Testicular fine-needle aspiration in infertile men with absolute non-obstructive azoospermia: A single-centre cohort study.

BACKGROUND: The methodology of surgically extracted sperm cells in fertility treatments remains debated, mainly due to the lack of data evaluating its predictive value on treatment outcomes. AIM: To gain insight into the effectiveness of testicular fine-needle aspiration (TEFNA) in a cohort of infertile men with absolute non-obstructive azoospermia and to examine whether the number of retrieved sperm cells affects the fertilisation rate. MATERIALS AND METHODS: A total of 89 infertile men, aged 26-47, meticulously diagnosed with non-obstructive azoospermia, participated in the study. All participants underwent TEFNA. The primary outcome measure was the TEFNA success rate in retrieving mature sperm. The secondary outcome measures included fertilisation rate, clinical pregnancy rates, and live births associated with the retrieved sperm. RESULTS: Sperm cells were successfully retrieved from 40 out of 89 patients (45%) with no significant postoperative complications. Retrieval of up to ten sperm cells occurred in 11 procedures (25%); ten procedures (22.7%) resulted in producing dozens of sperm cells, and 100s to 1000s of sperm cells were obtained from the remainder of 23 procedures (52.3%). Patients whose TEFNA resulted in only a few sperm cells had a much lower fertilisation rate (16.6%) than the other two groups (40.1% and 47.2%, respectively, P = 0.003). CONCLUSIONS: The utilisation of TEFNA for sperm extraction in men with non-obstructive azoospermia is a simple, fast-learning, effective, and safe treatment option. In cases where sperm retrieval was successful, the fertilisation rate was strongly related to the number of sperm cells obtained.

Is there a difference in ovarian reserve biomarkers and ovarian response between the right and left ovaries?

RESEARCH QUESTION: Is there a difference in ovarian reserve biomarkers and ovarian response between the right and left ovaries of infertile women undergoing IVF treatments? DESIGN: A total of 100 infertile women aged 27 to 37 years, diagnosed with either unexplained male factor or mechanical factor infertility, participated in the study. All women had both ovaries intact, and regular menstrual cycles with no previous diagnosis of polycystic ovaries or endometriosis. The data were collected separately for each ovary, and included parameters of basal sonographic ovarian reserve, as well as ovarian response to ovarian stimulation. RESULTS: Basal sonographic ovarian reserve markers were similar between the two ovaries. The right and left ovaries did not differ in their basal antral follicle count (AFC) (6.9 ± 3.9 versus 6.8 ± 3.8, respectively, P = 0.672), nor did they differ in their ovarian volume (10.3 ± 6.7 versus 9.8 ± 8.0 cm3, respectively, P = 0.636). Nevertheless, a superior right-sided ovarian response to ovarian stimulation was observed, with a significantly higher total number of follicles in the right compared with the left ovary (7.8 ± 4.3 versus 6.8 ± 4.2 follicles, respectively, P = 0.006), and a higher number of follicles ≥14 mm on the day of human chorionic gonadotrophin administration (4.9 ± 3.2 versus 3.8 ± 2.4 follicles, respectively, P = 0.002). CONCLUSIONS: Despite comparable basal AFC and ovarian volume, the two ovaries are distinguishable in their response to ovarian stimulation with a clear right-side preference. These findings imply that the superiority of right ovarian response may be derived from local pelvic factors, presumably a more efficient vascularization.

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

PURPOSE: To investigate whether unexplained infertility at a young age demonstrates manifestations of decreased ovarian reserve. METHODS: A total of 100 women were divided into two equally sized groups. The study group comprised women aged ≤ 37 years diagnosed with unexplained infertility, and the control group included age-matched women with either mechanical factor or severe male factor infertility. RESULTS: Both groups were comparable in their basic characteristics. Overall, women with unexplained infertility presented with inferior ovarian reserve results set against women of the control group. The number of ≥ 14-mm follicles on the day of hCG administration was significantly lower in the study compared with the control group (7.0 ± 4.5 vs. 10.4 ± 4.1 follicles, respectively, P < 0.001). Likewise, basal serum FSH was higher in the study compared with the control group (8.4 ± 5.5 vs. 6.4 ± 1.7 IU/L, respectively, P = 0.015), while antral follicle count was lower (10.9 ± 6.6 vs. 16.2 ± 6.6 follicles, respectively, P < 0.001). Furthermore, women with unexplained infertility required a higher total dose of FSH for ovarian stimulation (2,923 ± 1,701 vs. 2,196 ± 941 IU/L, respectively, P = 0.010), but exhibited a lower number of retrieved oocytes (9.3 ± 6.3 vs. 15.6 ± 7.9 oocytes, respectively, P < 0.001), alongside a lower number of achieved embryos (5.3 ± 4.0 vs. 8.0 ± 4.7 embryos, respectively, P = 0.002). Interestingly, the cumulative clinical pregnancy rate was not significantly different between the two groups (44% vs. 58%, respectively, P = 0.163). CONCLUSIONS: Young women ≤ 37 years of age with unexplained infertility have clear manifestations of sub-optimal ovarian reserve set against controls. Our findings suggest that unexplained infertility at a young age may be a risk factor for developing poor ovarian response, specifically as a quantitative, rather than a qualitative, risk factor.