Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration and testicular sperm aspiration: intracytoplasmic sperm injection with obstructive azoospermia

Objective: The study aimed to compare intracytoplasmic sperm injection (ICSI) outcome of patients with epididymal sperm and testicular sperm in different paternal age with obstructive azoospermia. Methods: We retrospectively studied the records of 177 men with obstructive azoospermia who underwent sperm retrieval for ICSI. 71 cases were performed with testicular sperm aspiration (TESA), 106 cases with percutaneous epididymal sperm aspiration (PESA). Patients were divided into three groups according to age: < 30 y (n = 81); 31-34 y (n = 56); and ≥35 y (n = 40). We compared ICSI outcomes in each group with different sperm source. Results: There was no difference in maternal age, E2, and P on HCG administration day, the number of retrieved oocytes, and the number of 2PN in each group. A comparison between TESA versus PESA revealed significant lower high-quality embryo rate in paternal age < 30 years (45.31% vs. 54.85%; P = 0.031) and in paternal age ≥35 years (36.22% vs. 50.46%; P = 0.035). Paternal age in the 31-34 years showed a TESA cleavage rate that was significantly lower than the PESA group (93.96% vs. 98.58%; P = 0.025). However, for the paternal age ≥35 years group, the implantation rate (55.56% vs. 29.73%; P = 0.034) with TESA was significantly higher than that with PESA; the pregnancy rate (70.59% vs. 42.1%; P = 0.106) was also higher but there was no significant difference. Conclusions: When paternal age is ≥35 years, using testicular spermatozoa has a higher developmental potential than those obtained using epididymal spermatozoa.