Effects of testicular sperm aspiration upon first cycle ICSI-ET for type 2 diabetic male patients

ABSTRACT

Male diabetes mellitus (DM) can affect erectile function and sperm quality. In severe cases, DM can lead to retrograde or no ejaculation, so testicular sperm aspiration (TESA) is combined with intracytoplasmic sperm injection (ICSI) to treat subfertility and infertility for DM couples. However, the effect of TESA upon ICSI (TESA-ICSI) for DM patients remains unclear. This research investigated the effect of TESA-ICSI on first cycle ICSI-embryo transfer (ICSI-ET) for type 2 diabetic mellitus (T2DM) patients and the potential mechanisms. The subjects consisted of 1219 male patients with azoospermia or retrograde ejaculation who were treated with TESA-ICSI from 2015.01 to 2019.11. They were classified into two groups, the T2DM group (n = 54) and non-diabetic control group (n = 1165). Sperm selection for injection was performed using motile sperm organelle morphology examination criteria. The number of available embryos and the high-quality embryo rates following a single ET as well as cleavage, fertilization, implantation, clinical pregnancy and the abortion rates were noted. Compared with the non-diabetic group, the available embryo rate (75.20 ± 26.40% vs.78.36 ± 23.25%) and high-quality embryo rate (46.49 ± 30.37% vs. 47.55 ± 28.57%) in the T2DM group were lower and the abortion rate (20.83% vs. 8.88%) was higher, but these differences were not statistically significant. There were no significant differences in clinical pregnancy, implantation, normal fertilization, and cleavage rates between the two groups. The results show that TESA for male T2DM patients does not influence the effect of ICSI. For T2DM patients with severe oligozoospermia, asthenospermia, teratozoospermia, or retrograde ejaculation that do not meet ICSI criteria, TESA-ICSI may perhaps be considered for reproductive assistance.

Abbreviations

DM: diabetes mellitus; TESA: testicular sperm aspiration; ICSI: intracytoplasmic sperm injection; ICSI-ET; ICSI-embryo transfer; LH: luteinizing hormone; mL: milliliter; TES: testosterone; FSH: follicle-stimulating hormone; P: progesterone; HCG: human chorionic gonadotropin

KEYWORDS:

• Male diabetes mellitus
• TESA
• pregnancy outcome
• high quality embryo rate
• ICSI

Ethics approval

Each patient signed a written informed consent form before TESA surgery. This study was approved by the Research Ethics Committee of the Northwest Women’s and Children’s Hospital.

Acknowledgments

The authors acknowledge the Reproductive Center of the Northwest Women and Children’s Hospital. We received strong support from the entire team during the writing process. We want to send our special thanks to Li Xiaomian (School of International Studies of Xi’an Jiaotong University) who has contributed a lot in revising and polishing the paper. We also thank Charles Allan, PhD, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

Each author has contributed to the research process. Conceived and designed the experiments: XJp, SJz, LX; Performed the experiments: GM, SZ, SJ, SJh; Analyzed the data: XX; Wrote the manuscript: LX; Critically revised, and completed/corrected the manuscript, and approved the final version: XJp, SJz, ZZ.

Additional information

Funding

This work was supported by the Chinese Medical Association Clinical Medical Research Project - Reproductive Medicine Young Physician Research and Development Project (contracts 17020120681).