The effect of advanced paternal age on the outcomes of assisted reproductive techniques among patients with azoospermia using cryopreserved testicular spermatozoa

摘要

Objective: To determine whether advanced male age influences the outcome of intracytoplasmic sperm injection (ICSI) following the cryopreservation of spermatozoa obtained through testicular sperm extraction (TESE). Materials and Methods: Data were collected from infertile couples suffering from azoospermia who underwent TESE and ICSI from January 1998 to August 2010. There were 212 ICSI cycles using extracted testicular sperm after cryopreservation in this retrospective clinical analysis. The participating men all underwent testicular biopsy and subsequent tissue cryopreservation in a single academic tertiary care medical center. Those cryopreserved sperm were used during consecutive intracytoplasmic sperm injection treatment cycles. Female partners underwent individualized controlled ovarian hyperstimulation programs. Results: A total of 184 ICSI cycles were divided into the following two evaluation designs: (1) total cycles irrespective maternal age; (2) ICSI cycles with maternal age <34 years. Male partners were stratified into age categories at 5-year intervals (31-35 years, 36-40 years, and 41-51 years) in these two designs. In the first design, most outcomes of assisted reproductive techniques were similar during the three groups, but the maternal age is much lower in the first group, and the mean number of retried oocytes and estradiol level on the day of human chorionic gonadotropin injection was significantly higher in the first group. In the second design, the outcome of intracytoplasmic sperm injection and clinical factors including the estradiol level on the day of human chorionic gonadotropin injection, the number of retrieved oocytes, the rate of cleaved oocytes, the number of transferred embryos, the numbers of transferred good embryos, the clinical pregnancy rate per transfer cycle and the implantation rate were similar among the three groups of women aged <34 years after adjusting for female age. Conclusions: There is insufficient evidence to demonstrate an unfavorable effect of advanced paternal age on the fertility outcome for TESE-ICSI. The thawed testicular spermatozoa from males aged ≤40 years did not have an adverse impact on ICSI outcomes.