New Information About Severe Male-Factor Infertility

Severe male factor infertility, where no sperm is found in the semen, is devastating to a couple. With intracytoplasmic sperm injection (ICSI) and the ability to surgically retrieve sperm from the epididymis and testis, these males now have an opportunity to father a child.

Cleveland Clinic’s in vitro fertilization (IVF) program has a high success rate with the most severe cases, where sometimes only a handful of barely twitching sperm are found after hours of searching. A studypresented at the 2016 American Society of Reproductive Medicine meeting in October revealed clinical pregnancy rates of 57 percent with epididymal sperm and 51 percent when sperm were obtained from the testis in men with more severe dysfunction.

“These data clear show how successful ICSI can be for treating azoospermic men with no viable sperm in their semen,” says Nina Desai, PhD, HCLD, head of the IVF laboratory at Cleveland Clinic Beachwood and principal author of the paper.

The benefits of time-lapse imaging

A unique aspect of this study was a comparison of the kinetics and cleavage patterns of embryos derived from both types of surgically retrieved sperm. The comparison was made possible by use of the EmbryoScope, a specialized culture incubator fitted with sophisticated imaging software. The EmbryoScope takes photographs of embryos every 10 minutes at seven different focal planes, thus creating a detailed visual record of embryonic development.

“The purchase of our first EmbryoScope in 2012 changed our practice of IVF and embryo selection,” says Dr. Desai. “For two decades, we had conducted IVF in the traditional manner, which involved removing dishes from an incubator once a day to evaluate embryo growth. The new tool provided time-lapse imaging and continuous visualization of embryo development that gave us a new understanding of embryo growth kinetics and aberrant cleavage patterns. For the first time, we could more accurately identify critical transition points at which embryos derived from both types of sperm differed.”

New findings revealed

Dr. Desai and colleagues discovered that development was delayed with testicular sperm until shortly after the 10- to 12-cell stage when the embryo starts compacting and individual cells start to merge to form a morula. “Compaction is a critical transition point for continued embryo development and an early indicator of embryonic genome activation. We found a higher percentage of testicular sperm-derived embryos were unable to make it past this hurdle,” says Dr. Desai.

Another important finding was that once this hurdle was overcome, embryos derived from testicular and epididymal sperm appeared to have similar kinetics for blastocyst formation and expansion.

“These findings were intriguing,” says Dr. Desai. “Future studies examining the severity of testicular dysfunction and sperm quality in patients with testciular-derived embryos and their relationship to embryo morphokinetics should give us a better understanding of how male factor infertility affects embryonic development.”