Outcome of ICSI with motile testicular spermatozoa obtained through microscopically assisted testicular sperm extraction in relation to the ovarian response.

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?40years 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±4.9years. The mean age, mean FSH level and mean AFC of women were 32.1±4.9years, 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 ?40years, yielding significantly diminished LBRs with<8 antral follicles and/or<7 oocytes retrieved.

The influence of sperm parameters on the outcome of intracytoplasmic sperm injection-embryo transfer cycle in poor responder women under 35 years of age.

To evaluate the influence of sperm parameters on the outcome of intracytopiasmic sperm injection (ICSI) cycies in poor responaer women under the age of 35 years in a retrospective analysis in a fertility center. MATERIALS AND METHODS: A total of 432 poor responder women who underwent ICSI cycles were evaluated. The interventions included ICSI and microdissection testicular sperm extraction (m-TESE). Main outcome measures included fertilization, cleavage, clinical pregnancy, and delivery rates. RESULTS: Patients were di- vided into four groups according to the sperm parameters and the source of sperm; testicular spermatozoa obtained from men with azoospermia (group 1; n=26), severe oligoasthenoteratozoospermia (OAT) (group 2; n=35), OAT (group 3; n=104), and normal semen analysis (group 4; n=267). Average age of the women, antral follicle count, FSH level, male age, number of previous ICSI cycles, duration of infertility, and the maximal endometrial thickness were similar among the groups. In group 1, the fertilization rate was lower than those in all other groups. Cleavage, clinical pregnancy, and delivery rates were similar among the groups. CONCLUSIONS: Neither sperm parameters nor the source of spermatozoa affects delivery rate through ICSI in poor responder women < 35-years-old.

Complete down-regulation is not mandatory for good assisted reproductive treatment cycle outcomes.

OBJECTIVE: To determine the implications and predictive value of estradiol concentrations following pituitary down-regulation with gonadotrophin releasing hormone agonists in women undergoing controlled ovarian hyperstimulation for assisted reproductive technology. STUDY DESIGN: A total of 277 patients undergoing ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) were enrolled into the study and the patients were divided into four groups according to estradiol levels on the initial day of stimulation of which group-A consisted of the patients who had < or =25 pg/ml (n=90), group-B with levels between 26 and 50 pg/ml (n=104), group-C with levels between 51 and 75 pg/ml (n=67) and group-D with levels > or =76-90 pg/ml (n=16) and the results were compared. The primary outcome measures included ovarian response and the clinical pregnancy rates. RESULTS: The clinical pregnancy rates in groups-A, B, C and D were 33.3% (30/90), 26.0% (27/104), 35.8% (24/67), and 25.0% (4/16), respectively, and there was no statistically significant difference (P=0.482). The mean number of oocytes retrieved in groups were (9.7+/-5.8, 10.3+/-6.5, 11.0+/-6.8, and 12.1+/-6.6), respectively (P=0.453) and the fertilization rates in groups-A, B, C and D were found to be similar (75, 80, 73 and 79%, respectively; P=0.658). CONCLUSION: Complete and deep desensitization obviously seems not to be mandatory for successful stimulation in assisted reproductive technology cycles.