Human Reproduction, Vol 12, 2693-2700, Copyright © 1997 by Oxford University Press
SJ Silber, Z Nagy, P Devroey, M Camus and AC Van Steirteghem
Factors other than spermatozoa could be the major determinant of the
success of assisted reproduction treatment in cases of male infertility.
Our aim was to evaluate the effect of the wife's age and ovarian reserve on
assisted reproduction success rates in the most severe type of male
infertility, i.e. azoospermia. A total of 249 consecutive couples suffering
from male infertility caused by azoospermia underwent microsurgical
epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE)
with intracytoplasmic sperm injection (ICSI). Of these men, 186 had
irreparable obstructive azoospermia, and 63 had non-obstructive azoospermia
due to testicular failure. Neither the pathology, the source, the quantity,
nor the quality of spermatozoa had any effect on fertilization or pregnancy
rates. Maternal age and ovarian reserve (number of eggs) had no effect on
fertilization or embryo cleavage, but did dramatically affect the embryo
implantation, pregnancy and delivery rates. Wives of azoospermic men who
were in their 20s had a 46% live delivery rate per cycle, wives aged 30-36
years had a 34% live delivery rate per cycle, wives aged 37- 39 years had a
13% live delivery rate per cycle, and wives > or = 40 years had only a
4% live delivery rate per cycle. The number of eggs retrieved also affected
pregnancy and delivery rate, but to a lesser extent than age. In virtually
all cases of obstructive azoospermia, and in 62% of cases with
non-obstructive azoospermia caused by germinal failure, sufficient
spermatozoa could be retrieved to perform ICSI, with normal fertilization
and embryo cleavage. However, the pregnancy rate and the live delivery rate
were dependent strictly on the age of the wife, and on her ovarian reserve.
Unfortunately, exaggerated claims of high pregnancy rates can thus easily
be made by manipulating, in a very simple way, selection for female
factors.
ARTICLES
The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection
Infertility Center of St. Louis, St. Luke's Hospital, MO 63017, USA.
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