RE: SPERM DEFECT SEVERITY RATHER THAN SPERM SOURCE IS ASSOCIATED WITH LOWER FERTILIZATION RATES AFTER INTRACYTOPLASMIC SPERM INJECTION
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SIDNEY VERZA JR, SANDRO C. ESTEVES

Androfert, Center for Male Reproduction, Campinas, Sao Paulo, Brazil

Int Braz J Urol, 34: 49-56, 2008

To the Editor:

     I sincerely hope that I may be permitted to comment on a very important issue in the male factor infertility aspect: the male gamete and its role in the outcome of intracytoplasmic sperm injection (ICSI). We read with interest the article published by Verza and Esteves entitled: “Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection” (1).
     In the past, we had the opportunity to publish 2 articles regarding this issue (2,3). One of these articles we reported that the pregnancy rates is significantly lower in patients with non-obstructive azoospermia compared to patients with obstructive azoospermia (1). In the other article, we detected higher fertilization and implantation rates seen in azoospermic patients from congenital causes of obstruction. In addition, epididymal sperm results in higher pregnancy rates and lower miscarriage rates compared to testicular spermatozoa (3).
     In fact, various factors may influence the outcome of ICSI in azoospermic patients. These include parameters linked to male partner - such as serum FSH and testicular histology - that may reflect upon the quality of the surgically retrieved sperm cells.
     The authors evaluated one very interesting issue that has been left apart from the other articles published regarding the outcome of ICSI with the use of sperm from different etiologies. The quality of the semen is very important and not only the origin of the sperm retrieved. In the past, Nagy et al demonstrated that, irrespective the source of the semen, the outcome using ICSI is the same (4). Additionally, Svalander et al., demonstrated that sperm morphology according to the strict criteria is not related to the ICSI outcome (5). However, this is not completely true. In clinical practice, the quality of the semen does matter. The worst the semen quality, the worst outcome result. This emphasizes the role of the urologist in order to improve semen quality instead of referring this patient for assisted reproduction without any sort of urological treatment before. Our role of urologists is to try to improve semen quality, for instance, operate varicoceles, perform vasectomy reversals, etc.
     Once again, as a urological community, we thank such important article.

REFERENCES

1. Verza S Jr, Esteves SC: Sperm defect severity rather than sperm source is associated with lower fertilization rates after intracytoplasmic sperm injection. Int Braz J Urol. 2008; 34: 49-56.
2. Pasqualotto FF, Rossi-Ferragut LM, Rocha CC, Iaconelli A Jr, Borges E Jr: Outcome of in vitro fertilization and intracytoplasmic injection of epididymal and testicular sperm obtained from patients with obstructive and nonobstructive azoospermia. J Urol. 2002; 167: 1753-6.
3. Pasqualotto FF, Rossi LM, Guilherme P, Ortiz V, Iaconelli A Jr, Borges E Jr: Etiology-specific outcomes of intracytoplasmic sperm injection in azoospermic patients. Fertil Steril. 2005; 83: 606-11.
4. Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A: Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril. 1995; 63: 808-15.
5. Svalander P, Jakobsson AH, Forsberg AS, Bengtsson AC, Wikland M: The outcome of intracytoplasmic sperm injection is unrelated to ‘strict criteria’ sperm morphology. Hum Reprod. 1996; 11: 1019-22.

Dr. Fabio Firmbach Pasqualotto
Professor of Anatomy and Urology
University of Caxias do Sul, RS, Brazil
Caxias do Sul, RS, Brazil
E-mail: fabio@conception-rs.com.br

Dr. Edson Borges Jr
Fertility, Center for Assisted Fertilization
São Paulo, SP, Brazil
E-mail: edson@fertility.com.br