Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Testicular Sperm Extraction and Intracytoplasmic Sperm Injection in Management of Obstructive Azoospermia: A Two-Year Multicenter Review in Ghana

Authors
Promise E Sefogah 1
Alim Swarray-Deen 1
Edem K Hiadzi 2
Rudolph K Adageba 3
Nana Oduro 4
Hanson G Nuamah 5
Mercy A Nuamah 1
1 Department of Obstetrics and Gynaecology, College of Health Sciences, University of Ghana Medical School, Accra, Ghana
2 Department of Obstetrics and Gynaecology, Lister Hospital and Fertility Centre, Accra, Ghana
3 Department of Obstetrics and Gynaecology, Ruma Fertility and Specialist Hospital, Kumasi, Ghana
4 Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
5 Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
10.18502/jri.v23i4.10811
Abstract
Background: The objective of this study was to evaluate treatment outcomes and assess predictors of clinical pregnancy in obstructive azoospermia cases treated with testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) in Ghana. Methods: This study was a retrospective study conducted on 67 men seeking treatment for obstructive azoospermia at two study sites in Ghana from January 2018 to December 2019. First, archived data were reviewed and treatment outcomes of cases of obstructive azoospermia from the hospital records were evaluated. Infertile men who met the inclusion criteria were recruited. Descriptive data were expressed in the form of frequencies and percentages. The dependent and independent variables were analyzed using multiple logistic regression and reported as odds ratios (ORs). The confidence interval (CI) was set at 95% and a p-value <0.05 was considered significant. Results: The mean age of male participants was 42.43±9.11 years (mean±SD) while the mean age of their partners was 32.89±5.73 years (mean±SD). The average duration of infertility before intervention was 5.01±3.60 years (mean±SD). Successful pregnancy was observed in 52.2% (35/67) of the participants. After adjusting for confounders, the rate of a successful clinical pregnancy was 0.07 lower for every additional year increase in the male’s age [AOR=0.93 (95%CI=0.87 - 0.99), p=0.02]. Conclusion: Overall the rate of clinical pregnancy following TESE/ICSI from our study was 52.2%. A man’s age was a strong predictor of successful clinical pregnancy among couples treated with TESE-ICSI for obstructive azoospermia in Ghana.
Keywords
Azoospermia
Intracytoplasmic Sperm Injection
Male infertility
Testicular sperm retrieval
Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.
Dupree JM. Insurance coverage for male infertility care in the United States. Asian J Androl. 2016;18(3):339-41.
Mehta A, Nangia AK, Dupree JM, Smith JF. Limitations and barriers in access to care for male factor infertility. Fertil Steril. 2016;105(5):1128-37.
Tüttelmann F, Werny F, Cooper TG, Kliesch S, Simoni M, Nieschlag E. Clinical experience with azoospermia: aetiology and chances for spermatozoa detection upon biopsy. Int J Androl. 2011;34(4):291-8.
Gyasi-Sarpong CK, Manu Maison PO, Koranteng AK. The pattern of male infertility in Kumasi, Ghana. Afr J Infertil Assist Concept. 2017;2:3-5.
Esteves SC, Lee W, Benjamin DJ, Seol B, Verza S, Agarwal A. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol. 2013;189(1):232-7.
Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al. European association of urology guidelines on male infertility: The 2012 update. Eur Urol. 2012;62(2):324-32.
Abdulwahed SR, Mohamed EEM, Taha EA, Saleh MA, Abdelsalam YM, Elganainy EO. Sensitivity and specificity of ultrasonography in predicting etiology of azoospermia. Urology. 2013;81(5):967-71.
Lee HS, Seo JT. Advances in surgical treatment of male infertility. World J Mens Health. 2012;30(2):108-13.
Abdel Raheem A, Garaffa G, Rushwan N, De Luca F, Zacharakis E, Abdel Raheem T, et al. Testicular histopathology as a predictor of a positive sperm retrieval in men with non-obstructive azoospermia. BJU Int. 2013;111(3):492-9.
Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl. 2013;23:5.
