#49 : Does Percutaneous Epididymal Sperm Aspiration (PESA)-Sperm Attribute as the Game Changer in High-Risk Male Factor Fertility for Intracytoplasmic Sperm Injection (ICSI)?

Abstract

Background and Aims: The surgically retrieved sperms either from PESA, TESA and microTESA are considered to contribute satisfactory outcome in ICSI cycles in male factor infertility especially in Azospermia. Although the different sources of sperm for ICSI don’t affect the fertilisation rates in ICSI cycles, but the sperm obtained from fresh PESA may become game changer with higher implantation rates, resulting in better clinical pregnancy and live birth outcomes. Method: This comparative study was based at single reproductive center and evaluated 344 PESA-ICSI patients with high-risk male factors from July 2021 to Dec 2022 henceforth were compared with ejaculated-ICSI. The following high-risk male infertility patients were included - 1. No blastocyst formation in two stimulation cycles with ejaculated sperm, 2. If >2 IVF failure (with/o > 4 blastocyst transfer), 3. Severe OAT/azoospermia, 4. Sperm morphology 25%) even after 6 week of lifestyle n antioxidant therapy and 5. Miscellaneous factor like morbid obesity BMI>40, age >45 with/o history of chronic smoking and alcoholic. The embryo quality was assessed from good blastocyst rate and pregnancy outcome was recorded as implantation and clinical pregnancy rate. Results: As per the inclusion criteria 344 high-risk infertile male (21%) underwent PESA-ICSI and compared with 1346 ejaculated-ICSI patients. The average no of M2 oocytes were takes for ICSI purpose is similar in both group (9.2 and 9.4 per oocyte retrieval). The blastocyst rate in PESA-ICSI group was 51% as compare 48% in ejaculated-ICSI but there was outstanding good-blastocyst rate (34% compared to 24%, P<0.01). Both the group showed nearly equal implantation rate (83% compare to 80.4%) but ongoing pregnancy up to 12 weeks was significantly high as compare to ejaculated-ICSI group (77% vs 62% P <0.01) Conclusion: The high-risk male infertility must be addressed with timely evaluation and decision. PESA offers safe, simple, daycare and promising results in terms of sperm yield and pregnancy outcome, must be offered as first line approach.