Prognosis for AZF deletions testis sperm retrieval and intracytoplasmic sperm injection results

Patients with AZFc deletions carry the best prognosis for finding sperm during testicular sperm retrieval procedures performed for intra-cytoplasmic sperm injection (ICSI). Although results vary by center experience and retrieval method, approximately 50-55% of AZFc deleted men will have testis sperm available for ICSI (Hopps et al., 2003; Krausz et al., 1999). In patients with complete AZFa or AZFb microdeletions, a negative prognosis for sperm retrieval is the expectation, but this is based on a very limited number of cases to date (Hopps et al., 2003; Krausz et al., 1999). Deletions involving one or more regions that include AZFa or AZFb have met with a similar poor prognosis. The ability to find testicular sperm in patients with partial deletions of AZFa or AZFb regions is not well described. One critical variable in this analysis is the technique and expertise of the reporting center, as a sperm retrieval that involves a single or few testis biopsies may not have the same sperm 'yield' as a testicular microdissection or be as informative as a systematic fine needle aspiration 'map' in this cohort of patients (Turek et al., 2000).

Four studies have assessed in vitro fertilization (IVF)-ICSI outcomes in men with AZF deletions (Table 10.1), presumably to assess whether such deletions may affect embryogenesis in addition to spermatogenesis. In one study, normal oocyte fertilization rates and embryo quality were poorer than contemporary, non-AZF-deleted controls (van Golde et al., 2004). In the other studies, no discernable or significant differences were noted in fertilization or pregnancy rates (Choi et al., 2004; Kihaile et al., 2004; Oates et al., 2002). However, these studies constitute small

Table 10.1. Summary of studies that address IVF-ICSI outcomes in Yq deleted couples

Normal fertilization rate Pregnancy/cycle No of _

Table 10.1. Summary of studies that address IVF-ICSI outcomes in Yq deleted couples

Normal fertilization rate Pregnancy/cycle No of _

Author

patients

Yq deletions

Controls (%)

AZF (%)

Controls (%)

AZF (%)

Mulhall et al.

3

AZFc

45

36

-

-

(1997)

(n = 25 cycles)

(n = 6 cycles)

van Golde et al.

8

AZFc with

71

55

25

16

(2004)

oligozoospermia

(n = 107 patients)

Oates et al.

26

AZFc

-

47

-

27

(2002)

Choi et al.

17

AZFb and c with

58

49

43

33

(2004)

azoospermia and oligozoospermia

(n = 53 patients)

numbers of patients and are subject to Type II statistical errors that may render it difficult to detect small but real differences in outcomes.

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