Outcomes of patients undergoing conventional testicular sperm extraction for intracytoplasmic sperm injection in a South African fertility centre
Background Surgical sperm retrieval for intracytoplasmic sperm injection (ICSI) has revolutionised the treatment of male factor infertility. This study aims to compare sperm retrieval rates (SRR) of conventional testicular sperm extraction (c-TESE) at our centre with SRR in the literature as well as describe the demographic and clinical features of our patients and the pregnancy outcomes following c-TESE and ICSI. Materials and Methods A retrospective review of 163 men who underwent c-TESE for ICSI between January 2016 and September 2019 in a South African fertility centre. Results Sperm retrieval rate was 58% (58 of 100) in the group with spermatogenic failure and 100% (63 of 63) in the group with post-testicular pathology. Preoperative follicle stimulating hormone (FSH) levels in those with spermatogenic failure demonstrated a statistically significant difference between the positive sperm retrieval group (6.50IU/l 4.74) and negative sperm retrieval group (15.4IU/l 7.67), p< 0.0001. Intracytoplasmic sperm injection was performed for 115 of the 163 patients (70.6%), with an overall clinical pregnancy rate of 67.8% (78 of 115). A single ICSI cycle was performed in 61 couples and multiple cycles, defined as more than one cycle, were performed in 54 couples with a pregnancy rate of 62.3% and 27.6% per cycle, respectively. Conclusion Conventional TESE in our setting has similar sperm retrieval rates to the international literature, however a significant proportion of our patients had a posttesticular cause of male infertility which may over-estimate sperm retrieval rates. Further studies are needed in South Africa to evaluate the causes and treatment options available and offered for male factor infertility. The information regarding sperm retrieval rates and pregnancy outcomes is valuable for counselling South African patients embarking on fertility treatment.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Urology to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, 2022