P-078 Comparison of embryological and clinical outcomes in mumps orchitis and non-obstructive azoospermia patients treated by Microdissection testicular sperm extraction combined with ICSI (microTESE-ICSI)
Authors: Nguyen Phan T , Lai V  T T , Dinh V  H , Nguyen D  M 
Published: July 2024

Abstract

Study question
The objective of this retrospective study was to examine the embryological and clinical outcomes in mumps orchitis and non-obstructive azoospermia (NOA) patients undergoing microTESE-ICSI treatment.

Summary answer
microTESE combined with ICSI is an effective treatment regimen that can help mumps orchitis and NOA patients to have their biological offsprings.

What is known already
Non-obstructive azoospermia can be caused by different etiologies, and one of factors is mumps orchitis. These patients cannot retrieve spermatozoa via ejaculation, so microTESE is an intervention indicated to retrieve their sperm. Recent studies showed that the combination of microTESE and ICSI increase the success of in-vitro fertilization (IVF) treatment for NOA patients. IVF effectiveness can also be influenced by maternal age; however, most of the previous studies on NOA group reported sperm retrieval rate and male factors. Few studies have focused on embryo development and clinical outcomes, especially, under the adjustment for female partner’s age.

Study design, size, duration
This retrospective study was conducted to analyze the embryo development and clinical outcomes in 212 patients who had spermatozoa retrieved from microTESE and treated by ICSI from 4/2022 to 10/2023. 212 microTESE-ICSI patients were divided into two groups including mumps orchitis group (n = 101) and NOA group by other etiologies (n = 111). These patients had spouses who were under 35-year-old.

Participants/materials, setting, methods
Effectiveness of microTESE-ICSI between mumps orchitis and NOA groups was evaluated by comparing the embryological development and clinical outcomes. The mean of fertilization rate, good cleavage embryo rate (following alpha consensus) and good blastocyst rate (embryo quality higher than 2BB at day 5) in two groups were compared to assess embryological outcomes. Pregnancy rate, miscarriage rate, ongoing pregnancy rate (≥ 30 weeks), and live-birth rate were examined to evaluate the clinical outcomes.

Main results and the role of chance
The mean of paternal age in mumps orchitis group and NOA group was similar (32.0±4.4 vs 32.0±4.9). There was no difference in the mean of maternal age between these two groups (28.7±3.4 vs 27.8±3.8, p &gt; 0.05). The means of retrieved oocytes and mature oocytes in two patient groups were not significantly different (19.4±8.7 vs 20.1±11.3; 13.7±6.5 vs 14.1±8.3, respectively). The fertilization rate of mumps orchitis group was significantly higher than NOA group (66.1% vs 57.7%, p &lt; 0.01). Rate of good embryo on day 3 and rate of blastocyst on day 5 in mumps orchitis group were 17.9% and 49.8% respectively. These rates in NOA group accounted for 13.3% and 43.8% respectively.
The pregnancy rate (positive beta hCG-test) in mumps orchitis patients was 80.2% (77/96), and this rate in NOA group was 75.5% (77/102). The miscarriage rates in these two groups were not significantly different (0.03% vs 0.06%, p &gt; 0.05). There were no significant differences in ongoing pregnancy rate between mumps orchitis group and NOA group (38.5% (37/96) vs 37.3% (38/102); p &gt; 0.05, respectively). Live-birth rate of these groups was also similar (mumps orchitis vs NOA: 25% (24/96) vs 20.6 (21/102, p &gt; 0.05).

Limitations, reasons for caution
This research is a single-center retrospective study performed in a brief time, so our sample size is small. Our study had a lack of information of body mass index and male hormonal factors because the database missed in several patients at the retrospective time.

Wider implications of the findings
These data suggested that microTESE is an optimal method for mumps orchitis and NOA patients who cannot ejaculate retrieve their own sperm. microTESE-ICSI might increase the success rate of fertility treatment in these patients.

Trial registration number
Not applicable