Virtual Azoospermia and Cryptozoospermia—Fresh/Frozen Testicular or Ejaculate Sperm for Better IVF Outcome?

• Published in: Journal of andrology Vol. 32; no. 5; pp. 484 - 490
• Main Authors: Hauser, Ron, Bibi, Guy, Yogev, Leah, Carmon, Ariella, Azem, Foad, Botchan, Amnon, Yavetz, Haim, Klieman, Sandra E., Lehavi, Ofer, Amit, Ami, Ben‐Yosef, Dalit
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2011; American Society of Andrology
• Subjects: Adult; Azoospermia; Biological and medical sciences; Birth control; Cryopreservation - methods; Ejaculation; Female; Fundamental and applied biological sciences. Psychology; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Male infertility; Mammalian male genital system; Medical sciences; nonobstructive azoospermia; Pregnancy; Pregnancy Rate; Semen Preservation - methods; Specimen Handling; Sperm Injections, Intracytoplasmic - methods; Spermatozoa; Sterility. Assisted procreation; testicular sperm; testicular sperm extraction (TESE); Testis - cytology; Vertebrates: reproduction; Spermatozoa; testicular sperm extraction (TESE); Assisted procreation; Ejaculate; Germinal cell; Testicle; Male genital system; Azoospermia; Reproduction; Cryptozoospermia; testicular sperm; Male infertility; Male sterility; Male genital diseases; nonobstructive azoospermia
• ISSN: 0196-3635; 1939-4640
• DOI: 10.2164/jandrol.110.011353

Men diagnosed as having azoospermia occasionally have a few mature sperm cells in other ejaculates. Other men may have constant, yet very low quality and quantity of sperm cells in their ejaculates, resulting in poor intracytoplasmic sperm injection (ICSI) outcome. It has not been conclusively established which source of sperm cells is preferable for ICSI when both ejaculate and testicular (fresh or frozen) sperm cells are available. It is also unclear whether there is any advantage of fresh over frozen sperm if testicular sperm is to be used. We used ejaculate, testicular (fresh or frozen) sperm cells, or both for ICSI in 13 couples. Five of these couples initially underwent ICSI by testicular sperm extraction, because the males had total azoospermia, and in later cycles with ejaculate sperm cells. Ejaculate sperm cells were initially used for ICSI in the other 8 patients, and later with testicular sperm cells. The fertilization rate was significantly higher when fresh or frozen‐thawed testicular sperm cells were used than when ejaculated sperm cells were used. Likewise, the quality of the embryos from testicular (fresh and frozen) sperm was higher than from ejaculated sperm (65.3% vs 53.2%, respectively, P < .05). The use of fresh testicular sperm yielded better implantation rates than both frozen testicular sperm and ejaculate. Therefore, fresh testicular sperm should be considered first for ICSI in patients with virtual azoospermia or cryptozoospermia because of their superior fertility.