Inability to obtain sperm for fresh IVF cycles: analysis and incidence of outcomes using a database from the United States

Alexandra Joice Berger; Valary Raup; Ramy Abou Ghayda; Andrea Lanes; Martin Kathrins

doi:10.1186/s40738-020-00082-3

Inability to obtain sperm for fresh IVF cycles: analysis and incidence of outcomes using a database from the United States

Fertil Res Pract. 2020 Aug 11:6:14. doi: 10.1186/s40738-020-00082-3. eCollection 2020.

Authors

Alexandra Joice Berger¹, Valary Raup¹, Ramy Abou Ghayda¹, Andrea Lanes², Martin Kathrins¹

Affiliations

¹ Division of Urology, Brigham and Women's Hospital and Harvard Medical School, 45 Francis St ASB-II, Boston, MA 02115 USA.
² Department of Obstetrics and Gynecology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115 USA.

Abstract

Background: Azoospermia is present in 10% of men presenting with infertility and surgical sperm retrieval rates for men with azoospermia due to spermatogenic dysfunction remain low. We investigated the incidence of failed fresh IVF cycles due to inability to obtain sperm and describe predictors for subsequent IVF.

Methods: A national IVF database was used to identify fresh IVF cycles in which there was failure to obtain sperm. Patient linkage was utilized to determine outcomes of subsequent IVF.

Results: 243,291 fresh IVF cycles were identified; 719 (0.3%) listed "inability to obtain sperm" as reason for embryo non-transfer. Male infertility was a factor in 537 (75%) and ejaculation was the most common anticipated sperm source (414, 57%). 713 (99.2%) cycles resulted in retrieved oocytes, but only 627 (87.2%) cryopreserved oocytes. 265 (37%) of couples underwent subsequent IVF. On multivariable analysis, lack of initial oocyte cryopreservation (OR 0.34, p = 0.01) and male infertility (OR 0.14, p = 0.01) were associated with having no subsequent cycles. Partner sperm was used in 213 (80%) second cycles and sperm retrieval method was largely conserved (181/213, 85%). Embryos were transferred in 186 (70%) second cycles. Failed embryo transfers were due to repeat inability to obtain sperm in 5 (6%) cycles.

Conclusions: Failure to obtain sperm during fresh IVF is rare, but most affected couples will not pursue further cycles of IVF after their initial failed attempt.