Analysis of Outcomes of Cryopreserved Surgically Retrieved Sperm for IVF/ICSI

Abstract

ABSTRACT:We evaluated our experience to date with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) after either cryopreserved sperm or sperm produced on the date of IVF/ICSI was used. We performed a retrospective statistical analysis of data derived from 188 women undergoing IVF/ICSI cycles using surgically retrieved sperm. A total of 318 IVF/ICSI treatment cycles with 3280 ova were performed using testicular sperm extraction (TESE, 304 cycles) or microsurgical epididymal sperm aspiration (MESA, 14 cycles). Sperm obtained at time of IVF/ICSI (fresh) or thawed cryopreserved sperm samples were used in 38 and 280 of the ICSI cycles, respectively. For IVF/ICSI cycles using both TESE and MESA sperm, the fertilization rate was 59.9% for cryopreserved sperm, and 53.6% when fresh sperm was used ( 2 P-␣ Ͻ .02, Cramer's 0.04). The fertilization rate for the TESE group alone was 60.0% for cryopreserved sperm and 55.1% for fresh sperm ( 2 P-␣ ϭ .075). Cohen effect size was computed at 0.03; yielding for P-␤ ϭ .8, 6597 ova would be required to demonstrate similarity between fresh and cryopreserved sperm in the TESE group. To demonstrate superiority of cryopreserved sperm in this group at a P-␣ significance level of .05, 7524 ova would be necessary. The pregnancy rate for the TESE group was 27.3% for cryopreserved sperm and 27% for fresh sperm. Further analysis of the pregnancy data in this group, using the methods described, yielded a 2 P-␣ and power of 0.971 (effect size calculated at 0.002). While our fertilization rates for cryopreserved sperm are greater in analyses of surgically derived sperm, based on the 7 years required to obtain data on 3280 ova, full numerical resolution of the issue of whether cryopreserved sperm is superior or similar will not be available until approximately 2010. However, we believe these results, along with the similarity shown in pregnancy rates achieved with both types of sperm, clearly indicate that cryopreserved sperm is not inferior to fresh sperm.

Outcome of intracytoplasmic sperm injection cycles with fresh testicular spermatozoa obtained on the day of or the day before oocyte collection and with cryopreserved testicular sperm in patients with azoospermia

“…However, fertilization rates and PRs with motile sperm were comparable in the same study, in the fresh testicular tissue or frozen-thawed sperm (77% vs. 70% and 38.8% vs. 33.9%, respectively). Wald et al (34) reported that a PR with cryopreserved testicular sperm did not differ from that achieved with fresh sperm (27.3% vs. 27%) with ICSI. Cayan et al (35) compared the outcome of ICSI with fresh and cryopreserved epididymal spermatozoa from the same couple and reported the clinical PRs as 31.6% with fresh and 36.8% with frozen-thawed spermatozoa.…”

Current options for preservation of fertility in the male

“…According to other studies, in vitro fertilization outcomes using cryopreserved testicular sperm samples are no different from those using fresh specimens (30)(31)(32)(33)(34). However, in cases of nonobstructive azoospermia, uncertainty still exists concerning the possible superiority of one of these sperm-handling methods (35).…”

Therapeutic testis biopsy for sperm retrieval

“…A recent review of the data concerning IVF/ICSI outcomes with cryopreserved versus fresh sperm showed overall comparable fertilization rates (39.0-61.7% and 47.0-61.9%, respectively) and clinical pregnancy rates (20-41% and 23-33%, respectively) reported for frozenthawed and fresh sperm [47 ]. High fertilization and pregnancy rates were reported in IVF/ICSI treatments using fresh sperm obtained by TESE, in both obstructive and nonobstructive azoospermia patients [16][17][18].…”

“…While some authors reported lower fertilization and pregnancy rates with frozen-thawed sperm compared with fresh, others demonstrated similar IVF/ICSI outcomes for both sperm-handling methods [3, [48][49][50][51][52]. We recently reported our experience to date with IVF/ICSI after either fresh or cryopreserved sperm was used [47 ]. This large study involved retrospective analysis of data derived from a total of 318 IVF/ICSI treatment cycles with 3280 ova, using TESE (304 cycles) or MESA (14 cycles).…”