Reproductive and obstetric outcomes in TESE-ICSI cycles: A comparison between obstructive and non-obstructive azoospermia

Massimo Romano; Federico Cirillo; Noemi Ravaioli; Emanuela Morenghi; Luciano Negri; Bulbul Ozgur; Elena Albani; Paolo Emanuele Levi-Setti

doi:10.1111/andr.13568

Reproductive and obstetric outcomes in TESE-ICSI cycles: A comparison between obstructive and non-obstructive azoospermia

Andrology. 2023 Dec 18. doi: 10.1111/andr.13568. Online ahead of print.

Authors

Massimo Romano^{1

2}, Federico Cirillo^{1

2}, Noemi Ravaioli³, Emanuela Morenghi⁴, Luciano Negri¹, Bulbul Ozgur¹, Elena Albani¹, Paolo Emanuele Levi-Setti^{1

2}

Affiliations

¹ Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
³ Department of Gynecology and Obstetrics, Hospital of Lugo (RA), Lugo, Italy.
⁴ Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

PMID: 38108554
DOI: 10.1111/andr.13568

Abstract

Purpose: Comparison of intracytoplasmic sperm injection cycles with testicular sperm extraction in obstructive azoospermia and non-obstructive azoospermia are limited, and few studies have addressed obstetric and neonatal outcomes.

Design: This study analyzed couples who underwent testicular sperm extraction-intracytoplasmic sperm injection cycles for obstructive azoospermia and non-obstructive azoospermia to determine whether impaired spermatogenesis in non-obstructive azoospermia patients would lead to worse reproductive outcomes and higher rates of pregnancy complications and fetal anomalies. This study is a retrospective, single-center analysis of all testicular sperm cycles performed between January 1, 2001 and December 31, 2020.

Results: A total of 392 couples were considered in the study, leading to 1066 induction cycles, 620 (58.2%) from patients with obstructive azoospermia and 446 (41.8%) from non-obstructive azoospermia. The cumulative delivery rate did not significantly differ between the two groups (34% vs. 31%; p = 0.326). The miscarriage rate was similar between obstructive azoospermia and non-obstructive azoospermia patients. Fertilization rate instead showed a statistically significant difference (obstructive azoospermia: 66.1 ± 25.7 vs. non-obstructive azoospermia: 56.1 ± 27.0; p < 0.001). The overall maternal complication rate in the non-obstructive azoospermia group was higher (10.7% vs. 18.4%; p = 0.035), but there was no statistical significance for each pathology. There was no statistical difference in gestational age between the two groups for both single and twin pregnancies. Seven cases of congenital defects occurred in the obstructive azoospermia group, while two cases occurred in the non-obstructive azoospermia group.

Conclusions: Despite impaired spermatogenesis in non-obstructive azoospermia patients, there were no substantial differences in reproductive outcomes compared to patients with obstructive azoospermia, even in terms of obstetric safety and neonatal well-being.

Keywords: azoospermia; fetal anomalies; neonatal outcomes; non-obstructive azoospermia; obstetric complication; obstetric outcomes; obstructive azoospermia.