Testicular sperm extraction vs. ejaculated sperm use for nonazoospermic male factor infertility

Objective: To study the potential benefit of testicular sperm compared with ejaculated sperm for men with oligospermia. Design: After exemption from institutional review board approval, we performed a retrospective cohort study using the Mayo Clinic Assisted Reproductive Technology database. Setting: Single academic center. Patient(s): Couples with nonazoospermic male factor infertility (total motile sperm <25 million per ejaculate) undergoing intracytoplasmic sperm injection with sperm obtained by testicular sperm extraction (TESE) or ejaculated sperm between 2016 and 2019. Intervention(s): In vitro fertilization, Intracytoplasmic sperm injection, TESE. Main Outcome Measure(s): The primary outcome was live birth rate. The secondary outcomes were fertilization rate, blastulation rate, pregnancy rate, and miscarriage rate. Result(s): Subjects in the two groups were similar in age, body mass index, and ovarian reserve. Baseline sperm parameters were similar in the two groups: total motile sperm (5.4 in the ejaculate sperm group vs. 3.6 million motile per ejaculate), except that baseline motility was higher in the group that used ejaculated sperm (40% vs. 29%). The total number of mature oocytes retrieved was similar in the two groups, but the use of TESE was associated with a 20% decrease in fertilization (60.0% vs. 80.6%) and half the number of biastocyst embryos (two vs. four) compared with ejaculated sperm. Compared with ejaculated sperm, use of TESE did not improve the miscarriage rate (11% vs. 9%) or the live birth rate (50.0% vs. 31.3%). Conclusion(s): Patients with male factor infertility and oligozoospermia did not have improved ICSI outcomes with the use of TESE samples compared with ejaculated sperm. (C) 2021 by American Society for Reproductive Medicine.

Automated summary

This study found that for men with oligospermia, the use of testicular sperm did not result in better outcomes compared to ejaculated sperm for intracytoplasmic sperm injection. The two groups of patients had similar baseline characteristics, but the TESE group had lower fertilization rates and fewer blastocyst embryos compared to the ejaculated sperm group.