Male infertility intracytoplasmic sperm injection (ICSI) using surgically retrieved sperm from the testis or the epididymis
Mandate The Directorate for Health and Social Affairs has asked the Norwegian Knowledge Centre for the Health Services to answer the following question using available scientific documentation: In the case of male infertility, what is the effect of ICSI treatment with sperm retrieved from the epidid...
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| Format: | eBook |
| Language: | English |
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Oslo, Norway
Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH)
2007, 2007
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Mandate The Directorate for Health and Social Affairs has asked the Norwegian Knowledge Centre for the Health Services to answer the following question using available scientific documentation: In the case of male infertility, what is the effect of ICSI treatment with sperm retrieved from the epididymis or testis on the risk of spontaneous abortion, chromosome aberrations, growth restriction, malformations, abnormal neurological development, and transmission of reduced sperm quality to subsequent generations? Methods Searches for relevant literature were performed using the following databases: Cochrane Library, Medline, Embase and Registry of Current controlled trials. The following designs were included in the search: systematic reviews, randomized controlled studies, reports/registry data with well defined comparisons between groups, and cohort and case control studies with relevant comparisons. Results We identified 15 relevant cohort studies. Most of the studies were of medium quality. Eleven of these studies reported spontaneous abortions, whereas six studies reported malformations. Only two studies reported chromosome aberrations. We were unable to identify relevant studies reporting on growth restriction or abnormal neurological development in offspring conceived after ICSI with the use of retrieved sperm from the testes or epididymis. A meta-analysis of the available data on abortions showed no difference in risk of spontaneous abortions between pregnancies conceived by ICSI using ejaculated sperm compared to sperm retrieved from the epididymis (RR= 0.95, 95% CI 0.75-1.19) or the testes (RR=1.23, 95% CI: 0.96-1.58). There was however a tendency towards an increased risk of abortions in ICSI pregnancies using sperm collected from the testes relative to sperm retrieved from the epididymis (RR=1.47, 95% CI 1.12-1.93, p=0.006). Background Lack of sperm in the ejaculate (azoospermia) occurs in about 5% of infertile men. Sperm may, however, be present in the epididymis or the testes depending on the type of azoospermia. Sperm can be extracted surgically or by needle aspiration biopsy, and subsequently used for intracytoplasmic sperm injection (ICSI). In Norway, some infertility clinics have a provisional permission to retrieve sperm for ICSI treatment. The Norwegian authorities will in 2007 assess whether sperm retrieval will be permitted also in the future. Due to the relatively small number of children conceived in Norway using different methods of assisted reproductive technology, there is a need for international collaboration to initiate follow-up studies of children beyond pregnancy and birth Whether this reflects a true increased risk of abortion or can be explained by selection bias is uncertain. In a meta-analysis of malformations, no associations were observed between source of sperm and risk of malformation. The studies on chromosome aberrations were too small to be conclusive. Conclusion We found no differences in the risk of malformations in ICSI pregnancies when comparing the use of testicular, epididymal and ejaculated sperm. The risk of spontaneous abortion showed a non-significant tendency to be higher for testicular sperm than for epididymal sperm. This finding deserves attention in future research and surveillance. No studies with follow-up data on children conceived after ICSI using sperm retrieved from testis or epididymis were found. There is a need for further research and surveillance related to the use of assisted reproduction technology both in Norway and internationally. |
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| Item Description: | English summary excerpted from full report in Norwegian: Mannlig infertilitet: Intracytoplasmatisk spermieinjeksjon (ICSI) med spermier uthentet fra bitestikkel eller testikkel. - Excerpt of Systematic review no. 07-2007 |
| Physical Description: | 1 PDF file (4 pages) |
| ISBN: | 9788281211483 |