Caroppo E, Colpi EM, Gazzano G, Vaccalluzzo L, Scroppo FI, D’Amato G, et al. Testicular histology may predict the successful sperm retrieval in patients with non-obstructive azoospermia undergoing conventional TESE: a diagnostic accuracy study. J Assist Reprod Genet. 2017;34(1):149-54.
Sartorius GA, Nieschlag E. Paternal age and reproduction. Hum Reprod Update. 2010;16(1):65-79.
Hammiche F, Laven JSE, Boxmeer JC, Dohle GR, Steegers EAP, Steegers-Theunissen RPM. Sperm quality decline among men below 60 years of age undergoing IVF or ICSI treatment. J Androl. 2011;32(1):70-6.
Enatsu N, Miyake H, Chiba K, Fujisawa M. Predictive factors of successful sperm retrieval on microdissection testicular sperm extraction in Japanese men. Reprod Med Biol. 2016;15(1):29-33.
Gnessi L, Scarselli F, Minasi MG, Mariani S, Lubrano C, Basciani S, et al. Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE). BMC Urol. 2018;18(1):63.
Busch AS, Tüttelmann F, Cremers JF, Schubert M, Nordhoff V, Schüring AN, et al. FSHB −211 G>T polymorphism as predictor for TESE success in patients with unexplained azoospermia. J Clin Endocrinol Metab. 2019;104(6):2315-24.
Belloc S, Cohen-Bacrie M, Amar E, Izard V, Benkhalifa M, Dalléac A, et al. High body mass index has a deleterious effect on semen parameters except morphology: results from a large cohort study. Fertil Steril. 2014;102(5):1268-73.
Eisenberg ML, Kim S, Chen Z, Sundaram R, Schisterman EF, Buck Louis GM. The relationship between male BMI and waist circumference on semen quality: Data from the LIFE study. Hum Reprod. 2015;30(2):493-4.
Klonoff-Cohen HS, Natarajan L. The effect of advancing paternal age on pregnancy and live birth rates in couples undergoing in vitro fertilization or gamete intrafallopian transfer. Am J Obstet Gynecol. 2004;191(2):507-14.
Mehta A, Bolyakov A, Schlegel PN, Paduch DA. Higher pregnancy rates using testicular sperm in men with severe oligospermia. Fertil Steril. 2015;104(6):1382-7.
Tsai YR, Lan KC, Kung FT, Lin PY, Chiang HJ, Lin YJ, et al. The effect of advanced paternal age on the outcomes of assisted reproductive techniques among patients with azoospermia using cryopreserved testicular spermatozoa. Taiwan J Obstet Gynecol. 2013;52(3):351-5.
Kavoussi PK, West BT, Chen SH, Hunn C, Gilkey MS, MacHen GL, et al. A comprehensive assessment of predictors of fertility outcomes in men with non-obstructive azoospermia undergoing microdissection testicular sperm extraction. Reprod Biol Endocrinol. 2020;18(1):90.
Cameron NJ, Bhattacharya S, McLernon DJ. Cumulative live birth rates following blastocyst- versus cleavage-stage embryo transfer in the first complete cycle of IVF: a population-based retrospective cohort study. Hum Reprod. 2020;35(10):2365-74.
Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016;(6):CD002118.
Blake DA, Proctor M, Johnson NP. The merits of blastocyst versus cleavage stage embryo transfer: A Cochrane review. Hum Reprod. 2004;19(4):795-807.
Rehnitz J, Rösner S, Harsch J, Dietrich J, Bruckner T, Capp E, et al. Factors influencing success rate of intracytoplasmic sperm injection with azoospermic male patients. Geburtshilfe Frauenheilkd. 2020;80(7):713-22.
Kamath MS, Mascarenhas M, Kirubakaran R, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2020;8(8):CD003416.
Pandian Z, Marjoribanks J, Ozturk O, Serour G, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2013(7):CD003416.
Journal of Reproduction & Infertility
Volume 23, Issue 4
Autumn 2022
Pages 264-270