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. 2019 Dec;8(6):631-640.
doi: 10.21037/tau.2019.11.20.

Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis

Kuan-Wei Shih  1 , Ping-You Shen  2 , Chien-Chih Wu  1   3 , Yi-No Kang  3   4   5   6
Affiliations

Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis

Kuan-Wei Shih et al. Transl Androl Urol. 2019 Dec.

Abstract

Background: Intracytoplasmic sperm injection (ICSI) is a popular treatment for male infertility due to obstructive azoospermia (OA). Testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) are two common sperm retrieval approaches for ICSI among men with OA. However, the comparative efficacies of TESA and PESA have been debated for more than a decade and there has been no synthesis of the available evidence. This meta-analysis compared fertility outcomes between TESA and PESA among men with OA undergoing ICSI.

Methods: We searched Embase, PubMed, ScienceDirect, and Web of Science to identify studies comparing the effectiveness of TESA and PESA for ICSI. Study quality was assessed using the Newcastle-Ottawa scale. Data were pooled using a random-effects model. Outcomes were fertilization rate, implantation rate, pregnancy rate, and miscarriage rate. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs). Study heterogeneity was evaluated by the I-square (I2) statistic.

Results: Of 2,965 references retrieved, eight studies met eligibility criteria. These studies included 2,020 men receiving 2,060 ICSI cycles. The pooled results showed no significant differences in pregnancy and miscarriage rates between TESA and PESA groups, but TESA yielded a significantly higher implantation rate than PESA (OR =1.58, P=0.02, I2=24%).

Conclusions: TESA and PESA yielded similar pregnancy and miscarriage rates for couples receiving ICSI because of OA, but each demonstrated unique advantages and disadvantages. Further studies are required to evaluate safety outcomes and efficacy for specific clinical groups.

Keywords: Obstructive azoospermia (OA); intracytoplasmic sperm injection (ICSI); percutaneous epididymal sperm aspiration (PESA); testicular sperm aspiration (TESA).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of evidence selection according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OA, obstructive azoospermia; ICSI, intracytoplasmic sperm injection; TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration.
Figure 2
Figure 2
Forest plot of implantation rates. TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration; CI, confidence interval.
Figure 3
Figure 3
Forest plot of pregnancy rates. TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration; CI, confidence interval.
Figure S1
Figure S1
Forest plot of fertilization rates. TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration; CI, confidence interval.
Figure S2
Figure S2
Forest plot of pregnancy rates (stratified by maternal mean age). TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration; CI, confidence interval.
Figure S3
Figure S3
Forest plot of miscarriage rates. TESA, testicular sperm aspiration; PESA, percutaneous epididymal sperm aspiration; CI, confidence interval.
Figure S4
Figure S4
Small study effect test.
See this image and copyright information in PMC

References

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