O-147 Factors influencing ICSI outcome after sperm retrieval in nonobstructive azoospermia patients with different types of etiologies: a retrospective study of 1157 patients
Authors: Zhang L , Wenhao T , Ping L , Kai H 
Published: June 2023

Abstract

Study question
What are predictors of fertilization, clinical pregnancy, miscarriage and livebirth delivery outcomes after microdissection testicular sperm extraction (mTESE)-ICSI in NOA patients with different etiologies?

Summary answer
Predictors for ICSI outcome were different in patients with various etiologies and type of NOA are associated with ICSI outcome in these patients.

What is known already
NOA patients due to spermatogenic dysfunction, accounting for about 60 percent of the total azoospermia cases, may have opportunities to be fathers with their own biological children by mTESE combined with ICSI. For them, there were some of predictive factors for ICSI outcome including sperm motility, sperm morphology, testis volume and levels of reproductive hormone including follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T), while the predictive factors of ICSI outcome remains underappreciated, especially about the relationship between ICSI outcome and male factors after reviewing the large scale clinical data.

Study design, size, duration
This retrospective study involved 1157 NOA patients with treated 1534 complete ICSI cycles at the Reproductive Medical Centre of Peking University Third Hospital from March 2012 to October 2021.

Participants/materials, setting, methods
1534 ICSI cycles included 558, 359, 243, 155, 128, 56 and 35 cycles performed in males with idiopathic NOA (iNOA), Klinefelter syndrome (KS), AZFc microdeletions, cryptorchidism, a history of mumps orchitis, cryptozoospermia and with other causes separately. Primary outcome was livebirth delivery per ICSI cycle (LBR) and secondary outcomes were clinical pregnancy rate per ICSI cycle (PR) and fertilization rate (FR). Multi-variable logistic and linear regression was used to analyze ICSI outcome.

Main results and the role of chance
Overall LBR, PR and FR were 37.35%, 44.98%, 49.34% separately. Patients with mumps orchitis showed the highest LBR, PR and FR of 53.13%, 60.94% and 59.52% respectively, and AZFc-deleted patients displayed the lowest LBR, PR and FR of 25.93%, 30.04% and 32.87% separately. Lower female age (0.947 [0.904;0.993], p = 0.024), more transferred embryos (1.345 [1.225;1.477], p＜0.001), higher AFC (1.033[1.011;1.056], p = 0.003) were related with higher LBR, and higher male BMI (0.974[0.950; 0.999], p = 0.046) and lower AFC (1.057[1.034; 1.080], p＜0.001) were related with lower PR. Comparing outcome of mumps orchitis group, patients with cryptorchidism were associate with lower LBR(0.467[0.281; 0.778], p = 0.003), PR (0.440[0.268;0.721], p = 0.001) and FR(-0.169 [-0.226; -0.11], p＜0.001) separately. AZFc-deleted patients had a relationship with lower LBR (0.426[0.260; 0.697], p = 0.001), (0.273[0.170; 0.437], p＜0.001) and FR (-0.282 [-0.336; -0.228], p＜0.001) respectively. KS patients were related with lower LBR (0.455[0.288; 0.720], p = 0.001), PR (0.477 [0.306; 0.745], p = 0.001) and FR (-0.073 [-0.126; -0.020], p = 0.007) separately. iNOA patients were associated with lower PR (0.616 [0.409; 0.928], p = 0.020) and FR (-0.076 [-0.124; -0.029], p = 0.002) respectively. Furthermore, patients with cryptozoospermia were related with lower FR (-0.141 [-0.220; -0.061], p = 0.001).

Limitations, reasons for caution
Sperm characteristics maybe predictors for ICSI outcome which is a potential selection bias. Pituitary prolactin and Anti-Müllerian hormone weren’t included as covariates due to limited information in our database. We couldn’t verify the conclusion in more population from multicenter despite the current study with the large sample size so far.

Wider implications of the findings
Our results provide valuable information for NOA patients who want to counsel surgeons about their ICSI outcome to help patients and surgeons to perform a shared decision-making for optimal therapy methods, especially for AZFc-deleted patients with worse ICSI outcome who may consider donor semen to get better ICSI outcome.

Trial registration number
not applicable