title: Pregnancies and live births following ICSI with testicular spermatozoa after repeated implantation failure using ejaculated spermatozoa.
abstract: The use of testicular spermatozoa for IVF/intracytoplasmic sperm injection (ICSI) is currently indicated exclusively for patients with azoospermia, since a favourable outcome is expected even when very few spermatozoa are present in the ejaculate. Here, a series of four couples with long-standing male factor infertility and multiple failed IVF/ICSI cycles are described. In all couples, the use of ejaculated spermatozoa for ICSI resulted in poor embryo quality and repeated implantation failure. Testicular sperm aspiration was performed in subsequent cycles, and testicular spermatozoa were used for ICSI. Embryo implantation and ongoing pregnancies/deliveries were achieved in all four couples. It is postulated that spermatozoa are subjected to post-testicular damage during sperm transport between the seminiferous tubules and epididymis, with the injection of damaged spermatozoa being the cause for repetitive IVF/ICSI failures. In selected patients, the use of testicular spermatozoa for IVF/ICSI should be considered, even when motile spermatozoa can be identified in the ejaculate.
authors.affiliation: IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Weissman
authors.forename: Eran
authors.initials: E
authors.lastname: Horowitz
authors.forename: Amir
authors.initials: A
authors.lastname: Ravhon
authors.forename: Hana
authors.initials: H
authors.lastname: Nahum
authors.forename: Abraham
authors.initials: A
authors.lastname: Golan
authors.forename: David
authors.initials: D
authors.lastname: Levran
mesh_terms: D000328:Adult; D004542:Ejaculation; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007248:Infertility, Male / Q000473:pathology / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013737:Testis / Q000473:pathology; D017211:Treatment Failure