE-ICSI) in non-obstructive azoospermia. MATERIAL AND METHODS: A retrospective cohort study was conducted at a Dutch tertiary care academic training hospital between July 2009 and December 2013. With logistic regression analysis we explored the influence of treatment variables, including testicular sperm parameters - (i) motile or tail touch spermatozoa, and (ii) use of fresh or frozen testicular semen-samples - on biochemical and ongoing pregnancy rates after single (n = 393) and double embryo transfer (n = 352). RESULTS: Multivariate logistic regression analysis identified the rank of the TESE-ICSI attempt [odds ratio (OR) 0.8, 95% confidence interval (95% CI) 0.70-0.93], the number of embryos available for transfer (OR 1.1, 95% CI 1.06-1.19) and quality of the embryo(s) transferred (OR 12.8, 95% CI 5.00-32.67) as possible predictors of biochemical pregnancy, whereas only embryo quality (OR 16.9, 95% CI 5.23-54.87) was independently associated with ongoing pregnancy. CONCLUSIONS: The use of cryopreserved testicular sperm does not negatively influence the ongoing pregnancy and live birth rate after TESE-ICSI. However, sperm motility seems to increase the pregnancy rate through its influence on embryo quality. Therefore, fresh TESE has no added value when there is still cryopreserved testicular sperm available. Motile sperm is preferred for injection, but the use of tail touch sperm results in an acceptable treatment outcome.

Long-term ongoing pregnancy rate and mode of conception after a positive and negative post-coital test.

OBJECTIVE: Many fertility clinics have decided to abolish the post-coital test. Yet, it is a significant factor in prognostic models that predict the spontaneous pregnancy rate within one year. The aim of this study was to evaluate (1) the long-term outcome of infertile couples with a positive or a negative post-coital test during their fertility work-up and (2) the contribution of the different modes of conception. DESIGN: Retrospective cohort study. SETTING: Three fertility clinics in the Netherlands, of which two are secondary care training hospitals and is a one tertiary care academic training hospital. POPULATION: 2476 newly referred infertile couples, where a post-coital test was performed in 1624 couples. METHODS: After basic fertility work-up, couples were treated according to the national treatment protocols. MAIN OUTCOME MEASURES: Spontaneous and overall ongoing pregnancy rate. RESULTS: The spontaneous and overall ongoing pregnancy rates after three years were 37.7 and 77.5% after a positive post-coital test compared with 26.9 and 68.8% after a negative test (p < 0.001). Even in couples with severe male factor infertility (total motile sperm count <3) (p = 0.005) and mild male factor infertility (total motile sperm count 3-20) (p < 0.001), there was a significantly higher spontaneous ongoing pregnancy rate, justifying expectant management. CONCLUSION: After a follow-up of three years a positive post-coital test is still associated with a higher spontaneous and a higher overall ongoing pregnancy rate, even in couples with severe male factor infertility.