Effect Of Sperm Sources On The Outcome Of Intracytoplasmic Sperm Injection Of Non-obstructive Azoospermia

ObjectivesAzoospermia is one of important causes for male infertility,of which about 60%is non-obstructive azoospermia(NOA).These causes can be divided into primary or secondary factors.Such patients rarely have the possibility of obtaining a blood-related next generation under natural conditions.After successful application of intracytoplasmic sperm injection(ICSI)technology,urologists can obtain sperm with capacity from NOA patients through percutaneous epididymal sperm aspiration(PESA)or testicular sperm aspiration(TESA)to help couples of patients with NOA are conceived to get their blood offspring.MethodsThis research is a retrospective analysis of 937 fresh ICSI cycles from January 2015 to June 2018 in the Reproductive Hospital Affiliated to Shandong University.According to the sperm source and the cause of NOA,the sample is divided into primary NOA with PESA group(group A),primary NOA with TESA group(group B),secondary NOA with PESA group(group C),and secondary NOA with TESA group(D group).Respectively comparing various relevant indicators and pregnancy outcomes.At the same time,based on known data and conclusions,a regression model is established to analyze the predictive factors of pregnancy outcomes in patients with NOA.ResultsThere are no significant differences in age,infertility,and body mass index(BMI)between groups A and B and between groups C and D.The male FSH in group A is lower than that in group A(P<0.001);the normal fertilization rate(P<0.001),high-quality embryo rate(P=0.021),and superior embryo rate per egg(P<0.001)in group A are higher than in group B,the difference is statistically significant.There are no significant differences in female FSH and female hCG injections of daily estradiol(E2),number of mature MⅡ eggs,clinical pregnancy rate,and miscarriage rate between groups A and B(P>0.05).The male FSH in group D is higher than that in group C(P<0.001);There are no significant differences in the female basal follicle stimulating hormone(FSH),the female hCG injection of estradiol(E2),the number of mature MⅡ eggs,fertilization rate,and high-quality embryo rate,superior embryos rate per egg,clinical pregnancy rate,and miscarriage rate between groups C and D(P>0.05).By including all 937 cycles,the success of ICSI in NOA patients is associated with lower female age,longer couple infertility years,and lower female FSH levels.The area under the receiver operating characteristic curve(ROC)is 0.615,and the above predictors have medium discriminative ability.ConclusionsSperm from different sources of NOA patients have no significant effect on ICSI embryo development,and similar fertility outcomes can be obtained,which cannot be used as predictors.The etiology(primary/secondary)of NOA,male age,female body mass index,male follicle stimulating hormone,and female hCG injection of estradiol cannot predict pregnancy outcomes.Lower female age,longer couple’s infertility years,and lower female FSH levels have predictive effects on good fertility outcomes.