Pharmacological stimulation of sperm motility in frozen and thawed testicular sperm using the dimethylxanthine theophylline

ObjectiveTo evaluate whether the use of theophylline improves sperm motility and treatment outcome in frozen-thawed testicular sperm extraction (TESE).DesignArtificial sperm activation was offered to azoospermic patients between January and October 2010 in two different centers (identical lab conditions).SettingIVF units of public hospitals.Patient(s)Sixty-five patients participated and gave informed consent.Intervention(s)Sibling oocytes were split into a study (intracytoplasmic sperm injection [ICSI] with thawed testicular sperm treated with theophylline) and a control group (ICSI with thawed untreated sperm).Main Outcome Measure(s)Sperm motility, time for sperm selection, rates of fertilization, implantation, clinical pregnancy, and live birth.Result(s)All patients but one (98.5%) showed a significant improvement in testicular sperm motility when theophylline was used. In addition, sperm selection took significantly less time in the study as compared with in the untreated control group. Corresponding rates of fertilization (79.9% vs. 63.3%) and blastulation (63.9% vs. 46.8%) were significantly increased. Significantly more patients achieved clinical pregnancy if embryos/blastocysts derived from oocytes that had been injected with pharmacologically stimulated testicular spermatozoa were transferred (53.9% vs. 23.8%). This also holds true for the implantation rate.Conclusion(s)Theophylline turned out to be a reliable tool in stimulating testicular spermatozoa after thawing. Its immediate effect allows for faster and more accurate selection of viable sperm, which in turn improved fertilization and pregnancy outcome in this prospective study.