Testicular sperm retrieval: What should we expect from the fresh and subsequent cryopreserved sperm injection?

Abstract

Approximately 5%-10% of men evaluated for infertility are azoospermic (Practice Committee of the ASRM, 2018). Intracytoplasmic sperm injection (ICSI) in combination with testicular sperm extraction (TESE) is an effective treatment for patient with nonobstructive azoospermia (NOA). TESE may be performed during an ICSI cycle, coinciding with oocyte pickup (OPU) using fresh spermatozoa, or alternatively, may be performed electively and cryopreserved for use in future ICSI cycles. Both strategies have theoretical advantages and disadvantages, and however, when comparing ICSI outcome using fresh versus frozen spermatozoa in NOA men, no difference between frozen and fresh spermatozoa was identified (Ohlander et al., 2014; Yu et al., 2018). In fresh TESE cases, where extra-spermatozoon is available, sperm cryopreservation may avoid repeated testicular biopsies. Yu et al. (2018) explored the effect of testicular sperm cryopreservation on intracytoplasmic sperm injection (ICSI) outcome. Their

Impact of Spermatozoa Cryopreservation on Clinical Outcomes of Intracytoplasmic Sperm Injection in Patients with Azoospermia: A Retrospective Cross-Sectional Study

“…This may be due to the different definitions of good-quality day 3 embryos used. In addition, Aizer et al [27] did not report any blastocyst formation rates, whereas we observed that it was significantly decreased in the frozen sperm cycle (57.5% vs 41.3%, p = 0.028).…”

“…Contrary to Aizer et al [27], our study supports the theory that the reproductive potential of retrieved testicular sperm from patients with azoospermia may be impaired by cryopreservation. Freezing/thawing induces intracellular ice crystals, osmotic pressure changes, and chemical/thermal stress, thus impairing sperm motility, morphology, and DNA integrity [28].…”

“…Currently, only Aizer et al [27] and our study compared the differences in ICSI outcomes of fresh and frozen sperm from the same TESE procedure. Both studies showed similar fertilization rates for fresh and frozen testicular sperm but Aizer et al [27] reported no statistically significant difference in the good-quality day 3 embryo rate per fertilized oocytes between the two groups (55.8% vs 55%), whereas we showed that this rate decreased significantly in the frozen group (39.5% vs 29.9%, p = 0.049). This may be due to the different definitions of good-quality day 3 embryos used.…”

Sperm Selection Procedures for Optimizing the Outcome of ICSI in Patients with NOA

“…Similarly, Kovacic et al reported that if immotile sperm in TESE tissue were cultured with pentoxifylline for 20 min, 97% of them started to move; hence, vital spermatozoa could be distinguished more easily, the procedure was shortened, and the fertilization rates and numbers of embryos increased [ 55 ]. The use of pentoxifylline to stimulate sperm motility in fresh or frozen/thawed suspensions has also been reported in other studies [ 56 , 57 , 58 ]. Since the cAMP level in spermatozoa with normal motility is sufficiently high to activate the subsequent cascades, PDE inhibitors have the most pronounced effect on sperm with poor motility [ 59 ].…”

“…Nevertheless, in many studies, the use of cryopreserved testicular spermatozoa in ICSI has yielded results comparable to or better than those of fresh cycles [ 135 , 136 , 137 ]. When compared to those with fresh spermatozoa, the cumulative miscarriage rate was significantly lower [4% vs. 14.7%) and the cumulative live birth rate was significantly higher (34.7% vs. 16%) for ICSI cycles with frozen/thawed spermatozoa obtained during the previous fresh TESE [ 57 ]. Likewise, a recent meta-analysis showed that fertilization and pregnancy rates were similar when using fresh vs. frozen sperm from testicles, even in men with poor spermatogenesis [ 138 ].…”