Intracytoplasmic sperm injection outcomes in patients with orgasmic dysfunction and anejaculation by percutaneous epididymal sperm aspiration (PESA)

BACKGROUND: Orgasmic dysfunction and anejaculation are two uncommon yet powerful factors of male infertility. The treatment of orgasmic dysfunction and anejaculation is especially important for men who desire paternity, who otherwise would have to undergo surgical sperm retrieval for use with intracytoplasmic sperm injection (ICSI). We evaluated the reproductive outcomes of percutaneous epididymal sperm aspiration (PESA) for ICSI in a cohort of infertile patients who had presented with orgasmic dysfunction and anejaculation in the past five years. METHODS: We conducted a retrospective study of 41 patients with orgasmic dysfunction and 55 patients with anejaculation who underwent surgical sperm retrieval for ICSI. The sperm was firstly aspirated from the cauda epididymis, and then from the caput of the epididymis. If aspiration attempts failed at both locations, testicular sperm aspiration (TESA) was performed. The ICSI outcomes following these collection methods were compared with those of patients with congenital bilateral absence of the vas deferens (CBAVD). The ICSI outcomes of PESA (fertilization rate, high-quality embryo rate, clinical pregnancy, and live birth rate) were recorded. RESULTS: Of all 96 participants, PESA was successfully performed in 91 patients (94.8%), and TESA was necessary for only 5 patients (5.2%). Of the 91 patients who received PESA, 90 succeeded in retrieving sperm from the cauda epididymis, and just 1 from the caput. Among the patients with anejaculation, there were 28 cases (28/55, 50.9%) of diabetes mellitus (DM). In 56 fresh transfer cycles, the clinical pregnancy rate and live birth rate were 57.1% and 51.8%, respectively, both similar to those of CBAVD (53.47% vs. 63.4%, P=0.483, 47.2% vs. 53.5%, P=0.393, respectively). The fertilization rate, transferable embryo rate, high-quality embryo rate, clinical pregnancy, early pregnancy loss, and the live birth rate did not show differences resulting from using fresh or frozen sperm in the two groups. The fertilization rate and high-quality embryo rate in patients with DM were lower than those of patients without DM (75.0% vs. 86.7%, P=0.002; 50.4% vs. 77.4%, P=0.028, respectively). CONCLUSIONS: Like TESA, PESA is an appropriate and convenient way to obtain sperm for ICSI for patients with orgasmic dysfunction and anejaculation. Performing ICSI with sperm from the cauda epididymis can achieve favorable clinical pregnancy and live birth rates in patients with orgasmic dysfunction and anejaculation.