Publication:

Intracytoplasmic sperm injection outcomes using ejaculated versus testicular sperm in severe male factor infertility: a retrospective study

Background Intracytoplasmic sperm injection (ICSI) using testicular sperm is commonly performed in severe male factor infertility. However, differences in sperm maturity and function between ejaculated and testicular sperm may influence reproductive outcomes.

Methods This retrospective cohort study included 92 ICSI cycles from 84 couples treated between January 2018 and December 2024 at the Institute of Reproductive Medicine, Madras Medical Mission. Cycles were grouped according to sperm source: fresh ejaculate (n=61), fresh testicular sperm aspiration (fresh TESA) (n=25), and frozen testicular sperm aspiration (frozen TESA) (n=6). Outcomes assessed included fertilization, embryo arrest, embryo transfer (ET), and clinical pregnancy rate (CPR).

Results Baseline characteristics were comparable among groups. The number of normally fertilized oocytes (2PN) was significantly higher in the fresh ejaculate group than in fresh and frozen TESA groups (7.08±4.4 vs 5.12±3.1 vs 3.17±2.9; p=0.021). The number of frozen embryos was also significantly higher with ejaculated sperm (p=0.02). Embryo arrest was highest in frozen TESA cycles (33.3%) compared to fresh TESA (8%) and ejaculated sperm cycles (3.3%) (p=0.02). Clinical pregnancy rate per cycle was higher with ejaculated sperm (50.8%) than fresh TESA (36%) and frozen TESA (0%) (p=0.042).

Conclusions ICSI cycles using ejaculated sperm were associated with better embryological outcomes compared to testicular sperm cycles. Frozen testicular sperm cycles demonstrated relatively poorer embryo developmental outcomes; however, interpretation is limited by the small sample size. Despite lower overall success, testicular sperm remains an important option when ejaculated sperm is unavailable.