Presentation Authors: Brent Hanson*, Basking Ridge, NJ, Taylor Kohn, Baltimore, MD, Alexander Pastuszak, Salt Lake City, UT, Richard Scott, Basking Ridge, NJ, James Hotaling, Salt Lake City, UT
Introduction: When no mature spermatozoa are obtained during testicular sperm extraction, men with azoospermia are often left with the options of donor sperm or adoption. However, it has been reported that round spermatids can be successfully injected into human oocytes and used as an alternative to mature spermatozoa; a technique known as round spermatid injection into human oocytes (ROSI). This study presents a meta-analysis of the effectiveness and clinical utility of ROSI.
Methods: We performed a systematic search of the MEDLINE/Pubmed electronic database for studies evaluating the effect of ROSI on oocyte fertilization (measured by oocytes fertilized per metaphase II (MII) oocyte injected), clinical pregnancy rate (measured by clinical pregnancy per embryo transferred), and resultant birth rate (measured as the number of deliveries per embryo transferred) published through October 2018. Studies were eligible for inclusion if they assessed fertility outcomes after ROSI in human subjects. Reviews were excluded. Estimates were pooled using a random-effects model for meta-analysis.
Results: Data were extracted from 23 observational studies involving 1,175 couples and 4,426 embryo transfers. Overall, fertilization rate after ROSI was 38.9% (95% CI: 33.2-46.7%) while clinical pregnancy rate was 6.0% (95% CI: 3.3-10.5%). The resultant birth rate was lower, with only 4.5% of embryo transfers resulting in a delivery (95% CI: 2.6-7.8%) (Figure 1). When assessing pregnancy rate per couple as reported in included studies, the pregnancy rate was 11.5% (95% CI: 6.6-19.3%) and the resultant birth rate was 9.4% (95% CI: 5.9-14.7%).
Conclusions: ROSI has resulted in clinical pregnancies and live births, but success rates are considerably lower than those using mature spermatozoa. While this technique may be viewed as a feasible alternative for a select group of men with azoospermia who decline other options, couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is particularly poor.
Source of Funding: A.W.P. is a National Institutes of Health K08 Scholar supported by a Mentored Career Development Award (K08DK115835-01) from the from the National Institute of Diabetes and Digestive and Kidney Diseases. This work is also supported in part through a Urol