title: Virtual azoospermia and cryptozoospermia--fresh/frozen testicular or ejaculate sperm for better IVF outcome?
abstract: 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.
authors.affiliation: Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. Ronh@tasmc.health.gov.il
authors.forename: Ron
authors.initials: R
authors.lastname: Hauser
authors.forename: Guy
authors.initials: G
authors.lastname: Bibi
authors.forename: Leah
authors.initials: L
authors.lastname: Yogev
authors.forename: Ariella
authors.initials: A
authors.lastname: Carmon
authors.forename: Foad
authors.initials: F
authors.lastname: Azem
authors.forename: Amnon
authors.initials: A
authors.lastname: Botchan
authors.forename: Haim
authors.initials: H
authors.lastname: Yavetz
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Klieman
authors.forename: Ofer
authors.initials: O
authors.lastname: Lehavi
authors.forename: Ami
authors.initials: A
authors.lastname: Amit
authors.forename: Dalit
authors.initials: D
authors.lastname: Ben-Yosef
mesh_terms: D000328:Adult; D053713:Azoospermia; D015925:Cryopreservation / Q000379:methods*; D004542:Ejaculation; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D012662:Semen Preservation / Q000379:methods*; D013048:Specimen Handling; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa; D013737:Testis / Q000166:cytology