Microdissection testicular sperm extraction in male partner with non-obstructive azoospermia: Fresh or frozen-thawed sperm for intracytoplasmic sperm injection?

AIM

To compare the outcomes of intracytoplasmic sperm injection (ICSI) of fresh and cryopreserved sperm obtained via microdissection testicular sperm extraction (micro-TESE) in cases of non-obstructive azoospermia (NOA).

METHODS

A total of 147 patients with NOA who underwent micro-TESE and obtained viable sperm via micro-TESE at Istanbul Medipol In Vitro Fertilization unit were recruited retrospectively. The cases were divided into two groups depending on the sperm used (fresh or frozen-thawed) for ICSI: The micro-TESE group (n = 93) underwent ICSI cycles with fresh spermatozoa and the micro-TESE-Thaw group (n = 54) underwent ICSI cycles with cryopreserved spermatozoa. Patient demographics, embryo development, and pregnancy outcomes were compared between the two groups.

RESULTS

No statistical difference was observed between the two groups in terms of demographic features (age, body mass index, etc.) and cycle characteristics (induction protocol, gonadotropin dose, etc.). Fertilization rates and embryo quality were also similar between the groups. Higher clinical pregnancy and live birth rates were observed in the micro-TESE group than in the micro-TESE-Thaw group (p <0.04 and p <0.003, respectively). The miscarriage rate was higher in the micro-TESE-Thaw group, although the difference did not reach statistical significance.

CONCLUSION(S): In cases where frozen sperm obtained by micro-TESE are used, even if viable and motile sperm are found after thawing, there may be a negative impact on the ICSI result. Fresh testicular spermatozoa appear to result in better clinical pregnancy and live birth rates than cryopreserved testicular spermatozoa in males with NOA.